Help with IVPB's?

[ainaya7]

This is embarrassing to write about but I'm desperate! I STILL don't feel confident about hanging IVPB's...Unfortunately I feel like I don't even know where to start half the time...this is one of those "skills" that makes you feel like you're ready to be a nurse, and it's not there for me!

I feel like I don't understand the most basic concepts, (and can admit I haven't checked my skills book for a refresher!) such as...why choose secondary tubing? why primary tubing? why primary tubing into another primary line (today I had a Hep Drip running primary into an infusaport and I hung K-Dur primary on a 2nd pump - can I connect at any port?? I picked the one closest to the pt. and the nurse seemed ok with it...)

Can anyone provide maybe a scenario or a step by step of what we do and how we set up supplies (and why we're picking what we're picking!) when getting an IVPB ready to infuse? (Using a pump to describe instead of gravity would be awesome!)

Thank you so much in advance!

[kgh31386, BSN, MSN, RN]

well first off you should check your skills book. and when doing a piggyback you should pick the port FARTHEST from the patient. if you're doin a push, you pick the port closest to the patient. really check your skills book for a start. buttt step by step. gimme a few minutes and i'll put it together

[iluvivt, BSN, RN]

Here is a quick reference and some definitions however you must purchase a IV drug book. The best is by Betty Gahart. A new edition is out every year Intravenous Medications 2oo9. Get one early as they are popular and often back ordered It is only for IV medications and each IV medication lists what it is incompatible with as well as other excellent information.

1 Primary tubing is used for any primary infusion,such as IV fluids,Heparin drips,Amiodarone drips. It can also be used as a primary intermittent or if you have an incompatibility between a primary infusion and a secondary. So you see before you make any decisions you need to know what is compatible and what is not.

2. Secondary tubing is a shorter tubing (usually 12-14 inches). It can only be used to piggyback an IV partial fill (or a mini-bag) into a primary continuous infusion. Because the tubing is shorter it is piggybacked or added at the medication port (or Y-site) near the drip chamber and above the pump. Most pumps will refer to this as your secondary medication. It of course,must be above the pump so you can switch back and forth between the primary and secondary. Let me give you an example. You have D5 1/2 NS infusing at 125 cc per hour . The MD orders orders some IV Timentin. OK so you verify any compatibility issues and there are none..so you can hang this as a secondary. If Your primary infusion had bicarb in it ...you would have to hang the antibiotic with a primary tubing and attach it at a T-extension or the Y-site at the site only since you cannot mix the two. If you had a multi-lumen line like a PICC you could use an available lumen for the antibioic.

3. The other type of tubing you will see is syringe pump tubing )or micro-bore). This is attaced to the syringe pump driver and can be added to any port BELOW the pump as long as it is compatable with the primary, If it is not compatible you must give it only at the site

Sometimes you will need to have an additional IV site d/t incompatibilities. Often you will have problems when trying to mix very basic medications (like Dilantin ph of 12) with acidic IVFs or medications (thus the problem with D5W and Dilantin

It can seem overwhelming at times,but you will learn the common IVFs and medications and will need to look up the rest and find a good compatibility chart for reference. Some will say call the pharmacy. I would just as soon look it up myself. If I was ever in a situation and I could not look something up and no one knew......my rule was consider it incompatible and administer it as such until the time I could prove otherwise