Secondary IV tubing question

[General E. Speaking, RN]

Frequently, I find numerous secondary IV tubings hanging on the pole. One for Levaquin, one for Flagyl, etc..

I was taught (many moons ago) to try and keep the IV set as closed as possible to minimize contamination. I was taught to back flush with the main IV fluid in order to clear the line and then to use the same tubing.

I have emailed our education dept but was wondering what everyone else's policy says?

Thanks

[queenjean]

Okay, okay, I'm seeing it, I'm wrapping my brain around it.

My question now--is it really much different (besides maybe substantially in cost)? If the end of all the secondary tubing is tightly covered when not attached, you are just switching out the bottom part every six hours(or however often it is ordered). If the clip and tubing remain attached, then instead you are switching out the top part of the tubing however often a secondary needs to be hung. One end is being switched every time, opening up the system. No matter which method you use.

Make sense?

So why would one be better than the other? Actually, we have some IV therapy nazis in our team, they are hard core. I think they have written up all our protocols. So I'm curious as to why they would have chosen to promote our use of each secondary having it's own tubing over simply back flushing. Is there a recommendation by the IV tx society, one way or another?

[Roy Fokker, BSN, RN]

We can run different meds with the same secondary set, but personally, I don't. I cap off individual secondary lines and use only what's properly capped off and dated.

Same here.

And I always back-prime.

Saves me the trouble of having to return 10 minutes later because one pesky air bubble has gotten into the air detector chamber....

[General E. Speaking, RN, RN]

Okay, okay, I'm seeing it, I'm wrapping my brain around it.

My question now--is it really much different (besides maybe substantially in cost)? If the end of all the secondary tubing is tightly covered when not attached, you are just switching out the bottom part every six hours(or however often it is ordered). If the clip and tubing remain attached, then instead you are switching out the top part of the tubing however often a secondary needs to be hung. One end is being switched every time, opening up the system. No matter which method you use.

Make sense?

So why would one be better than the other? Actually, we have some IV therapy nazis in our team, they are hard core. I think they have written up all our protocols. So I'm curious as to why they would have chosen to promote our use of each secondary having it's own tubing over simply back flushing. Is there a recommendation by the IV tx society, one way or another?

good point!

[Sisukas]

I stick the cap to the secondary tubing onto the tubing using the date change sticker. This way I always remember to put the sticker on. When I change piggybacks, I wipe off the cap with an alcohol and put the end of the tubing in, then wipe the port with another alcohol and connect the new bag.

[GeminiTwinRN, BSN]

stoopid question.

can someone explain step by step back priming to me? i've always just primed the secondary tubing using the med in the piggyback.

[Roy Fokker, BSN, RN]

stoopid question.

can someone explain step by step back priming to me? i've always just primed the secondary tubing using the med in the piggyback.

I'll try based on the assumption that you are running it through a pump

1. Pause/Stop IV pump (if not running through a pump, just find the roller clamp on main IV line and clamp shut). Make sure Primary IV bag is hanging on the plastic extender (you get these in the Secondary IV line set. It's a plastic thingie with two hooks on either end).

2. Make sure secondary line is clamped shut. Pierce secondary bag with secondary line.

3. Find the connector port on the Primary IV line ABOVE the pump.

4. Wipe both sides with alcohol. Securely connect secondary line to this port.

5. Bring secondary bag to a level lower than the primary IV bag.

6. Slowly release roller clamp on secondary IV line. You should see fluid move from Primary IV bag/line into secondary line.

7. Raise secondary bag above the primary bag when you see fluid start to enter secondary drip chamber.

8. Hang secondary bag at higher level than primary bag. Release roller clamp on secondary bag completely.

9. Restart IV pump (or unclamp roller on Primary line and set to desired rate).

:)

[GeminiTwinRN, BSN]

Roy, thank you so much! :)

[ROSYJO11]

Sounds like a lot of hassle. We use an Abbott Plum pump.

It has a line A and line B bung on the pump itself. (techinically on the special Plum tubing we put in the pump)

Line A is for the regular bags of fluid (saline/hartmans/glucose etc)

Line B bung ,using a sryinge (a bag and line when necessary), is for the additives

We choose to run the additive as a piggy back or run it concurrent with the line A continuous bag of fluids.

If the additive comes in a bag (e.g. flagyl) then we run a line from the bag to the lineB bung.

To prevent additives mixing that shouldnt be mixed and/or if the fluids are incompatible then we simply attach a saline flush to the line B bung to flush the line.

We enter in the pump how many mls in the sryinge and how long to go over (if it needs to be diluted we alter line A dosing and run concurrent) and the pump does the rest.

Maybe I have misinterpreted the above posts but do you hang a bag for a piggyback and it runs manually? or on a separate pump? rather than sryinge dosing?

Oh and LPN,VSN, MSN - what do they stand for?

Jo (from oz)

[Roy Fokker, BSN, RN]

Roy, thank you so much! :)

You're welcome :)

Sounds like a lot of hassle. We use an Abbott Plum pump.

Maybe I have misinterpreted the above posts but do you hang a bag for a piggyback and it runs manually? or on a separate pump? rather than sryinge dosing?

A. What do you do if there is no IV pump? Or no Abbott Plum pump?

B. What I explained above should work even if you have no pumps to infuse with.

We use IMED pumps at my facility :) As such, I admit that the method may vary depending on the pump you are using at your facility.

Oh and LPN,VSN, MSN - what do they stand for?

Jo (from oz)

LPN ~ Licensed Practical Nurse

BSN ~ Bachelor of Science in Nursing

MSN ~ Master of Science in Nursing

I'm not sure what the equivalent in Ozland terms might be - maybe a nurse from the commonwealth can help me out here? :)

[Roy Fokker, BSN, RN]

Now to confuse you all further:

If it is a syringe being used to infuse secondary abx/tx, rather than a pump, we use a mini infuser. (Like the Bard series)

Of course, the difference in this case would be that instead of hooking on the connecting tubing BEFORE the pump to the Primary IV line... you would have to connect it to a port AFTER the pump on the Primary IV line.

cheers,

[all4schwa]

we use plum sets. for the one that doesnt have a 'backprime' button, i flip open the door with the cassette in it and the main will backprime into the secondary.

[ROSYJO11]

i found a post on here with all the abbreviations.

in aus, we have en (enrolled nurses) that are a 1 yr course through a tafe.

een is endorsed enrolled nurse, an en that does extra training to be medication endorsed.

an is assistant nurse which basically only helps out with adl's, much the same as pca (personal care assistant), or support staff.

rn, registered nurse (now a 3 yr university course)

then it goes up level 1 to level 5. level 5 is a director of nursing. level 4 is assistant director of nursing. level 3 is nursing unit manager. level 2 is clinical nurse, level 1 - registered nurse.

an rn who specialises is still an rn. only differences are that when the training was through the hospital system, not the university then you could train just to be a midwife or just to be a psyche nurse. if you wanted your general nursing, it was extra training after you finished.

what do you do if there is no iv pump? or no abbott plum pump?

in this hospital i havent had to worry about that as we have ample stock.

i work in a surgical ward so most patients are on iv fluids at some point in their stay. loads of antibiotics and anti emetics, pca's, epidurals etc

in other hospitals, boluses were common with drugs administered under 5mins. sitting by the bedside watching your minute hand.....

burettes were also commonly used in other hospitals in years gone by. and flushing saline before and after through the burette if the fluids were incompatible.

due to the increased risk of drugs/iv fluids running through too quickly, it seems the hospitals and staff prefer the pump system now. at least where i work anyway.

gotta say, i love this website and these forums :)

cheers,

jo