IV Piggyback

[busybee88]

Today was my first day at clinical for the semester. My pt was on D5/0.45NS at a rate of 125cc/hr (1 L over 8 hours) q8h. Also, I noticed on the medication list that there are two PRN meds that are piggyback. On the med worklist, it says exactly this:

Dilaudid 1 mg= 0.5ml IV q4h PRN

Zofran 4mg=2ml IV q4h PRN

I don't understand how you would piggyback these with the only the .5 ml for dilaudid and 2ml for zofran. I thought you needed a larger fluid voulme to piggyback...at least 50 cc? If someone could please help me and let me know if there is something I may be missing...that'd be great! THANKS

[kgh31386, BSN, MSN, RN]

are you sure it's a piggyback and not an IV push? i agree, i thought you'd need a lot more solution to have a piggyback. but you can do an IV push with something that small.

[Kymmi]

Dilaudid is for pain and Zofran is for nausea....both drugs are given IV push therefore they are not piggybacked into the main IV but they are pushed IV which can either be done thru the current IV that is running by finding the hub in the IV tubing that the IV fluids are running in and pushing it thru there or you can give it IV push thru another IV site if you have one and then follow it with a saline flush.

[kgh31386, BSN, MSN, RN]

remember to flush before hand too. AND, flush after at the same rate you pushed the medication. small things like that, instructors watch. also wipe the hub with alcohol too. and yea you wouldn't give that much dilaudid.

[busybee88]

Thank you both so much, kgh31386 & Kymmi

I thought I had been losing my mind b/c on the Kardex is said IVPB. I'm going to bring that up tomorrow!

I knew a PUSH made alot more sense.

[Daytonite, BSN, RN]

be aware that in some facilities there may be a written policy that does not allow the nurses on medical units to push iv meds directly into patient's veins. any medication can be mixed in an iv piggyback bag and dripped or given through mini-infuser.

[chevyv, BSN, RN]

Also, remember if its push, you may need to give it over a certain amount of time. Be sure to look it up. Remember SASH Saline-Antibiotic (or med)- Saline- Heparin (if protocol- not for a continuous iv)

[kgh31386, BSN, MSN, RN]

yea the infusion rate will always be in the drug book.

[kgh31386, BSN, MSN, RN]

I've seen recently some piggybacks that are actually a syringe. Kind of weird looking, but you hang the syringe just like a piggyback. Even though it's only a few cc's. They come with instructions, which is convenient.

[Daytonite, BSN, RN]

I've seen recently some piggybacks that are actually a syringe. Kind of weird looking, but you hang the syringe just like a piggyback. Even though it's only a few cc's. They come with instructions, which is convenient.

Those are called mini-infusers.

[fabiusgile]

remember to flush before hand too. AND, flush after at the same rate you pushed the medication. small things like that, instructors watch. also wipe the hub with alcohol too. and yea you wouldn't give that much dilaudid.

Interesting thing my instructor taught us was if it was less than 2ml... I think... it doesn't even reach the pt because of the catheter length... so when your flushing thats when you should be counting the time u put the med in.... Alot of nurses I saw on the floor would count putting it in the catheter then flush w/ NS quickly

[chevyv, BSN, RN]

You should be pushing ns for the same amount of time that you pushed the med. Now, if they have an iv running, thats different. It took me some time to realize this. Even had more than one discussion with my ci because it was something we never even discussed during skills. If you've ever had the experience of not getting a common sense thing and then getting it and thinking duh, that was me for two days of clinical.

Didn't even try to hide my lack of understanding, I figure now is the time to look stupid and gain some understanding.