IV piggyback meds

[lovetonurse1234]

Hi, I'm a fourth year nursing student with a question. If a patient has multiple IV medications, such as 3 different antibiotics, to be given during the day at different times, and otherwise has a lock, how would you proceed. I know that it is vital to check that they are compatible with the main line running, and since no primary solution is running, normal saline will be used as a primary line while giving the meds. But is it necessary to make sure all medications are compatible with each other if they are not running at the same time? If they are not, can you share the same primary line with the saline and just flush it in between each med (and have separate secondary lines for each med of course) or would you need a completely different primary line. also, if flushing is sufficient, how much do flush in between each med.. is 10cc enough??

Thanks in advance!!

[Here.I.Stand, BSN, RN]

Nope, if they're not running at the same time they're not going to mix, so compatibility isn't an issue. I set the primary to give 30 ml after a med is finished if they're going to be saline locked after, so all of the med is flushed into the pt and not hanging out in the IV tubing.

If you have to hang one as soon as the other is finished and not saline locking right then, 10 ml is probably enough for "space" in between the two meds. Myself, I'd look up the compatibility though because if they are compatible I'd save myself the work of flushing. :)

I'm curious too, how often the pt is getting an antibiotic? Are the three meds each q 24 hrs? Or are any of them q 4-8 hrs? If the pt is getting an IVPB med every few hours and fluid overload isn't a concern, I would see about getting an order for IV fluids just at TKO. That way you don't have to lock after every. single. med. I'd think it would also minimize his disruptions overnight, since you would just have to take a quick peek at his ID band and IV site before hanging it--rather than wake up, ID pt, flush, hang med, come back and wake him up to disconnect/flush it.... Of course if pt has hallway or outside privileges, you can lock it for him then so he doesn't have to drag the pole.

[lovetonurse1234]

Thank you so much for the reply! Better to be certain about those kinds of things, now I'll save myself some time/be more at ease. One of the patient's antibiotics was Q6h one was Qday and the other i do not recall. You also bring up a good suggestion as far as running a solution at KVO. Although, for some reason this isn't a common practice I've observed on the floor. It would be interesting to inquire.

...running a solution at KVO. Although, for some reason this isn't a common practice I've observed on the floor.

From what I've seen, TKO/KVO isn't typically ordered mostly because the docs aren't interacting with the patients or balancing the hundreds of tasks a nurse has to complete through a shift. By this I mean that they don't appreciate how often a patient can be disrupted through the night by hanging IVPB on locked patients or the time a nurse can save by being able to piggyback onto a TKO line rather than reconnecting new lines.

It's the uncommon exception that a doc hasn't written for TKO whenever I ask but the very rare exception that they'll write it unprompted, even for pt's who really need it (that is, accessed ports).