IV Infusion/ question

[stervets]

I recently picked up a PRN job at a local SNF and there is this new nurse who was given a bottom management position who is going after everyone for basically nothing. Long story short, the her most recent obsession is IV ABT infusions. She writes up everybody who leaves tubing full of liquid (the bag is empty but there is some solution left in the tubing and a little in the chamber). I have worked in multiple hospitals and other SNFs and have never seen anything that ridiculous. Usually pharmacy slightly overfills their infusion bags taking this into consideration. Most ABT are therapeutic based on their levels and I am yet to see a low level caused by leaving 3ml of mixture in the tubing. I mean if a bag is a 250ml bag, 3-5ml is 1/50 of the total amount and seems so insignificant that it would be highly unlikely to affect therapeutic levels. What do you think?

[mluvsgnc]

Do you think her concern might be the tubing not being flushed all the way (possible adverse med reactions, etc.) versus the fact that the pt. isn't getting a couple of mLs for therapeutic purposes?

[workinmomRN2012, BSN]

In the hospital that I work (and when I worked in SNF) we would always try to leave some in the tubing so the next nurse doesn't have to prime the tubing again, just a consideration for the next nurse, or even for the next dose. As the previous poster stated the pharmacy takes that into consideration and adds 10ml's xtra. The IV infusion nurse (30 years experience) at my hospital is aware of this and has no problems with it, the issue she would have is if the bag of ABT itself still had fluid left in it. Since you stated that she is a new nurse/position, it sounds as though she is trying to push her weight around. Does your facility have a written policy already in place regarding infusion guidelines?

[MunoRN, RN]

If you're not using a primary/secondary setup to prime and flush the bag, you're leaving about 10-13 ml in the tubing (not counting what gets lost with priming). Not a huge deal in a 250ml bag, but it's a significant difference in a 50ml bag or even a 100ml bag. Giving only 3/4 of the ordered dose is usually considered a med error.

[blondy2061h, MSN, RN]

If we're not using a primary/secondary set up we set a NS or D5W bag behind it and flush it through with 20ml at the same rate. But why aren't you using a primary/secondary set up?

[VANurse2010]

If we're not using a primary/secondary set up we set a NS or D5W bag behind it and flush it through with 20ml at the same rate. But why aren't you using a primary/secondary set up?

Not all SNFs have NS or other primary fluid laying around to use as a base fluid. Some don't have even have secondary tubing.

[iluvivt, BSN, RN]

That is nuts! First of all low volume antibiotics can be set up on a syringe pumps that use micro bore tubing, which you are well aware has usually under 1 ml as a priming volume. If you are setting it up as a primary intermittent (you use a primary tubing to hook it directly to a locked VAD/no flush bag) you are most likely using an infusion pump and when the air gets to the air sensor which is usually housed somewhere near where you thread the tubing or cassette into the volumetric pump...You can no longer infuse anymore. There is a very small amount between the the drip chamber and the air sensor (about 2-3 ml). Even if you were running it by gravity when the fluid level gets to the level of the patient's heart the infusion stops!

If you are setting it up as a secondary with a flush bag or other compatible primary fluid you can backflush if you want or you can just stop it and leave some in the drip chamber and backflush it on the next dose. If you leave lot of air in there is just become a nightmare for the next nurse with air alarms and often requires the RN to disconnect. It it much better to minimize disconnections. According to INS once a secondary is disconnected it should be changes at 24 hr. If you try to give every last drop that you can in many of these systems you often end up wasting more of the next dose trying to get rid of the air or air lock you have created in the tubing!

She is trying to make a problem when none exists!

[klone, MSN, RN]

What is ABT?

[tyvin, BSN, RN]

What is ABT?

I'm guessing it's meant to be Abx which is shorthand for antibiotic where I come from or actual iron which it would be weird if so many were ordered...did I win!

[SinikRN101]

What is ABT?

I've seen ABT as short for antibiotic therapy as in documentation on adverse side effects (ase), lack thereof or therapeutic effects.

[Anna Flaxis, BSN, RN]

I think Muno is correct that if you are using primary tubing with 50-100mL bags of antibiotics, then yes, this is problematic. However, this nurse should be problem solving and figuring out how to address this (getting approval to stock secondary setups and small bags of NS, for example) rather than blaming the nurses who are no doubt crunched for time and doing the best they know how with what they have.

[klone, MSN, RN]

I've never seen it written as ABT. Only abx.