IV piggyback

[buttons4]

If a patient has an order for an IV piggyback, but there is no current primary or order for one, is it okay to hang the piggyback solo (as a primary line)? As long as you disconnect the piggyback as soon as it is done infusing (not leaving the empty bag attached to the patient for an hour)? Is this considered poor practice?

[buttons4]

Thank you for your feedback, I greatly appreciate it!

[blondy2061h, MSN, RN]

We occasionally run drugs primary, but always run a flush of whatever fluid it's in behind it. I think something like 15ml's is in the tubing, which could be half the drug for some meds. I know I've seen other posters in the past say that running a flush behind it is silly, or requires an order, but I can't imagine letting all that drug sit in the tubing.

[ChristineN, BSN, RN]

We occasionally run drugs primary, but always run a flush of whatever fluid it's in behind it. I think something like 15ml's is in the tubing, which could be half the drug for some meds. I know I've seen other posters in the past say that running a flush behind it is silly, or requires an order, but I can't imagine letting all that drug sit in the tubing.

Blondy, I think flushing all that drug out of the tubing is something too I see peds nurses more concerned with since the doeses they are giving are so small. If I'm giving an adult sized pt 1 gm of Vanco (150 ml), I'm not too worried about a few ml in the tubing. For a child I would absolutely flush, though.

[blondy2061h, MSN, RN]

Blondy, I think flushing all that drug out of the tubing is something too I see peds nurses more concerned with since the doeses they are giving are so small. If I'm giving an adult sized pt 1 gm of Vanco (150 ml), I'm not too worried about a few ml in the tubing. For a child I would absolutely flush, though.

A lot of our drugs tend to be more concentrated since so many of our patients are getting things like TPN that are volume heavy and may have kidney and heart problems from all of the chemo that can lead to volume overload. I know many drugs, such as Vanco, can be given more concentrated when using a central line.

[Piki]

Protocol at our hospital is that larger bags of IV antibiotics (say 250 cc or higher) can be run as primaries as long as you flush before and after with saline. Smaller bags we will run with a small bag of saline as a flush. Since our floor is post-surgical, we get many patients that get multiple antibiotics or IV protonix daily ... most will still have primary fluids running, but some will not after a day or two. I cannot imagine running each separate antibiotic bag through primary tubing and changing that out each time out of the pump (besides the cost of primary tubing vs the secondary tubing). Protocol has that we change out a NS flush bag q 24 hours, and all tubing q 72 hours.