Something my clinical instructor said...

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I was wondering if it is normal for a nurse to run a primary of NS at 10ml/hr when you are hanging a small bag of antibiotics (50ml), when there is no order for the NS to begin with. My pt had no fluids running or any order for fluids but my instructor said to hang the NS and back prime to avoid wasting a significant amount of the atb priming and then just set the rate for the NS at 10ml/hr. She said some nurses don't feel comfortable doing this...is it because it's illegal?

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Why didn't you just ask your clinical instructor why she was doing it?

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Why didn't you just ask your clinical instructor why she was doing it?

I did and she said that a lot of students trend to waste fluids when priming so I should do it this way. But she also said that my nurse may not feel comfortable with me doing this and if she had an issue with it to let my instructor know and she would "try to persuade her."

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Specializes in NICU.

It is common to run NS when the patient is getting antibiotics. The antibiotics are running at a slow rate. By running the NS concurrently it helps get the antibiotics into the bloodstream. Back priming is when there is air in the tubing. You back prime the pump and it puts NS up the piggyback tubing and pushes the air bubbles into the piggyback bag. The advantage is that you are not wasting the antibiotics by letting it flow down the tubing and losing some of it into the trash can when you prime the tubing. The disadvantage is that your piggyback tubing is full of NS. It is going to take time for the first drop of antibiotic to reach the pump. All of our tubing has a cap on the end that allows air to escape the end of the tubing but doesn't allow the fluids to run out the end (no waste into the trash can), that prevents the need to extensively back prime like your instructor does, plus the antibiotic is entering the bloodstream as soon as you start the pump. I can see why the other nurses don't like the way she showed you.

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Specializes in Telemetry.

are you sure the NS wasn't just the primary bag for the antibiotic piggyback?

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are you sure the NS wasn't just the primary bag for the antibiotic piggyback?

This was probably the case. No order needed. It starts when secondary is done to clear the line. Usually either at same rate as ABX or at KVO.

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I guess my confusion was just hanging a bag of NS without an order for it. Her saying that some nurses won't do it made me question it. Who pays for the bag? We never scanned it. It just seemed a little confusing... I'll ask her for more clarification next week.

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Specializes in Trauma, Teaching.

I always prime my tubing with saline, then run the antibiotic, then enough saline to make sure no med is left in the tubing; my manager totally agrees with this. Think about it: our pump tubing takes nearly 20 mL to prime. If I turned it off after just the piggyback, 20 mL of my 50 mL bag would never reach the pt. Nearly half the dose! Nurses are responsible for administering medications in such a way as the pt actually gets what they are supposed to. Using saline before and after, maybe 50 mL total. Not enough to change fluid balances except in extreme cases.

You can just prime with the abx, and follow with enough saline to completely infuse it.

It's called critical thinking.

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Specializes in OR, Nursing Professional Development.

You might also want to investigate the policy and procedure manual re: antibiotics. Something like this may be covered.

Working in the OR, all of my antibiotics are given as secondary infusions (or push, depending on the drug and anesthesia provider administering it) with either LR or NS as the primary.

Any patient in my hospital who has an IV is automatically ordered NS flushes via syringe and NS flushes via 250mL bag prn. This allows any medication to be completely flushed from the line and into the patient to ensure that the full dose is given.

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It's called critical thinking.

I'm actually asking about the legalities of hanging fluid without an order.

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Specializes in Hospice + Palliative.
I'm actually asking about the legalities of hanging fluid without an order.

do you routinely get orders to flush with an IV push med? It's sort of the same thing, IMO.

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This was probably the case. No order needed. It starts when secondary is done to clear the line. Usually either at same rate as ABX or at KVO.

We were just talking about this today during SimLab. We were told that it can be done at KVO without an order (we were told 15mL/hr) if you're running something (in our case, it was 3 bags of KCl, each bag for an hour) piggyback.

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