IV pump basics

[random666]

Hi, I am new to IV pumps.

My question related to IV Piggy back.

Our pumps have a piggyback setting. We attach the secondary bag, click IVPB and set the IVPB rate and volume and when it finished the primary bag continues to run at it's original rate/remaining volume.

I know that before pumps, the primary bag had to be raised to a higher level than the secondary bag. Whichever bag is highest will run due to (more gravity?).

My question is, do IV pumps control the flow from each bag or is gravity/height still relevant for IV pumps. I have been putting the bag I want to run higher, just in case. but wondering if this is necessary on a pump.

Also at my job most nurses leave the IVPB empty bag/line in place for the day, and when connecting the next IVPB, they replace the bag with a new IVPB bag. So sometime the primary bag flows into and fills up the secondary bag. I've been clamping the secondary empty bags to prevent this backflow. But I suspect the right thing to do it to throw out the bag and line and use a new one for each IVPB med, even if they are back to back.

Any advice on these issues? Im particulary confused on why the primary bag is backflowing into the secondary bag and If I should clamp the IVPB bag when not in use.

Thanks!

[MunoRN, RN]

For a true secondary infusion you do need to hang the secondary bag higher, what you're doing is essentially creating a single fluid column made up of the secondary and primary bags and the tubing. When a fluid column empties, it will empty from the top down if the fluid column is separated in any way, in this case by the tubing set-up.

When you program the pump to run a secondary infusion, all you're really doing is telling it to run at a different rate for a certain amount of time / volume, then once that volume is done it will switch back to the primary rate. This is why you don't necessarily have to program a secondary infusion into the pump to infuse a secondary, if your primary rate is 100ml/hr and the secondary rate is 100ml/hr, then all you need to do is set up the secondary and it will infuse until the level reaches that of the fluid in the primary bag that his hung below it. (although your VTBI will beep early since you've added the volume of the secondary to the infusion without increasing the VTBI by that amount .

There's often debate about this, but arguably the best practice is to leave the secondary attached when it's done, then back-flush it for subsequent secondary infusion, this minimizes unnecessary accesses of the otherwise closed system, which carries the risk of contaminating the system.

[random666]

Much appreciated

[DextersDisciple, BSN, RN]

Much appreciated

You can keep the empty secondary bag and tubing in place and do not need to clamp it as Morte explained. You will need the clamp open to backprime for your next IVPB bag. Dispose of the secondary tubing according to your hospitals policy i.e. every 96 hrs/4days.

[IVRUS, BSN, RN]

Yes, The secondary must hang higher, and remember that a secondary set is for use with a primary that has a pressure sensitive back check valve. Secondary sets don't hang by themselves, and they should remain attached, (as long as compatibility is acceptable) to give it the 96 hr dwell time. As Muno said, backpriming is the best route. If you disconnect the secondary set from the primary, then you should change that tubing q 24.