Secondary IV tubing question

  1. 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
  2. Visit General E. Speaking, RN profile page

    About General E. Speaking, RN

    Joined: Apr '02; Posts: 2,574; Likes: 1,622
    ICU nurse (finally); from US
    Specialty: floor to ICU

    24 Comments

  3. by   queenjean
    Well sure, you try to keep it as closed a system as possible. But, if there is only one hub/connector/opening thingy above the part that inserts into the pump, how can you run multiple secondaries through that? Many of our patients are on a couple of different piggybacks, and not all of them are compatible.

    I leave the secondary hanging connected to the primary tubing if nothing else is supposed to run. But if there is something else, then we are to cap off all secondary tubings with a connector that has a tightly fitting cap (specific to that connector), to protect against some type of contamination.

    I don't see how back flushing would clear the secondary line if you were reusing it with a different med--everything that was in the line would then flush into the next bag, so you would be mixing the remaining couple of ccs of one type of med with the next med, which would obviously lead to incompatibility issues. We only back flush to prime the secondary tubing initially; never to clear the med for use with a different secondary. Or am I not understanding what you are saying?
  4. by   oMerMero
    Ok, so say you have two antibiotic piggybacks that are incompatible. When the first one is finished, you back flush the maintence fluid into the empty bag unitl there is just maintance fluid in it. You clamp the secondary tubing, removed the first piggyback bag (that has the back flush), and the hang the second piggyback and unclamp the tubing. The two antibiotics are not mixed, and you use the same tubing with only opening the system to change the bag. The two antibiotics run through the same maintainence tubing, why can't they run through the same piggyback tubing? This is the way I do it. My hospital does not have a policy on it.
  5. by   all4schwa
    I hadnt thought of that, but i would say that would work...
  6. by   YooperNurse
    We use one line of piggyback tubing and backflush with the main IV fluid, keeping only one line hooked up continually (I am assuming there is compatibilty of the main IV fluid and the piggybacks here). If the patient does not have continuous fluids running, we keep a small bag of NS up to do the backflush with, in addition, flushing the enire line with NS after the piggyback is empty to ensure that the pt got all the medication that was in that piggyback bag.
    Last edit by YooperNurse on May 14, '07
  7. by   Mulan
    Quote from oMerMero
    Ok, so say you have two antibiotic piggybacks that are incompatible. When the first one is finished, you back flush the maintence fluid into the empty bag unitl there is just maintance fluid in it. You clamp the secondary tubing, removed the first piggyback bag (that has the back flush), and the hang the second piggyback and unclamp the tubing. The two antibiotics are not mixed, and you use the same tubing with only opening the system to change the bag. The two antibiotics run through the same maintainence tubing, why can't they run through the same piggyback tubing? This is the way I do it. My hospital does not have a policy on it.

    agree

    backflushing is encouraged at present facility to save money by using only one secondary tubing instead of two or more
  8. by   AlisonBSN
    That does seem like a neat way to do it. I don't know what our policy is, but my preceptor told me that secondary tubing is only good for 24 hours, when the primary tubing is good for 96. Another nurse told me that as long as it's capped it's good. So I don't know where the 24 hours comes from, because if you left it uncapped it wouldn't be OK for 24 hours.
  9. by   UM Review RN
    Ours is supposed to be dated matching the primary tubing, so that the secondary tubings get changed with the primary.

    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.
  10. by   miko014
    Hmm the only time I ever thought of back flushing is if there is air in the secondary line...that's an intresting idea. I personaly check compatibility. If it's two IVPB that are compatible, I reuse. If not, I get a new set and cap the old one. Ours are good for 72 hours or until the main line is changed.
  11. by   tridil2000
    what brand pump do you use?
  12. by   General E. Speaking, RN
    Quote from oMerMero
    Ok, so say you have two antibiotic piggybacks that are incompatible. When the first one is finished, you back flush the maintence fluid into the empty bag unitl there is just maintance fluid in it. You clamp the secondary tubing, removed the first piggyback bag (that has the back flush), and the hang the second piggyback and unclamp the tubing. The two antibiotics are not mixed, and you use the same tubing with only opening the system to change the bag. The two antibiotics run through the same maintainence tubing, why can't they run through the same piggyback tubing? This is the way I do it. My hospital does not have a policy on it.
    yes, this is what I mean!
  13. by   General E. Speaking, RN
    Quote from tridil2000
    what brand pump do you use?
    We use these: (The first one pictured)
    http://www.bbraunusa.com/products/infusion.htm
  14. by   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?

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