IV Piggybacks - page 2
Want some clarification... IV Piggybacks can run alone, or with a maintenance fluid right? For ex) say you have a triple lumen catheter & need to run Cipro, TPN, NS, and KCL. I would have TPN... Read More
Nov 6, '07Occupation: Staff nurse Specialty: ICU, Med/Surg ; From: US ; Joined: Feb '07; Posts: 805; Likes: 1,005I'm pretty sure you can run pepcid through TPN... I think you can run some electrolytes too.... Always call and ask pharmacy though!!
And another tip... When piggybacking antibiotics with fluids (such as D5, or any fluids with KCL in them) always make sure the antibiotic is compatible with the D5 and/or the KCL. I always call pharmacy and some antibiotics can't be hung with certain fluids...
Nov 6, '07Joined: Jul '06; Posts: 61; Likes: 19Quote from TigerGalLEand hopefully you'll be able to attend to the beeping pump in a timely manner... personally, I try to plan for the worst. I'd hate to leave a pump beeping because I'm tied up with a frest post op, a new admission, or another patient going bad, etc. Maybe a friendly co-worker will be able to help me out, maybe not.Just put the "piggyback" on a pump... it will beep when it is done and you can stop it and flush the line...
Oh well, though. "to each his own" I guess. :spin:
Nov 6, '07Occupation: Endocrinology Specialty: 15 year(s) of experience in ER ; From: US ; Joined: Sep '02; Posts: 179; Likes: 127I work in ER run antibx all the time with no piggy back, thing to do is program your pump to run 15 cc less than in your bag this leaves enough solution in your line allowing you to then run 50 cc nss flush bag after antibx. NOT LAZY just prudent and most often in ER you are running things faster than usual recommended because of emergent situation, like patients needing to be transfered and medics can't transport antibx or patient is emergently going to OR. ALWAYS check your floors policy on these kinds of questions.
Nov 6, '07Joined: Jan '07; Posts: 80; Likes: 10If a patient only has a heplock without any primary IVF running through, I always hang 100 ml of NS at TKO rate with my IVPB's, this way I am assured that I will not clog off the patient's IV access. I also think that it's ok to hang antibiotics/IVPB's without NS as long as you set it up on a pump....at least this way when the antibiotic has finished, the machine will go off letting you know that it's time to flush the line and shut it off.
Nov 6, '07Occupation: cardiothoracic transplant telemetry Joined: Jul '03; Posts: 339; Likes: 184i agree that it is convenientto hang a 250ml "flush" bag with your antibiotic, and i will do just that it i have a patient that is receiving multiple antibiotics through a peripheral line. however, it is just convenient, not necessarily best practice as some are making it seem. unless your policies and procedures say otherwise, there is nothing wrong with hanging the piggyback as a primary, but you do have to come back when it is finished to flush the line. if the patient is receiving antibiotics infrequently, it can be a waste to use that flush bag, that needs to be changed every 24 hours. if you are hanging that bag just because you don't want to have to flush the line, then that is what i would call lazy. the argument that by hanging the flush bag that you are limiting accesses to the line and thus the risk for infection ignores the fact that you are accessing the line when you add the antibiotic. i think that the bigger risk would be in cardiac patients that do not need the extra fluid that they would get when the flush bag ran for hours when it didn't have to. also, if the ns runs for longer than a standard 10ml flush, you are running fluids on a patient that were not ordered by an md.
Nov 7, '07Joined: Apr '06; Posts: 154; Likes: 83i have to agree with the others that a review of the unit's p&p is necessary. i have seen piggybacks run both ways but currently work on a unit that hooks them into a mainline like NS.
also, has anyone seen any research literature on this subject? best practice guidelines are the next logical stop, and may even suggest that the p&p be updated!
Nov 7, '07Joined: Dec '04; Posts: 1,111; Likes: 1,079Quote from poppy07Poppy07,Want some clarification...
IV Piggybacks can run alone, or with a maintenance fluid right?
For ex) say you have a triple lumen catheter & need to run Cipro, TPN, NS, and KCL. I would have TPN by itself, NS running with 20 mEq KCl piggybacked to that line, and Cipro running on its own primary IV tubing in the 3rd.
My preceptor argued that "the piggybacks have to run as piggybacks" with another fluid..."so wait until the other piggyback is done, and then start the Cipro as a piggyback with the NS."
At a later time, I tried to explain my understanding is that whether a "piggyback" is run and programmed as a piggyback with another fluid OR run in on its own line, it's still infusing by itself as it "takes over the other fluid running."
You would not want to "piggyback" NS with KCL into the same lumen where TPN is infusing... The line that has TPN infusing through it needs to be TPN dedicated only. (No other meds, no blood draws from that line). Concerns are not only compatibility, but introduction of bacteria as well. Remember that TPN is a rich bag of nutrients and bacteria love it... so don't take the chance of introducing bacteria or causing an incompatibility with the formentioned activities.
One concern re. whether or not the IVAB should hang as a secondary set with a NS or D5W mainline is the tubing you are using. Sometimes the internal volume that a tubing holds is 25 to 27 mls. If in fact you have a 50cc IVAB, half of that dose is still left in the tubing when the bag is empty. So, in that case, a mainline to act as a "chaser" is appropriate. Another aspect to consider is the pt's ability to handle the extra IV fluids from the mainline. Additionally, remember that some IV medications are incompatible with D5W and some are incomaptible with NSS. Check your drug books for appropriate reconstitution solutions, or call your pharmacy.
Hope this helps. DD:spin:
Nov 7, '07From: US ; Joined: Jul '05; Posts: 856; Likes: 1,525Definitely read your P&P's...I have worked in hospitals where it was against policy to use a flush bag with piggybacks if the pt did not have maintainence fluids running, i.e. if all the pt had were intermittent abx they were run through primary tubing. This was due to incidences where nurses were forgetting to unclamp tubing and saline was infused instead of abx, and then the abx was infused late; a pt on strict fluid restrictions inadvertantly kept getting extra 50-100 ml boluses of saline in addition to his abx, he was fluid overloaded to begin with.
Nov 7, '07Specialty: med surg/tele ; Joined: Jul '05; Posts: 73; Likes: 14This kind of discussion is precisely why I LOVE Allnurses. Great, thought-provoking posts.
Nov 8, '07Occupation: RN LTC From: US ; Joined: Jan '03; Posts: 3,760; Likes: 1,820Quote from KulRNIf a patient only has a heplock without any primary IVF running through, I always hang 100 ml of NS at TKO rate with my IVPB's, this way I am assured that I will not clog off the patient's IV access. I also think that it's ok to hang antibiotics/IVPB's without NS as long as you set it up on a pump....at least this way when the antibiotic has finished, the machine will go off letting you know that it's time to flush the line and shut it off.
In LTC settings we have people on IV abtx alot. Rarely are they getting fluids too. Docs never order IVF with the antibiotics.
What we do is flush, infuse via pump and flush.
If I had other fluids running that are compatible, then it would be piggybacked.
Nov 9, '07Occupation: Nurse Specialty: Oncology ; Joined: Mar '06; Posts: 49; Likes: 27Hi,
Last night again I watched my attending nurse give 50ml IV Zosyn IVPB over 30 minutes. Again, she used primary set tubing to infuse the abx. After priming the tubing, approximately 20 ml was left in the bag. She then first flushed the hep lock with 5 ml of NS and started the infusion. Within 10 minutes the infusion pump beeped, and the nurse stoped pump , d/c the IV and flushed the hep lock with another 5ml of NS.
I asked the nurse if she believed the pt had the right dose of the medication. She reluctantly said yes. She believed that the strenght of the medication was so high that even the 20 ml of the zosyn pt received was enough to cover him. I just thought that was a cop out answer. I did not believe this pt got the right dose of the meds. What do think? As a nurse what suggestion and what step should I take to advocate for this pt?
Nov 9, '07Joined: Mar '05; Posts: 166; Likes: 42The nurse posting this is right. Piggybacks take over from the fluid you piggyback it to. So if Cipro was piggybacked onto a bag of NS, the NS would stop running while the Cipro infused and then the NS would take over once the Cipro was done. Where I work antibiotics or any infusable med is diluted by the pharmacy and can be piggybacked if it is compatible to the main line of fluid running. If it isn't compatible or you don't have anything running, you can run the Cipro or whatever on its own. Seeing the responses, it looks like all facilities don't run piggybacks the same way.