Iv antibiotic running as primary?

[SquatsNScrubs]

Perhaps I am overthinking this, but alas...

I've recently noticed on my floor patients who are not receiving continuous IV fluids having IV antibiotics run as the primary on the pump. No small bag of normal saline is being used as the primary with the antibiotic as the piggyback. There is approximately 13mL in the distal primary tubing. This means that a patient who is receiving a 50 mL antibiotic is missing out on almost a third of their dose left behind in the tubing...right?

I am relatively new at my facility and am unsure how to go about this. If I see an antibiotic being run as the primary, I will swap the old abx bag for a 100 mL bag of NSS and run the abx as the secondary.

Should I send an email to my manager? I can't find a policy regarding this.

[xoemmylouox, ASN, RN]

I always run antibiotics as a secondary, unless the provider is very specific or the patient is on VERY strict fluid restrictions. For me, I don't want to have to rush into the room and unhook my patient from their IV right that very second or force my patient listen to the scream of the pump. I HATE that noise.. Plus I want my patients to receive as much of their medications as possible.

[Guest219794]

I was taught that even giving any NS or other fluid, as a primary, without orders is administering without orders. I have a few issues with hanging a separate primary line of NS if the patient does not have fluids ordered. First, fluids need to be changed every 24 hours, most of the times when I see people hang a ns primary with an abx piggybank no one ever changes that fluid every 24 hours. The other issue is that many times the patient does not need additional fluids due to other conditions, kidney failure or chf, they do not need the extra fluids given. Often times I find the night nurses tend to hang the small saline bags so that they can run the fluids, albeit slowly, overnight and not have to deal with mapping the patient. Just my thoughts on it, and what I was taught.

Which method do you use to give the entire dose ordered?

[LovingLife123]

They should be run as secondary. I think a lot of people are just lazy.

Absolutely not true. We don't even carry secondary tubing. We carry 25mL flush bags to flush behind so all antibiotic is given.

[Guest219794]

Absolutely not true. We don't even carry secondary tubing. We carry 25mL flush bags to flush behind so all antibiotic is given.

Thanks-

In this entire thread what has intrigued me is how common it is for nurses to give a partial dose with a clinically significant portion of medication being discarded rather than administered.

The issue here really has little to do with primary vs secondary, but techniques and policies that facilitate appropriate medication administration.

mrf0609- is this what you do in your facility?

[mrf0609]

No, We do not flush with a 25 ml bag post administration. We also do not prime the line with ns. Medication mixed in the pharmacy is often more than ordered dose, if primed appropriately and the pump is programmed exactly as directed, there is often medication left in the bag. If the first dose of a 100 ml bag is hung at 90 mls instead, due to priming, then all subsequent doses after are programmed as ordered. If the original line is primed with ns, then all doses can be given as ordered. We honestly have no policy at my facility, it is how I was trained.