IVPB as primary

[SilleLu]

Is it ever acceptable for a med ordered as IVPB to be hung as a primary and run a second IVPB as a secondary?

For example: patient has two IV sites. Orders include potassium drip, magnesium drip (IV compatible) and 2 Abx. Pt having arrythmias d/t low K+ and Mag levels. All except one of the abx will take several hours each to run.

So is it acceptable:

site 1 - run potassium chloride with mag sulfate as secondary

site 2 run NS with abx as secondary, - first one, then next (changing secondary line if not compatible of course).

[Oh'Ello, BSN, RN]

If the drugs are compatible I can't see why not. The IVPB is to distinguish between IVPush and whether or not its running through a pump. I don't think it specifically means you have to run it as a secondary.

The problem with your scenario though... is that if you're running potassium with mag as a secondary... you're not making your infusion times any faster. When you hang a secondary, the primary STOPs infusing until the secondary is complete. What you SHOULD do is get more channels and y-site them together if you want your administration to go faster.

Also... you don't need to change the secondary tubing if the antibiotics aren't compatible, you can just backflush and spike the next antibiotic.

[SilleLu]

Our pump allows for option to run primary and secondary concurrently, but yes, good point, y-site would be a good option also, thank you!

[ixchel]

I'm going to second Y'ing them in. IVPB means the pump will not pull from the primary until the secondary is done. You'll need 4 pumps, one per med, and you'll need to Y the compatible ones together.

That said, I wouldn't Y potassium if I didn't have to in the off chance of pain at the IV site or evisceration. Technically there wouldn't be any backflow, but how would you know for sure it was the K+ and not whatever you Y'ed it with? If you can get a third line in the patient, that might be best. If Y'ing were completely necessary, I would run the potassium very slowly.

[Guest219794]

Assuming compatibility:

If your pumps allow concurrent administration, no problem with the k/mag. Except- managing the volumes and giving all the med can be an issue. Primary tubing holds a lot of volume, there are ways to administer all the medication- make sure you aren't leaving a bunch in the line somewhere, and the pt get's what is ordered. (Nurses often miss this, and often give 60-80% of the medication.)

The easest way is to use 2 pumps, and Y-site, as mentioned above,

[akulahawkRN, ADN, RN, EMT-P]

Is it ever acceptable for a med ordered as IVPB to be hung as a primary and run a second IVPB as a secondary?

For example: patient has two IV sites. Orders include potassium drip, magnesium drip (IV compatible) and 2 Abx. Pt having arrythmias d/t low K+ and Mag levels. All except one of the abx will take several hours each to run.

So is it acceptable:

site 1 - run potassium chloride with mag sulfate as secondary

site 2 run NS with abx as secondary, - first one, then next (changing secondary line if not compatible of course).

Given two pumps that can run 2 channels concurrently, I would run this like so:

site 1 - NS Primary and run concurrently potassium chloride and possibly add mag sulfate on a 2nd pump y'd into the NS primary line. This assumes the K and Mg are compatible.

site 2 - NS Primary then run IVPB the faster of the 2 abx if it could otherwise be run as a primary on it's own, then backflush the secondary set and then run the 2nd abx IVPB after flushing the line with the primary NS fluid.

[SilleLu]

Great help, thank you all!