How do you define "piggyback"?

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I've noticed there is a wide range of definitions for "piggyback" where I work, which is sort of a problem since our IV policies refer to "piggyback" IV's numerous times.

Is it just where I work, or is there a more universally agreed upon definition out there?

Specializes in Critical Care.
MunoRN said:
So you'd call a line y'd in either above or below the pump a secondary?

Yes, it is a secondary line that is piggybacked onto the primary line.

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Specializes in Critical Care.
ObtundedRN said:
Yes, it is a secondary line that is piggybacked onto the primary line.

If I was trying to differentiate between a line y'd below the pump (and on it's own pump), and a shorter ("secondary") tubing line y'd in above the pump of another fluid that runs something like an ABO intermittently, what term would be used to identify it as something different from a line y'd below the other pump and running on it's own pump?

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Specializes in Critical Care.
MunoRN said:
If I was trying to differentiate between a line y'd below the pump (and on it's own pump), and a shorter ("secondary") tubing line y'd in above the pump of another fluid that runs something like an ABO intermittently, what term would be used to identify it as something different from a line y'd below the other pump and running on it's own pump?

Anything attached to the main IV line is piggybacked. No matter if it is on it's own pump, above or below a pump etc. If it attaches onto a primary IV line, it is piggybacked.

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Specializes in Pediatrics.

Wow, this thread can be very confusing to the student or novice nurse. These terms are too often used interchangably. A piggyback technically needs something to latch on to. If the patient is "locked" then it is an intermittent infusion (technically so is a piggyback, if it is a med that runs intermittently ;).

If you look at the tubing package for an IVPB line, it says "secondary". The length suggests it has to piggyback onto a primary.

When I worked in on oncology/bmt, we would refer to chemo lines as Y'ed onto a primary.

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Specializes in Critical Care.
ObtundedRN said:
Anything attached to the main IV line is piggybacked. No matter if it is on it's own pump, above or below a pump etc. If it attaches onto a primary IV line, it is piggybacked.

So would you consider secondary and piggyback to be interchangable, or all secondaries piggybacked but not all piggybacks are secondaries?

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Specializes in Critical Care.
MunoRN said:
So would you consider secondary and piggyback to be interchangable, or all secondaries piggybacked but not all piggybacks are secondaries?

I guess I use them somewhat interchangeable. When I say secondary, it is an IV line that is packaged and labeled as "secondary" by the manufacturer. It is usually only about 2 or 3 feet long. It has no Y ports on it. It is only meant to be attached to a primary line, either at a Y port, or at the cassette. Never attached directly to the patient's IV. (We use plum pumps).

I use the term "piggyback" as the actual process of another IV line being attached to the primary IV line. I guess you could piggyback a "primary" IV line (one that has it's own cassette and Y ports) by attaching it onto the Y port or cassette of another primary line. Does that somewhat clear it up?

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Personally, I only refer to a piggyback as a med that is piggybacked onto a primary line and uses the same pump. If a med requires a seperate pump from the primary fluid, I consider it to be Y'd in (and chart it as such). This is the quickest pic of our setup I could find. The piggybacked med temporarily stops the primary infusion (which is why it is hanging higher) and our pumps allow us to set up a seperate rate/volume infusion for piggybacks that once complete, will automatically switch back to the primary rate/volume. You can't see it in the pic, but on our pumps the piggyback (using secondary tubing, it's much shorter tubing than primary lines and can't be run through a pump on its own) is Y'd in to a port just prior to where the tubing is inserted on the pump. There are more ports below the pump on primary tubing for medications that are Y'd in and have their own pump. We put all medications on a pump, even antibiotics.

secondaryIV.gif

I have heard some nurses refer to any intermittent infusion as a piggyback. So if a patient is getting an antibiotic, they'll call it a piggyback even though there is no maintenance fluid. Since it's hung as a primary line without maintenance fluid, I don't consider it a piggyback. Our policies refer to piggybacks the same way I do but when talking with other nurses it would be arguing semantics since it's clear they are referring to an intermittent infusion if no maitenance fluids are present.

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Seperate pumps are not what we call " piggyback". Piggyback is when a secondary medication is infused with a primary.

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Specializes in Critical Care.
Perpetual Student said:
If it's on its own pump you would set it as a primary. On the pumps we use if you set up an infusion as a secondary without a primary infusion set on that pump it won't work.

With the pumps we use you can indeed program it to have concurrent administration of your primary and secondary lines on one pump.

How does your pump do that?

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Specializes in Critical Care.

It sounds like the variations in terminology is not just where I work.

I've also seen the uncertainty about what "secondary" means where I work, but unlike "piggyback", there is a definite correct answer to what "secondary" means: A secondary is an intermittent infusion by definition that uses a primary fluid (either the patient's maintenance fluid, TKO, or specifically for priming and flushing) and "secondary" tubing for the purposes of: priming both lines (flushing the primary and back-flushing the secondary) and then flushing the line again at the end of the infusion. A "secondary" is always y'd in above the pump from a bag that hangs higher than the primary. A line going through it's own pump and y'd in below the pump to another primary is also a primary; it doesn't matter which y's in to which if it's below the pumps, they are both primaries. Or, if you use the "primary" setting to program the pump, then it is a primary not a secondary.

I've never really used the term "piggyback" because I've never known it to have just one meaning, but if I had to choose, I'd agree with the definition that it refers to any fluid running with another fluid, which would mean that all secondaries are a type of piggyback, but not all piggybacks are secondaries. At least this way, the term "piggyback" serves a separate purpose from "secondary" rather than just meaning the same thing. Although using the terms "piggyback" and "secondary" interchangeably seems more common.

In the end though, the term piggyback seems to be beyond saving and it's probably best to just let it fade away.

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Specializes in Emergency & Trauma/Adult ICU.
MunoRN said:
How does your pump do that?

As in the pump pictured here ... the secondary/piggyback/pick your term is in the tubing connected to the blue syringe port. It can be programmed so that the main line continues to run while the secondary is also infusing, so long as the total volume of the two combined does not exceed some limit ... 500mL/hr., I think.

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Specializes in Critical Care.
Altra said:

As in the pump pictured here ... the secondary/piggyback/pick your term is in the tubing connected to the blue syringe port. It can be programmed so that the main line continues to run while the secondary is also infusing, so long as the total volume of the two combined does not exceed some limit ... 500mL/hr., I think.

Can you prime the secondary line by backflushing or flush the line after an infusion using the primary fluid?

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