Flushing tubing after IV ATB administration

[dexilna, ADN]

Good early morning Hivemind!

We’re working in a new IV ATB policy to avoid under administration during therapy. To those of you who are already at this point, how do you do it in your location?

Do you administer the ATB, and then spike another 50mL bag to flush the remainder, or is there an efficient way to do this while avoiding having to spike an extra bag 20 minutes later?

Thanks in advance!!

Edit: spelling errors

[iluvivt, BSN, RN]

Are you referring to antibiotics administered as a secondary or as a primary intermittent? Either way it is not necessary to hang a post flush 50 ml bag of NS in either circumstance.The volume left in this tubing is minimal and it is not necessary to try and get in the very small volume left in the tubing.Once the bag is empty you are done!

[LovingLife123]

1 hour ago, iluvivt said:

Are you referring to antibiotics administered as a secondary or as a primary intermittent? Either way it is not necessary to hang a post flush 50 ml bag of NS in either circumstance.The volume left in this tubing is minimal and it is not necessary to try and get in the very small volume left in the tubing.Once the bag is empty you are done!

Why would you not flush the rest in? Not just to infuse the entire amount, but for your next Ivpb to hang. You don’t know if they are compatible.

I always hang a 25mL flush after any ivpb. But we also run everything as primary. We do not use secondary tubing at my hospital.

[JadedCPN, BSN, RN]

6 hours ago, iluvivt said:

Are you referring to antibiotics administered as a secondary or as a primary intermittent? Either way it is not necessary to hang a post flush 50 ml bag of NS in either circumstance.The volume left in this tubing is minimal and it is not necessary to try and get in the very small volume left in the tubing.Once the bag is empty you are done!

I respectfully disagree with this. The tubing we use at my facility needs 28mL to prime/flush. Especially in pediatric world, 28mL of antibiotic is a significant amount of the prescribed dose that the patient is not getting.

OP, it depends on whether it is a secondary IV piggyback with IVF or if it is just a primary intermittent dose. If it is a secondary IV piggyback, we infuse the volume and then backprime the IV piggyback bag with the primary IVF, and infuse an additional 28mL to flush the line and ensure it has all gone through. If it is a primary intermittent dose, we program the pump to deliver 28mL less than the total volume of the antibiotic, and then when that is complete with either spike a 50mL NS bag or we have bag access devices that allows us to attach NS flushes to fill the antibiotic bag. We would then fill it with 28mL of NS flush and continue to infuse the last 28mL so all of the antibiotic is received.

[dexilna, ADN]

Thanks everyone!! I was talking specifically about a primary intermittent ATB, so it sound like the consensus is spiking another small bag and flushing the 25-28 mL line. And just to chip in to prior statements, even in an adult, leaving potentially half the dose of ATB in the line isn’t going to do them any good!

Thanks again for the advice!

[MunoRN, RN]

10 hours ago, iluvivt said:

Are you referring to antibiotics administered as a secondary or as a primary intermittent? Either way it is not necessary to hang a post flush 50 ml bag of NS in either circumstance.The volume left in this tubing is minimal and it is not necessary to try and get in the very small volume left in the tubing.Once the bag is empty you are done!

That has the potential to leave a significant portion of the dose un-infused, which besides being less effective also contributes to antibiotic resistance. We studied the volume of waste due to both priming and the remainder in the line and found that typically around 25ml were lost.

If the line is already primed with medication, then hanging a flush-bag would be acceptable, but if you're starting with new tubing then medication loss with the flushing of the line should also be a concern.

Our policy is that all antibiotics in bags up to 100ml are to be hung as a primary/secondary set-up, even if it's just a one-time dose with the tubing both primed and flushed with the primary fluid.

[emtb2rn, BSN, RN, EMT-B]

We do same as munro. Leaving any abx in the tube under doses the pt.

[Alex_RN, BSN]

Our primary lines are 18ml, secondary are 7ml. We always run ABX as a secondary.

[EllaBella1, BSN]

Our policy is to hang all abx as secondary lines and run a 30 mL/hr KVO for an hour as a flush. It makes it way easier to not have to go in and spike a bag of saline.