Updated: Mar 4, 2020
Published Jul 20, 2012
I'm currently doing my senior internship for nursing school. The other day, I set up a piggyback using the "backpriming" method, where you hook everything up and then lower the piggyback bag so the primary fluids run into the piggyback tubing. The primary tubing was on a pump where I set the primary rate and piggyback rate. This was my first time trying to backprime... I figured this method would be better because I am likely to waste some of the med if I prime the piggyback tubing the regular way. (I make a mess with everything I do )
If I remember correctly, I let a little too much fluid into the piggyback tubing, so the drip chamber was pretty much full. I couldn't see the drips coming out of the bag, but the pump was running and all my clamps were open so I figured everything was hunky dory. Well, I came back later and none of the antibiotic had run in! My preceptor came in, disconnected the tubing, let a little of the fluid run out and then hooked it back up. We watched as the pump ran and the primary NSS actually backed up into the piggyback tubing, raising the level in the drip chamber. We even tried putting the tubing on a different pump, and same thing happened.
So, what the heck did I do wrong to screw this set up so badly? My preceptor was as stumped as I was!! (We ended up adjusting the rate manually via roller clamp and running it in by gravity, which worked. Obviously not ideal, though.)
Silly question, but you did hang the primary bag lower than the piggyback, right?
I backprime everything. Way easier. If I fill up the drip chamber too much, I invert the bag and squeeze the drip chamber. There's usually enough air in the bag to fix it.
Hope that helps! What a strange problem! :)
I dont back prime but I have had the same issue of coming back later to none of the piggyback having run in. I dont have any explanation for it but what I do is bend the primary tubing above the pump and wrap tape around it, this usually makes the pump start to pull from the piggyback instead of the primary, as its suppose to. Then when it gets to the primary the pump will start beeping and i'll just remove the tape and let it pull from the primary again.
nurseprnRN, BSN, RN
If both bags are running into the same tubing which then goes into the pump, the bag that hangs higher will take the path of least resistance and run into the bag hanging lower unless your iv sets have backflow prevention valves in them.
If you do have a backflow preventer valve on the main line, and the abx is still running backward into the maintenance bag, replace the iv set, because the valve isn't working.
If you have a backflow preventer in the main line but none in the abx, be sure that your abx bag is hung all the way above the fluid level in the main bag, or the main bag will backflow into the abx bag (path of least resistance). that would also push any air in the abx drip chamber up into the abx bag, so that's what happened if your drip chamber had no air in it.
Sounds like a fun demo for skills lab!
iluvivt, BSN, RN
The pump is unable to determine which fluid is infusing b/c it just counts the volume infused. So you set the primary rate and secondary rate and then start for your secondary to begin infusion. BUT it must be set up correctly to work properly. So first check how you programmed the pump to rule that out as the problem. Next make sure your secondary is well above the primary IVF b/c you are using gravity as your friend. The secondary set should have come with with a plastic or medal hook..hook on to the IV pole and hang your primary line on the other end.Once you initiate the secondary make sure it is dripping before you take off. If the primary is backing up into your secondary the primary is probably not low enough b/c the primary IVFs are just follwing the path of least resistance. A second scenario could have been that there was an occlusion in the primary tubing below the level of the secondary. I would only suspect this if I had ruled out other causes and IF I had just threaded the primary tubing through the pump. I am sorry to say I have actually seen nurses that have slow rate infusions that have just reset the alarm multiple times thinking they have solved the problem. In reality it was a upstream occlusion that they never figured it. So the pump would run for a while until the pressure built up..then alarm. I saw this recently with a Heaprin drip...it had supposedly been infusing for hours with the nurses never able to figure out what was going on until they finally called me to troubleshoot the problem.
It is perfectly acceptable to backprime and prevents the breaking of the system thus potentially decreasing the infection risk.
My primary bag was hanging from the plastic hook that comes with the piggyback set. I guess this was just a fluke thing. What a pain, lol.
jadelpn, LPN, EMT-B
Make sure you prime the tubing correctly, and that a clave is attached to the cassette chamber opening. Turn cassette upside down then right side up when it fills, and continue to prime the line. Prime the secondary line with the second fluid. Hang both bags, and put primary with the cassette, into the pump. Attach the secondary line to the clave on the cassette, and open the line. Turn pump on and start line A. Switch to pump B and program that accordingly, press start, and it should show that Line A is stopped, and Line B is pumping. (unless you have programmed the pump to run concurrently). Hanging bags higher or lower are only for gravity lines. When using a pump, it takes from whatever line you program in. The need to backprime or it not working correctly has to do with not priming the line accordingly to begin with, or attempting to add a secondary to existing running fluids without using a clave and the cassette no longer has enough fluid in it from running out of the top of the cassette when adding a new secondary. It can happen with claves, but not that often. And when you backprime, it adds fluid to the top chamber of the tubing right below the bag, which can--depending on how much you backprime, can fill up. Then you end up with the dreaded "cassette failure" message.....So know your pump and what it can do. Make sure you prime accordingly, and don't try and add secondary's to the plain cassette upening when fluids are pumping. Hope this helps.
Jadelpn, I think you are describing a secondary setup, rather than a piggyback setup. For piggyback abx, we use a single pump that you program 2 different rates and volumes into. The piggyback must be hung higher than the primary bag so the abx run first. The pump doesn't know what fluid is actually running; it goes simply by what volume you enter, and gravity does the rest. Or, at least, that's the way it's supposed to work, haha.
Ktliz you are right ON ! What|I said in my first post is correct...You need to hang the piggyback higher than the primary line,usually about 20 cm higher than the primary at the Y connector above the pump. There should be a back check valve in the primary tubing so the secondary does not go back into the primary bag. Most modern pumps will allow you to program so that the primary IVFs will resume once the secondary is complete.
OOOOPs my bad..our pumps are different...petition for new pumps????!!!! HAHA! Good luck with this!!
No worries..my goal is to share and continue to learn.
Wait a second, now I am learning. I think (think) that a piggyback and a secondary line are the same thing. A piggyback would refer to a secondary line that is added to an existing hanging fluid to gravity. A secondary is a line that is added to an existing fluid through a pump. (which could also be set to run concurrently). I have always learned that if using a pump, the height of each (meaning one higher than the other) did not matter if the pump is set correctly. But as I noted earlier, it may be a matter of the pump. In my experience, most get mucked up if the cassette is not filled like it should be--either by not priming correctly (and that is a PAIN) or that some fluid comes out of the top when you take off the end cap on the port at the top of the cassette. Backpriming can fill the cassette to where it works again, but often will get a "cassette failure" notice.....
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