What to set VTBI to when antibiotic is the primary?

Specialties Infusion

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Hey y'all, new grad nurse here. I'm pretty cautious when it comes to running IVs. Yesterday I had an order to run vancomycin at 167 ml/hr for 90 minutes. The drug was diluted in a 250 ml bag of normal saline. I set the volume to be infused in the pump as 250 ml then it started running. This bag was not running as a piggyback, just a primary. I guess I'm confused about whether or not I used the correct VTBI. When I was in nursing school the nurses would always set the VTBI for the primary line slightly lower than the total in the bag (so say 950 for 1000 ml bag). Is it wrong that I put the VTBI as exactly what was in the bag (250 ml) yesterday? Or would the bag run dry if you do this? I guess I just wanted to make sure all the antibiotic got infused. Does the pump know when the bag is empty and air starts going through the line? I am really scared about air getting into the line! Just want to make sure I am performing the best and safest practice.

Honestly everyone sets their VTBI differently. Some set it to 250 while some set it to 225. Either way the pump isn't just going to be infusing air into the patient. Believe me it will beep and beep and continue to beep until the problem is fixed!

Thanks for your response FL_Nurse92.. I figured but I feel more confident about it now!

No worries, I'm a semi new nurse myself (1 year)

Specializes in Infusion Nursing, Home Health Infusion.

Are you using a pump with a functional air-in-line detector? What brand and type is it? You need to find out? As far as the volume to be infused: You want to set it as close as possible to the actual volume in the bag if you are running it as a primary infusion (you were doing it as a primary as opposed to a secondary). I prefer to set it just a bit under the actual volume because I could always come back and add some more volume to finish the medication. It is better than dealing with a pesky air alarm

Specializes in ICU, trauma.

The only reason other nurses do this is so that their line doesn't run dry. if you put in 225 instead of the 250 ml, it skips the step of having to reprime the line next time you give vanco

Don't set the antibiotic as the primary-there should always be a secondary. What if you get busy and the line goes dry? Even if it's just TKVO, you need to have that backup.

Check the drug monograph for medication specific infusion rates as well as your agency policy. We can advise you on vanc but you will need to know where to go for accurate and timely information for your next infusion.

Specializes in Education, OB, Peds, NRP.

I always run antibiotics as a secondary. If the patient doesn't have an IVF order, I use a 100ml or 250ml bag of NS. I set the primary at say 125ml/hr, then set that VTBI for 75 mls. Then I run the antibiotic as a secondary and set it at whatever run rate is ordered and set the VTBI for the total amount. The pump then delivers the entire abx, instead of just a partial. I am of the belief that if 200mg of Ampicillin is ordered, then I need to do what I can to run all 200 mg of Ampicillin in, not leave it in the line.

When the secondary pump is done, the line is flushed with the primary infusion. Then I saline lock. I even do this when I work ED, although I am in the minority in that area.

Specializes in Infusion Nursing, Home Health Infusion.

There is nothing inherently wrong in running a IV intermittent medication as a primary infusion.I get that the terminology can be confusing but by this I mean that you have any locked venous access device.such as a PICC,PIV,or any type of CVAD and you use primary tubing to administer and then disconnect and flush your line when completed.Technically you must have an order or policy or standardized procedure (depending upon your BRN in the US) to order any additional IV fluids.

iluvivt,

I am actually doing a project on this for my residency. When you run the IVPB on a primary line, what are your opinions on medication waste. For example, the tubing from the actual pump mechanism to the patient. Without a primary line running KVO, the pump was blaring "air in line" because the med had run out above the actual pump. I disconnected a 50 mL bag of Ancef the nurse before me ran on primary tubing and measured 18 mL of abx in the tubing from the actual pump to the PIV lock, almost 1/3 of the medication.

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