iv antibiotics and maintaining line

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Hello all!

I work in LTC and often hang IV antibiotics. I've been having a problem lately which is letting the IV line run dry (or partially dry) after the dose is over. For example, we'll do the IV q 4 hours or q 8 hours and the tubing is supposed to last 24 hours. Well if I hang new tubing (my shift hangs all new tubing) it runs dry after my dose, and I don't like leaving others to have to use old tubing with a lot of bubbles for the next day.

I understand in hospitals this probably doesn't happen because I assume most antibiotics are running with IV fluids, but we don't have that luxury at my facility. Any advice? Thanks!

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Specializes in retired LTC.

When you prime your tubing, make sure the drip chamber is adequately filled.

I also set the VTBI just a little less than the total amount - like if the bag is 100cc, I'll set the pump at 90cc. It gives me a little wiggle-room to stand there and get the pump to deliver the few last cc's of fluid. The drip chamber has given me a few cc's wiggle-room also and I'm right there to disconnect and flush. (You don't let the drip chamber empty out!)

I also start my IVs early enough so that I, myself, have the task of dc'ing it on my shift. The next nurse rarely can get in there fast enough to stop it in time.

Make sure your tubing is dated and timed.

Just FYI - If your pts are using EXTRA tubings from a backup IV box, it's likely your facility is being charged for the extra tubings as IV costs usually allow a charge for only ONE tubing daily (which is what your P&P IV/pharmacy manual dictates). You may need to notify your DON and Inservice nurse so the issue can be addressed facility-wide. It's a money-thing!

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Specializes in long-term-care, LTAC, PCU.

Another nurse and I actually measured ho much fluid IV tubing actually holds when the drip chamber was half- way filled and it was 20 mL. Of course every brand of tubing is different and it also depends on if there are filters in the tubing or not but just to give you an idea of how much fluid can get stuck in your first use of IV tubing.

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Specializes in Acute Care - Adult, Med Surg, Neuro.

I will attach the new bag of antibiotics and withdraw the bubbles from the tubing with a syringe from one of the ports. It's annoying.

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Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.

are you using pumps?

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Specializes in Critical Care.

Personally I prefer to set up a primary/secondary even if all they are getting is antibiotics. I use a smaller primary bag (250 or 500cc) and use that to prime the line and flush it between antibiotics (both the primary and secondary lines), plus you don't end up running dry. We change tubing every 96 hours so it's more worthwhile, although I'd probably still do it for tubing changed every 24 hours particularly with q 6 to 8 hour doses.

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The chamber is primed well. That is one thing I am good at - priming the tubing! I do usually program to give less than what is required - like if I'm supposed to run in 110 cc fluid, I'll program the machine to stop at 105 or 100, but it still runs dry.

Esme - yes we are using pumps.

AmoLucia, are you saying that to prevent drying the line out to stand there at the end and watch the tubing until the drip chamber itself starts to decline, and then turn it off? I'm just trying to clarify. I could certainly try that. Not a bad idea! And good to know for the tubings, luckily we usually have extra from old patients who've d/c so I'll just use those.

June, I have always wondered exactly how much is in there. I suspect it's a lot.

0.adamantite, that is what I suspect the other nurses most likely do when it is their turn to hang the antibiotics (on their shift with tubing that I hung) but I'd like to make it easier on them. I just hate leaving dry tubing hanging.

Muno, the only equipment I've got is the IV antibiotic bag itself, which generally is 50 cc, and saline flushes. I've no bags of saline or anything. I don't think I'm able to do what you described therefore.

Thank you for all your help! Any more thoughts please let me know. I will have random days where

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Specializes in Critical Care.
...

Muno, the only equipment I've got is the IV antibiotic bag itself, which generally is 50 cc, and saline flushes. I've no bags of saline or anything. I don't think I'm able to do what you described therefore.

Thank you for all your help! Any more thoughts please let me know. I will have random days where

Something to keep in mind is the amount of medication being wasted. The initial priming of line typically results in 20+ ml that ends up in the sink/trash, then there's the volume that gets thrown away when the tubing gets taken down, which is also 20+ml, those are pretty significant medication errors due to wrong dose. I would make a case for stocking secondary tubing and flush bags with your facility and if that's not something they want to do they probably shouldn't be offering this as a service.

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Specializes in retired LTC.

To OP - pumps usually go into standby or sloooow KVO when VTBI goes in. And then it alarms. That's why I program less to be infused. Try decreasing the VTBI a little bit more than you have done so. I do play with the pump WHILE I STAND THERE monitoring the last few cc's in the bag (usually the drip chamber I leave at half level).

I pretty much got it down to a science so I rarely had a dry tubing. My 12mn doses were usually a mess, but after I ran my dose, my next 6am doses were pieces of cake.

To Munro - are you LTC? We usually don't have any luxury of hanging that extra bag like you do. We use what we get from pharmacy - that's it. And that's usually how our P&P manual dictates.

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Muno, I guess I don't quite understand...when I prime the tubing with the antibiotic I don't waste any. I've never had to dump it in the sink or trash. I attach the tubing, slide the slide clamp closed and then prime the drip chamber. Then I unclamp the slide clamp and let it flow. When the tubing is all primed I attach it to the IV line/PICC line.

I would think I'm doing it wrong lol but I know my coworkers do it this way so I'm not sure where the wasting comes in.

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I agree w/ the other replies that recommended lowering the VTBI a little more. Also, a secondary flush bag is ideal but I understand that you can't do that due to lack of supplies.

This is probably a dumb question but did this happen on the same pt. using the same pump each time? Maybe the pump is faulty. I would switch out the pump (again, if it's been the same pump every time this has happened to you). It should be beeping as soon as the VTBI is complete.

Is the alarm working properly? Do you hear it when it goes off for VTBI complete?

I had an incident w/ a faulty pump once. They can get glitchy.

If you think it could be the pump, get a new one, take the questionable pump out of service and send it to be thoroughly checked out.

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It's different pumps. This has happened to me with a few different patients.

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