Having trouble with changing iv bags

[student200977]

I haven't had the chance to practice changing iv bags, or tubing. My question is, for example, if a bag of 1000 NS is done infusing, the bag is bone dry and the chamber is empty, and I need to hang another bag, do I clamp the tubing 1st then spike a new bag, and then squeeze the drip chamber till its half full, then start the infusion again? or is there no need to clamp the tubing and to just spike the bag and hang it?

When hanging an IVPB, and I want to backflush do I unclamp both the primary and secondary line, or do I just unclamp the secondary line and clamp the primary line?

Thanks

[Dolce, RN]

I haven't had the chance to practice changing iv bags, or tubing. My question is, for example, if a bag of 1000 NS is done infusing, the bag is bone dry and the chamber is empty, and I need to hang another bag, do I clamp the tubing 1st then spike a new bag, and then squeeze the drip chamber till its half full, then start the infusion again? or is there no need to clamp the tubing and to just spike the bag and hang it?

When hanging an IVPB, and I want to backflush do I unclamp both the primary and secondary line, or do I just unclamp the secondary line and clamp the primary line?

Thanks

If the primary bag is empty and the chamber is also empty it probably means there is air in the line. First, clamp the primary tubing. Second, spike the new bag of fluid. Third, fill the drip chamber. Fourth, use an empty syringe to "suck" the air out of the tubing. Now you can unclamp the tubing and adjust to your desired rate.

I'm going to let someone else answer the backflush method because I never do it that way. :) I always prime my secondary line separately and then plug it into the primary system. Hopefully someone else will have the answer to that question.

[Straydandelion]

I always prime my secondary line separately and then plug it into the primary system. Hopefully someone else will have the answer to that question.

I do it this way also.

[Kyrshamarks, BSN, RN]

to backflush the secondary you do not need to clamp the primary. hook the secondary to the port nearest the primary bag, open the clamp on the secondary and hold below the level of the primary bag, it will pull from the primary to the secondary. We do this in peds all the time and in ICU.

[patwil73]

I haven't had the chance to practice changing iv bags, or tubing. My question is, for example, if a bag of 1000 NS is done infusing, the bag is bone dry and the chamber is empty, and I need to hang another bag, do I clamp the tubing 1st then spike a new bag, and then squeeze the drip chamber till its half full, then start the infusion again? or is there no need to clamp the tubing and to just spike the bag and hang it?

Unfortunately your answer really depends on if you are using a pump to infuse the IV or not.

1) Changing with a pump. If the IV is bone dry it will often be easier simply to change the tubing along with the IV bag. You can take the old IV bag off, spike a new one, squeeze until the drip chamber is half or so full and then use the pump to advance the air past the pump (depending on the model), or you can remove the tubing from the pump after spiking a new bag and filling the drip chamber, unclamp the line and allow gravity to advance the air far enough that a syringe at a distal port will remove the air.

See changing the line just might be easier and this is the reason if you have a 1000 ml bag always program for 980 or so, that way you won't be bone dry.

2) If gravity infusion, then clamp your primary line. Unhook the old bag and spike a new one. Squeeze the drip chamber half full or so. Attach a syringe (10 ml) to a distal port (closer to the patient and past the air). Now slowly open the clamp and allow the fluid to start to flow. As the air gets close to your syring apply gently pressure to pull the fluid and air into the syringe. Once all the air is gone continue with your normal infusion.

All this is dependent on your tubing still be in date (meaning usually no more than 72 hours old). If tubing is out of date or unknown simply change and redate tubing.

When hanging an IVPB, and I want to backflush do I unclamp both the primary and secondary line, or do I just unclamp the secondary line and clamp the primary line?

Thanks

1) Clamp the secondary tubing and spike the IVPB. Drop the IVPB below the level of the main IV bag. Unclamp the secondary tubing and the fluid from the primary will flow back up into the secondary line. When it reaches half the level of the drip tube bring the bag back up and start your IVPB.

2) Clamp the secondary tubing and spike the IVPB. Squeeze the drip chamber till it is half full and then slowly unclamp the secondary line and allow the fluid to flow down the line to the end. Reclamp and hook the line up to your primary line. Begin IVPB.

Hope this helps

Pat

[lpnflorida]

All the above is standard practice.

However in regards to the secondary IV fluid it will depend on the policy the institution you work in. Our policy, we are no longer to back flush into the secondary tubing. We now either start with fresh tubing for each secondary solution each and everytime .

[meownsmile, BSN, RN]

I agree that doubling up on the secondary IVPB tubing can be dangerous. If you dont backflush enough and then invert the IVPB bag to empty the chamber into the empty bag you run the risk of incompatable fluids infusing.

A much safer choice is to use a separate secondary tubing for each IVPB. And discard them after 24 hours.

It also seems to me that joint commission made the decision for us as to whether we have to use pumps or not. I dont think joint commission allows gravity infusions anymore. At least in the clinical setting. OR may be different because the patient is monitored continuously while there.

[student200977]

Thanks so much...it was very helpful.