IV piggyback question

[dorkomatic]

Say you have a patient with continuous normal saline and you need to piggy back a med, but after that med has finished infusing you need to administer another med by piggyback that is incompatible with the first med. Both meds are compatible with the primary fluids. Do you need ALL new tubing or just new piggyback tubing?

[generalRN2008]

Just new piggy back tube but check your facility policy

[Here.I.Stand, BSN, RN]

New secondary tubing, and make sure some of the NS has had time to flush through the primary line so that the two piggybacks aren't mixing. If the two meds are back to back and I'm not able to wait half an hour or so in between, what I'll do is program a flush into the pump--set the primary rate to several hundred ml/hr (depending on what kind of access the pt has) and the VTBI for 20 ml. Wait there, and when the pump alarms that the infusion is finished, set the primary back to the prescribed rate, and hang the 2nd piggyback.

[TU RN, DNP, CRNA]

Neither. Depending on where you work and how your facility stands on back-priming secondary tubing, you can use the same secondary tubing for two separate incompatible medications as long as your primary IV fluid is compatible with either secondary medication (which is your situation). Let me repeat: in some institutions it is acceptable, per the policy, to use the exact same secondary tubing even if the secondary medications are incompatible with each other as long as you're:

1. lowering the secondary container below the level of the primary,

2. completely back-priming the primary solution into the completed secondary medication's container,

3. clamping the secondary container off so that no residual from that container re-enters the tubing,

4. un-spiking the old and re-spiking the new medication.

In my hospital there has recently been an initiative to reduce CLABSIs (Central Line Associated Blood Stream Infections), and one of the main interventions is to prevent unnecessary breaks in the IV tubing system with excessive new tubing changes. As long as the tubing itself hasn't expired you should be good. By this I mean some hospitals have preset expiration dates for tubing in use to be disposed of (ie, tubing for continuous infusion is good for 96 hours, tubing for intermittent infusion is good for 24 hours).

[Do-over, ASN, RN]

Back flush.

[MunoRN, RN]

We backflush the secondary and don't change either tubing. I'm not sure why it's felt that primary tubing and the IV itself can be used for incompatible medications so long as it is flushed in between, but for some reason that doesn't seem to apply to the secondary tubing. Flushing is flushing.

[Sun0408, ASN, RN]

Back flush as previous poster stated. Less breaks in the system, fewer chances of infection plus this helps keep costs down with less room for error with 5 or so secondary sets hanging.

[Asystole RN]

The need to change tubing HIGHLY depends upon what the medications are and what kind of incompatibility there is.

Some medications are VERY sensitive to other medications. You really need to look it up and check with your pharmacy. Even though you think the medication from the first secondary has flushed through you really do not know. Anyone who has continued hydration through blood tubing or run something not clear like Venofer can attest that the lines never seem to flush 100%.