How do you re-prime primary tubing?

[Albertson]

So the place I do clinicals at hangs abx on primary tubing. I can’t seem to manage re-hanging the same abx for the next set of abx on the same tubing without getting an insane amount of air in the line. It is also common practice when the abx are complete that the line is flushes with 20ml NS to ensure all abx are administered. So how do you properly reuse primary tubing without getting air in line or wasting medication? No one can seem to help me here.

[FiremedicMike, RN, EMT-P]

A few ideas,

1.  Set your VTBI to 5-10cc less than the bag volume so  that it stops while there’s still med in the line.

2.  Watch your pump like a hawk and stop it before the drip chamber empties.

3.  Run saline on a secondary bag that will pick up as soon as the primary bag ends.

4.  Use fresh tubing with each bag

5.  Just d/c the old bag and flush the tubing like your normally would.  You’re only wasting 2-3cc of medication…

[Rogue1]

Why battle with large amount of air in the line at all?  Better to just put your small NS bag on the primary tubing and add secondary tubing to run the abx. 

[Albertson]

This is a great suggestion and if they have a maintenance fluid I absolutely will hang the abx as a secondary but if they don’t have any maintenance fluids ordered or the abx aren’t compatible with those fluids they have to run on a primary and this is where my issue comes in. Thank you for the response!

[Rogue1]

Quote

This is a great suggestion and if they have a maintenance fluid I absolutely will hang the abx as a secondary but if they don’t have any maintenance fluids ordered or the abx aren’t compatible with those fluids they have to run on a primary and this is where my issue comes in. Thank you for the response!

At my facility we have small 50ml NS bags that can be connected to the primary line, and there is usually always an order in for 'NS flush'.

[LovingLife123]

All of my abx at my old facility were primary.  You hang a 25mL flush bag behind and add 25mL for the flush.  You end up with about 5mL left in the bag.

There should never be huge amounts of air in your line.  Unless you are running the bags dry and not putting the appropriate VTBI when you start the flush.  

[Albertson]

At this facility they have us program each individual abx into the pump so I am hanging abx as a primary if the pt doesn’t have maintenance fluids ordered and then once the abx are complete…I.e. pump runs dry and says “air in line” because the bag has run dry we are then to hand flush the line with 2 (10)ml flushes of NS. This facility does not carry small flush bags as this is very expensive and it’s a surgical floor so every pt is getting abx frequently. I can not figure out how to re-prime the tubing with the same abx for the next round since primary tubing can be reused without getting huge amounts of air in the line and wasting med. 

[NorCalKid]

On 7/31/2022 at 9:23 AM, Albertson said:

This is a great suggestion and if they have a maintenance fluid I absolutely will hang the abx as a secondary but if they don’t have any maintenance fluids ordered or the abx aren’t compatible with those fluids they have to run on a primary and this is where my issue comes in. Thank you for the response!

We can place a standing order for a NS bag to be used for piggyback.  We regularly get pts from the ER with abx as primary.  I just change it when hanging the next bag so I don't have to fight with it all day.  Ya I'll have to unhook and prime everything once but saves a lot of time in the long run.