Iv infusion confusion


When giving a piggyback IV medication, I am sooo confused about what RATE to set the IV infusion pump at for the primary line.

Say that the medication is running at 100ml/hr, is it right to set the primary solution at the same rate 100ml/h BUT set the volume to be infused at 30ml/h so that only 30 ml goes in to flush the IV tubing of medication at the same rate.

The nurse i am orientating with at my new job said that this is wrong and I would be bolusing my patient of the primary solution HOWEVER how would I be bolusing them if I only set the volume to be infused at 30ml because the pump would alarm and stop after this amount has infused?

My nurse said the right way to do it is to set the primary rate at 30 ml/h and the volume to be infused at 30 ml, however this would take an hour, its not wrong, just takes longer to flush the medication...

Please help!! I want to understand if i'm doing it right


337 Posts

You hang the IVPB higher and gravity will make it administer first. do your pumps allow to program the primary and secondary at the same time? those are the only type I have used, I am not sure how you would do it if you can only program a single primary with no piggyback program. (probably set alarm to alert when the secondary is finished?)

after the IVPB has administered the programmed volume and at the programmed rate, the pump switches back to the primary which is hung lower and will just infuse at whatever rate it was set for before doing the IVPB


6 Posts

i'm asking what rate to run the primary if there was no primary already infusing?, like the rate to run just to flush the IV line

Our pumps can program primary and secondary lines separate, but when it switches back to the primary what should the rate be if there was no set rate for it already?

Specializes in Hospice.

You should check your hospital policy. I always did it the way you described.

MunoRN, RN

8,058 Posts

Specializes in Critical Care. Has 10 years experience.

If there is no primary infusion and I'm going to disconnect it when the intermittent infusion is complete then I just program the volume to be infused at 20-30ml more than the volume of the bag, this will account for some overfill of the bag and still flush the line of the intermittent infusion so that the patient receives the entire dose.

MunoRN, RN

8,058 Posts

Specializes in Critical Care. Has 10 years experience.

To answer your question about the rate to flush it at, no you don't have to flush it at a rate of 30 ml/hr, that's a bit silly if you're flushing something that was infusing at 100 ml/hr. Keep in mind that you're flushing the medication in ahead of the fluid being pulled from the primary bag, so generally you should flush at the same rate or slower than what the medication is safe to infuse at.


6,534 Posts

I would do the same as you. And things like this are part of what makes being new SO much harder than it needs to be. The other nurse's idea is goofy. That's always an interesting situation: Someone who thinks they know something but really doesn't, telling someone else how it should be done.

Just...carry on! :nurse:


472 Posts

When you're experienced, you'll find that there are many ways to skin the proverbial cat.

When you're semi-experienced, you have a way that works for you and figure that most or all other ways are wrong (maybe this is where your preceptor is at).

When you're new, save yourself a lot of headaches and just follow hospital policy whenever possible. If no policy exists, follow your preceptor as long as their advice isn't actually dangerous.

dream'n, BSN, RN

1,162 Posts

Specializes in UR/PA, Hematology/Oncology, Med Surg, Psych. Has 30 years experience.

Basically just don't flush the line at a rate higher than the medication infusion rate. Therefore the left over medication in the line won't infuse too fast.

Julius Seizure

1 Article; 2,282 Posts

Specializes in Pediatric Critical Care.

I agree with how you are doing it. You are thinking about it correctly - good job!