IV Abx?

[sweetieann]

Quick question~

In my med surg rotations, IV antibiotics were always piggybacked with something (even if the person wasn't on maintenance fluids before). In the psych hospital I'm at anow, all the nurses just run the antibiotic straight (they connect the antibiotic bag to IV tubing, put the tubing on the pump. When the infusion is done, they disconnect the bag and flush with a NSS syringe).

Isn't this wrong? Shouldn't you always piggyback with some fluid so that the fluid runs into the bag after the antibiotic is done and gets all of the antibiotic out of the bag and flushed into the patient?

Thanks for any input!

[MoopleRN]

If patients on my floor don't normally have maintenance fluids running, sometimes they'll get put on NS at a TKO rate if they have multiple abx. That makes things SO much easier for us not having to run in after every piggyback and manually disconnect/flush. Having said that, we often just run in the abx, flushing before and after manually with either a 2 ml or a 10 ml syringe depending on whether the patient has an IIVD or a PICC. I don't see that there's anything wrong with that. You can set the pump to continue infusing a little bit more if there's still some med in the bag when the pump "thinks" it's done. You just eyeball the amount and reprogram the pump for a few extral mls.

[beachbum3]

We run ours alone all the time. I can't remember if I heard in school that was not what we are supposed to do. I don't think they ever said not to. Also, even if you do run it as a piggyback, the fluid from your main bag doesn't run up into the piggybacked bag, I don't think. I can't recall ever seeing that happen.

[NightNurse0711]

I think this is standard practice. Even if you have an ABX piggybacked, the primary fluids are not going to flow into the piggy bag to "wash out every last drop" of the ABX. All you can do is run is as much as you possibly can and not stress if there is a couple of drops or even several mLs left after running the bag through the pump. Most pts who are on IV ABX get those doses frequently. Alot of ABX are small volume bags anyways, so I usually just hang the ABX by gravity if the pt does not have any primary IVF running. Hanging by gravity pretty much ensures that as much of the fluid as possible is going to run in, EXCEPT ( there is always one of those!! ) if the pt's IV site is positional!! Check your hospital's policy on hanging by gravity. It is just as easy as using a pump!

[Virgo_RN, BSN, RN]

We run them alone all the time.

[azor]

The right thing to do is to run ur abx on a tbing,then if the person is on ns ivf,piggyback.At times,i get like 250 ml ns and piggy back it esp if it is like 4 or 6 hrs interval abx so that i dont keep chargin and priming new tubing all the time but the right way is running abx alone.

Another thing is this,at times,if u want to piggyback and not sure of compatibility,i call pharmacy to maintain safety of my patient.

[wubbzy]

I've done piggybacks when they have another maintenance line running, otherwise just give it straight and flush before and after.

[CoffeeRTC, BSN, RN]

In LTC they are run alone. You would need a separate order for the flush bag and in the last 13 or so yrs I don't ever remember using one. We do tons of IVs too.

[MoopleRN]

The right thing to do is to run ur abx on a tbing,then if the person is on ns ivf,piggyback.At times,i get like 250 ml ns and piggy back it esp if it is like 4 or 6 hrs interval abx so that i dont keep chargin and priming new tubing all the time but the right way is running abx alone.

Another thing is this,at times,if u want to piggyback and not sure of compatibility,i call pharmacy to maintain safety of my patient.

What's a "tbing"?!? I don't understand the 250 ml bag of NS to piggy back in your abx, either. Seems like a waste to me, why not just infuse the med and be done if you don't have maintenance fluids going? You say the right way is to infuse it alone so I don't get what you're doing with 250 ml bags of NS.

We don't change the tubing on our abx bags every time. Our policy lets us use them for 72 hrs (tubing is clearly labelled so we can keep track of when to change) and the end is capped off when not infusing.

[beachbum3]

We change abx tubing q 24 hours, tubing for fluids and other meds q 72 hours. (unless TPN, then its q 24 hours also)

[mcknis]

if you think about it...when a med is piggybacked, the pt is not getting IVFs, but just the ATB at the time of infusion. Thus the reason to piggyback (in order to get every last drop). so there is no reason why you couldn't just give the med alone and then flush with at least 20cc NS

[blondy2061h, MSN, RN]

It's okay to run them alone, but a 50cc normal saline (or D5, or whatever the abx was mixed with) should run after it to flush out the tubing- there's about 25 cc in there. It's not okay to just use a 10 cc flush afterwards to clear the actual IV but not the tubing.