Question about priming tubing

[aship]

Hey everyone,

When you hang an ABX through a primary line how to prevent the line from going completely dry so that you can hang the same ABX a little later?

It seems like most people use the same tubing but I have found that when I try to reprime it there's air mixed with leftover medication and I feel like I am just wasting the meds when I try to prime the line again.

This might be a super obvious answer but I'm a new nurse!

[retiredmednurse]

It depends upon how I'm going to run the medication. If I'm just using the IV intermittently, I'll just prime a primary line and not worry about running the drip chamber dry. If I have a maintenance running, I'll hang a secondary line, placed above the primary bag, and program a "secondary" med into the pump. This way the med runs until it's gone and the primary bag takes back over and flushes the line. With that setup, very little medication is left in the tubing, and if I want it ALL I can just backprime the secondary set, spike a new small bag of NS (or whatever maintenance fluid) and hang that as a secondary for a few mL to push all the med firmly into the primary tubing and into the patient. Then I'm left with a primed NS secondary set... That being said, that's a lot of work for what's usually just a couple mL of a medication from a bag that's usually slightly overfilled to compensate for whatever is left in the dripset when the infusion is done. Most of the Abx I run will "finish" with the bag still having a little left in it and the tubing still primed. It's rare for me to have a dripset run dry to the pump before the infusion "completes".

I TOTALLY agree with him. I preferred running my IVPB as a secondary and let the flush bag or maintenance bag take over. At my hospital not all meds had to be on a pump. Using a primary line saved many times a line going dry on my if I didn't catch it in time. Very frustrating if I have to restart my saline lock when I'm busy enough as it is.

[MunoRN, RN]

Yes you can run an antibiotic or any IV med on a locked VAD .This is a perfectly acceptable practice and we do it all the time when no IV fluids are ordered. Is it easier to hang a flush bag and run it as a secondary...some may think so.What if your patient just has an antibiotic.once a day? I think it's so much easier to administer as a primary intermittent....that is the correct terminology.All you need to do is not let the drip chamber go dry and then there is no air to worry about and just spike and prime out the minimal amount left over.

Using the antibiotic to prime the tubing will typically waste at least some amount of the antibiotic, we measured the actual amount used among our nursing staff, and wasting 20ml while priming wasn't unusual, with a 50ml bag of antibiotic that means almost half the dose is going in the sink rather than the patient. If you're using a saline or other bag to flush the in the end then at least you're not losing what's in the line, but at that point why not just add the secondary set (which my facility pays $0.81 for) and not lose the priming waste either.

Primary intermittent tubing,according to INS should be changed every 24 hours anyway so if you do have a q 24 hr dose you can get a new tubing.If you have the desire to know why this is the INS standard I will be happy to explain.

I haven't been able to get the INS to explain their rationale, so if you can explain it I'd be happy to hear it.

[Cat365]

Check your hospitals policy. We have to run antibiotics on a secondary line. The primary has to be used to prime and flush the line to avoid the patient not getting the full dose per policy. We can actually order normal saline " for line care per policy if there are no orders for a primary. Of course I work ER and our charting/rules, and policies are a bit different than inpatient. I think that's hospital wide though. I would suggest checking your unit/hospital policies.

[retiredmednurse]

If the frequency of the ABX is more than daily, I always liked to use a flush bag for my saline locks when going by gravity. Not only does the patient get nearly all of the med, but one doesn't have to worry about the line going dry and blood backing up. It is always easy to back-flush by dropping the empty ABX bag below the flush bag and allow the flush solution to run into the secondary tubing. Close the clamp when the fluid starts entering the filling chamber.

[IVRUS, BSN, RN]

A secondary medication, when attached to a primary tubing, may hang for 96 hrs if backprimed and NOT disconnected. The secondary medication which is dis-connected from the primary, is to be changed q 24. All the manipulation of connecting and dis-connecting introduces bacteria, and therefore, that tubing should be changed q 24.

If the tubing remain connected and one is merely backpriming and changing the small minbag, then changing q 96 becomes best practice.

[SarHat17, ASN, RN]

We used to have a 250ml flush bag for ABX. But our policy has changed to program every abx 20ml less than what's in the bag. When the pump beeps, you are supposed to unhook from pump and flush 20ml saline through the upper port to get as much meds in. It is so easy to forget to adjust the pump, and I feel uncomfortable flushing saline behind a large amount of air to get the leftover medication into the patient, no matter how careful I am. ?‍♀️

[IVRUS, BSN, RN]

Sarhat,

That is an absolute crazy policy. So, are you saying that there is air in the administration set, and you are using a syringe to flush that, and whatever IVAB is left into the patient? The increased manipulation alone is scary!

[BlueShoes12, BSN, RN]

On my unit, we're supposed to set up all IV antibiotics as a piggy back. I set up the maintenance fluid as a KVO if they don't have other fluids and then program the IV antibiotic as a secondary on the pump. This lets the KVO fluid flush whatever little bit of the antibiotic is left into the patient.

If they're getting frequent antibiotics, we'll leave a KVO running continuously - 10 ml/hour for a peripheral IV or 10 ml/hour for a central line. This setup is good for 96 hours per hospital protocol. If it's disconnected and reattached for each ABX, you need new tubing every 24 hours.

Before using it again, I always back prime the secondary tubing thoroughly - if it's two meds back to back that don't really play well together, I'll switch out the whole tubing set since I'm a little paranoid. Make sense?

[SarHat17, ASN, RN]

On 2/1/2019 at 7:19 AM, IVRUS said:

Sarhat,

That is an absolute crazy policy. So, are you saying that there is air in the administration set, and you are using a syringe to flush that, and whatever IVAB is left into the patient? The increased manipulation alone is scary!

Ah! I wasn't clear. The policy is to set the pump to infuse less than what is in the bag, so having air in the line is not happening, and then you flush to get the remaining abx in the line into the patient. Sorry for the confusion!

It is easy to forget to set the pump for that, so there IS air in the line that triggers the pump to stop, and then there is an amount of abx that the patient didn't receive.

It is definitely not policy to "flush air" towards the patient in any way with this. (I'm sorry for the poor explanation!)