IV PB meds-- silly question, but need to know!

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Specializes in Tele, ED/Pediatrics, CCU/MICU.

Hi all!

I have a somewhat silly question about hanging IV Piggyback meds... antibiotics, etc.

I have observed the nurses that I work with, and they all do this a little differently...

Under the assumption that you are giving your secondary med as a piggyback with a primary infusion that will kick in at a KVO or some other rate when your PB is done....

how nitpicky are you about getting ALL of the med into the person? Is there a way to get all of the med out of the seconday bag without infusing air? Or do you just infuse to the point where there's no med in the bag but the tubing stays full?

I know it's an odd logistical question, but it's bothering me. I want the patient to get all of the med, but no air emboli.

Some nurses will mainline the antibiotics, some will just open the secondary line and let the little bit left in the bag/tube run in through it's connection to the primary line and then clamp it quickly before air gets in the main tubing, and some just leave a little in the bag.

Thoughts?

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Specializes in Education, Acute, Med/Surg, Tele, etc.

The IV machines that I work for have the secondary or 'piggy back' port in a certain spot that if any air goes in the machine sounds and stops...even a small bubble. SO that is very helpful if you get caught up and can't get there in time to watch it at the end (which I always recomend watching your IV's machine or not).

As for me, I will let the chamber stay a little full and the line full and shut the pb off. Most of my pts get these meds so often in a day that it keeps the line open for the next dose, and my pharmacy knows this delema and ratios things to allow for at least a 20ml difference in ratio of the med so that the proper amount or tiny bit extra (for those that drain the entire bag and tubing) does get in.

Personally I don't think that 5-10 ml left in the tubing is a serious offence...LOL! Just think about the body and how much medication is being sent off to the toliet because it is not being used...MD's compensate for that little gem and dose accordingly or if they don't, the pharmacutical companies have and that is why they have certain doses in their meds you can use or buy... Whatever abx being used...the body will only take in so much, and typically you urinate the rest away (IE that wonderful smell...uhggggg, you get good enough you can 'name that abx' when you dump your toilet hats...LOL!).

Anywhooo...wouldn't loose sleep over this one for sure...much of what you are putting in is going to turn to urine anyway..LOL! (man...us nurses...we put in, and watch come out, and clean it if it doesn't go as planned...why did we all do this again??? LOL!).

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If you are hanging the PB above the main bag then its not really an issue, the PB will run dry and the main will take over before any emboli have a chance of reaching the patient. If air does get into the line, simply hold the empty bag below the main bag and it will force main solution back through the pb line...does this make sense?

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Specializes in MPCU.

I like to leave the small about in the line to keep it ready for the next dose. Just spike the next bag and I'm ready to go. I think, I waste almost as much charging a dry line and the patient will get that small amount next dose.

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my own personal preference is that if it is an antibiotic that needs to stay refrigerated i try to program it so that all the med is out of the piggyback bag. i dont like leaving extra in the PB line if it something that needs to be refrigerated to stay stable. because if i am giving my next dose 8 to 12 hrs later - thats a little long for that to stay in the tubing not refrigerated - but that is me being nit-picky.

all you have to do to prime the line for the next dose is hold i lower than the primary bag and the fluid from the primary bag will prime the PB line. remember the tubing contains 10-15 ml so if for example you prime the line with NS from the primary bag and the anitbiotic is 50 ml, i program the pump for 60ml.

i am pretty sure there isnt a chance of air emboli with the PB method. once the PB line is empty is automatically draws from the main bag with no intervention needed.

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I agree with RNBelle it has always bothered me leaving an antibiotic in the tubing that requires refrigeration, so I do it the same way she does

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Specializes in Hematology/Oncology and Medicine.

I kinda go along with the concensus here. Personally if I am using an infusion pump, I won't in theory have to worry about air emboli. But per practice of my charge RN, I always setting the pump to make sure that the bag drains completely taking care of the overcompensation principle that seems to be the norm with IV bags/Pharmacy (If it's a 50ml PB then it likely has about 60-65ml in bag, 100ml has about 110ml and so on). For the amount that is left in the line... 4-5ml after the bag dries, don't sweat it because 99.5% got into the pt.

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Specializes in RN CRRN.

I only read the question, no responses, but this is a pet peeve of mine....When I orient new nurses, if we are hanging an IV ATB or whatever, and it is say 250 ml, I make them enter the Amount To Be Infused as say 235---so it beeps before it all runs out and air enters line. Sure you have to add more to the pump when you get to the room but you can see about how much is left. Many times a 50 ml bag has been 60 or 45 mls....so it can vary....but I cant TELL you how many times they have entered 250 ml on the pump I get to the room and 247 has infused and there is already air in the line. This means when you hang the next bag, you have to REprime the line, which means you Lose all the fluid already in the line JUST to get the air out......SO decrease your amount to be infused by say 10ml and then adjust it later.....you will make other pp who follow you very happy....OH I KNOW YOU ASKED ABOUT PB LINES---and you got alot of answers so I just wanted to go over single lines....no PB but the concept is somewhat the same.....

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Specializes in FNP.

A question in relation to IV antibiotics - if the order is to infuse 250ml of the med, do you empty the bag, or give 250, then flush the line? At times, the bag will empty and at other times there will be 10-30cc left in the bag. I was just told that I should empty the bag - our policy states to 'administer the dose completely' - and ensure there's not anything left, regardless of what the order is - seems to me that patients would then be getting too much antibiotic (280ml, etc)... I have asked a few people, and those of us who have graduated within the past few years set the pump and administer as ordered; the senior nurses empty the bag. I hate to think that I've been doing this incorrectly for 2 1/2 years, yet it's never been brought up, and I wasn't ever trained to empty the bag... thank you!

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administer it as it is ordered, don't shoot to empty the bag. Most bags will have purposeful overflow for priming. Its usually not a big deal if they get an extra 5cc abx or whatnot, but if the order says 250cc give 250cc and just that. "Administer the dose completely" to me means administer the full 250cc, not the full bag.

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Specializes in Acute Care Cardiac, Education, Prof Practice.

I run 5ml for small IVPB (50ml-100ml) and 10ml for large IVPB (Vanco at 250ml) over the listed amount on the label. This usually leaves the line primed and a scant amount at the bottom of the drip chamber.

Tait

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