IV piggyback question

patwil73 · Mar 13, 2009

Hi,
I just started working on a medical/nephrology unit. One of my patients had a NS lok and also had two IV antibiotics ordered during the course of the day. Looking at the pump I realized that the nurses had been running the cipro through a primary line instead of piggy backing it into NS. The charge nurse said that this was wrong and that it should only be hung as a piggy back. What do you guys think?

Cipro can be run as a primary line - it is just easier a lot of times to piggyback it into the main line. You just have to answer a few questions:

1) Is the main NS line being run for a particular reason - to replenish dehydration or normalize electrolytes? If yes - you might want to consider cipro on it's own line because you will be interfering with the primary purpose of the NS line if you piggyback it.

2) Is the NS intermittant? Are you disconnecting it each time the Abx is finished? If so you might want to consider running cipro as a main line and change the tubing each time - since the constant disconnecting can increase chances of infection.

3) Is the NS continuous but running at a slow rate? Then running the Abx as a piggyback would be fine - you are not interfering with anything.

Hope this helps

Pat

carmen7 · Mar 14, 2009

The patient had a saline lok that was only accessed to administer the IV antibiotics. So what I understand from your answer is that piggy back would not be necessary?

oMerMero · Mar 14, 2009

Either way works...I think it is personal preference.

patwil73 · Mar 15, 2009

The patient had a saline lok that was only accessed to administer the IV antibiotics. So what I understand from your answer is that piggy back would not be necessary?

Correct - you don't need the piggyback. However, in the end it will come down to personal preference and your hospital policy.

I will tend to use piggybacks when I have 2 or more abx to give near the same time. I find it easier to just switch out the secondary tubing we use rather than disconnect the primary from the pump and prime a new tubing with the next abx.

However, if I only have one to give a day - I will often mainline it and throw everything away afterwards (I find it hard to trust the tubing is remaining clean enough to hook back up after sitting around all day in the corner of the room).

I don't think their is a hard and fast right and wrong answer - it really depends on the patient, policy, and what makes your day just a bit easier to get everything done in.

Hope this helps

Pat

carmen7 · Mar 15, 2009

Thanks for the info. This has helped to clear things up for me :)

Maliffy · Mar 15, 2009

I think it is a matter of hospital policy.

At our hospital if a patient does not have an order for NS we can't hang it, period, end of statement. For us it's a state inspection thing, what happens if inspectors walk into the room while you're running a piggyback into a mainline of NS that is NOWHERE on the MAR. If our patients have saline-loks, they receive their antibiotics through primary IV tubing.

Hope that helps.

Virgo_RN, BSN, RN · Mar 17, 2009

I think it is a matter of hospital policy.
At our hospital if a patient does not have an order for NS we can't hang it, period, end of statement. For us it's a state inspection thing, what happens if inspectors walk into the room while you're running a piggyback into a mainline of NS that is NOWHERE on the MAR. If our patients have saline-loks, they receive their antibiotics through primary IV tubing.
Hope that helps.

Same here. I think it's about the bottom line. Mini bags of NS and tubing are not linked to individual patients in the billing system, however, NS flushes are. It takes more flushes to run intermittent infusions as primaries than it does to piggyback them. At 12 bucks a pop, the hospital makes more money this way. Because seriously, if you set the primary NS infusion at a TKO rate, the patient is not going to get any more fluids than if you flush with 10mL NS before and after the infusion, providing you get in there to stop the NS that's hanging as a primary after the piggyback is done. Only if you leave it running could it be a problem, but really having that extra few minutes to get in and disconnect them is a huge convenience for the nurse and the patient, because you're not going to get the beeping IV pump while you're in the middle of something else in another room. You can just go back in when you have a moment and disconnect them instead of having to drop what you're doing to go in there or hover until it's done, both of which are a pain in the behind when you're busy.

No, it's not about what's best for the patient or convenient for the nurse, it's about money.

[/rant]

Can you tell this is a hot button topic for me?

carolinapooh, BSN, RN · Apr 13, 2009

Same here. I think it's about the bottom line. Mini bags of NS and tubing are not linked to individual patients in the billing system, however, NS flushes are. It takes more flushes to run intermittent infusions as primaries than it does to piggyback them. At 12 bucks a pop, the hospital makes more money this way. Because seriously, if you set the primary NS infusion at a TKO rate, the patient is not going to get any more fluids than if you flush with 10mL NS before and after the infusion, providing you get in there to stop the NS that's hanging as a primary after the piggyback is done. Only if you leave it running could it be a problem, but really having that extra few minutes to get in and disconnect them is a huge convenience for the nurse and the patient, because you're not going to get the beeping IV pump while you're in the middle of something else in another room. You can just go back in when you have a moment and disconnect them instead of having to drop what you're doing to go in there or hover until it's done, both of which are a pain in the behind when you're busy.
No, it's not about what's best for the patient or convenient for the nurse, it's about money.
[/rant]
Can you tell this is a hot button topic for me?

Here the bags of saline are tied to the patient, and the flushes are not. So it would also depend on your hospital.

We don't need an order here for KVO fluids, and the only time we can't hang them is if we're expressly ordered not to (which is rare, because at 10 ml/hr you generally lose more fluids to insensible loss than you're gaining through the IV). Our pts get LOADS of stuff - I had one pt last shift who got vanc, Zosyn, Flagyl, and 20 meq of potassium over the course of twelve hours. If you're not running KVO with him, you'd go nuts. We run KVO at 30 ml/hr with PICCs/Midlines to keep the line open.