IV tubing terminology

miss81, BSN, RN · Aug 31, 2009

Primary Sets some times called Adminisration Sets are usually 60 inch or longer in length, can be used with IV pumps or used by themselves for gravity infusions. For example, I'd use this tubing for a plain NS infusion.

Secondary Sets or Piggyback Sets are used in conjuction with Primary Sets ususally connects to a Y-site on the primary line. They measure between 20 and 45 inches in length. I'd use this for say an iv abx piggyback and attach it to the upper port on the primary line.

That's my definition... :nurse: but i'd love to hear what others have to say

P_RN, ADN, RN · Aug 31, 2009

Way, way back when Nurses first started being allowed to hangantibiotics....I'm talking 60's here, there was an IV line with an access port about 20" down the line to which a short "ADD-A-Line" could be used with a NEEDLE into the port and the line to the abx (minibag, piggyback whatever) would be hung higher than the main bag of fluids. There was not an antireflux valve in this port, but when the mini was empty theoretically the main bag would take over.

Unfortunately because some nurses forgot to hang the big bag lower, it would flow into the path of least resistance, and the tiny bag would over fill and sometimes pop. Ahhhh those were the days. No pumps and all sets had a flow rate of 10 gtt/min

Check out the images in this GOOGLE site.

http://books.google.com/books?id=BhYp4gvS76MC&pg=PA39&lpg=PA39&dq=add+a+line+IV+tubing&source=bl&ots=KN-2xoU8Xh&sig=KWaEdMl-J6H8o1a6GQwMWLLQQFM&hl=en&ei=ZhmbSp6bA-qStgfGq4zTBA&sa=X&oi=book_result&ct=result&resnum=1#v=onepage&q=add%20a%20line%20IV%20tubing&f=false

HamsterRN, ADN, RN · Aug 31, 2009

The reason why I ask this is that the Infusion Nursing Society divides tubing into three categories: Primary continuous, secondary continuous, and primary intermittent. The common wisdom seems to be that secondary tubing refers to the shorter length of tubing used connect a bag to the port of a primary line above the pump, for the purpose of running an intermittent infusion. Since all intermittent infusions should use a secondary set-up, why is there no "secondary intermittent" option? Aren't "Primary" and "Continuous" synonymous, as well as "secondary" and "intermittent"? What would be an example of a primary intermittent?

IVRUS, BSN, RN · Aug 31, 2009

The reason why I ask this is that the Infusion Nursing Society divides tubing into three categories: Primary continuous, secondary continuous, and primary intermittent. The common wisdom seems to be that secondary tubing refers to the shorter length of tubing used connect a bag to the port of a primary line above the pump, for the purpose of running an intermittent infusion. Since all intermittent infusions should use a secondary set-up, why is there no "secondary intermittent" option? Aren't "Primary" and "Continuous" synonymous, as well as "secondary" and "intermittent"? What would be an example of a primary intermittent?

An example of a Primary Intermittent Set is one where you have primary tubing attached to an IVAB like Ancef and you are giving that Ancef q 8hrs. Without a mainline (500cc-1000cc) of IVF, all you have is the 50-100cc minibag and the primary tubing. You connect the minbag to the primary set, purge the tubing and hook up to pump, or count the drops after you hook up to the pt's IV line. Once the med infuses over 30 minutes, you dissconnect and place a sterile end cap onto the tubing's end and then that tubing is ready for the next dose 7.5 hours later.

That is a primary intermittent. Because you are connecting/disconnecting throughout the day, and you have the increase in manipulations, you change the tubing daily, or in this case, after each third dose infuses.

So, in essence, if you dose 6a,2p,10p, a new tubing would be hung with the start of each new day for the 0600 dose.

All minbags, like IVAB, do not have to have a primary set with a mainline of saline or D5W unless you work for an institution which requires that it be given in this manner.

Sometimes it will be required because the pump that is being used, requires tubing which contains 25-30 cc of fluid to prime. In this case, I would use a "mainline" in order to use a secondary set to give my IVAB. If it wasn't done in this fashion, 1/2 to 1/3 of a small minibag could be left inside the IV tubing.

Hope this helps.

HamsterRN, ADN, RN · Aug 31, 2009

If that is what a "primary intermittent" is, then it should not exist. Our tubing doesn't require 30ml to prime, but it does leave 15 ml un-infused if hung without a secondary set-up, and with a 50ml antiobiotic that would represent nearly 1/3rd the dose. Regardless of hospital policy, no intermittent infusion should be hung as a primary only, particularly given the small volumes of typical intermittent infusions.

I we can agree that intermittent infusions should be hung as with a secondary set-up, then changing the tubing every 24 hours actually increases the chance of contamination. This is because while changing the tubing gives you a supposedly clean tip that attaches to the patient, it requires that a new secondary is attached to the new primary line, requiring an aligator clip to placed and then the aligator clip to be applied to the mainline, producing two new port manipulations that would not have been needed otherwise. Also, while we can assume the tip of the new primary line is cleaner than the old one, it still doesn't change the port of the IV itself, the far more likely culprit of contamination.

IVRUS, BSN, RN · Sep 1, 2009

But,

What about that pt who is on Fluid Restriction, or that RF pt, who is on strict Intake and output? Sometimes, Antibiotics are hung alone, and though 15 mls may be left in the tubing, How much overfill was in the bag to start with? So, no I don't agree that a minibag should always be hung with a primary. In addition, if you are using a secondary set along with a primary fluid, why are you disconnecting the secondary each time you hang a new bag? Ideally, you should be "back priming" so the increase in manipulation does not exist and the primary will purge any air from the secondary set. In this regard, only the antibiotic bag will need changing out at MD ordered intervals. This then becomes a tubing which can stay for 72 hours, instead of 24. :typing

HamsterRN, ADN, RN · Sep 1, 2009

Regardless of the amount of overfill, any overfill in the bag would still contain an equal amount of antiobiotics, still leaving it un-infused. The extra 10 to 15 ml a renal failure patient would get is worth the fact that they would actually get all of their ordered antibiotic, I doubt 15 ml of fluid will require an additional round of dialysis, but it will help prevent them dying from an infection. As for using the same tubing, that's my point exactly, we shouldn't be manipulating intermittent tubing more than necessary, which I why I disagree with the Infusion Nursing Society that these set-ups should be changed every 24 hours since that only increases the port manipulations. But according the Infusion Nursing Society, even a intermittent set-up with a primary and secondary set-up would still need to be changed q 24 hours.

IVRUS, BSN, RN · Sep 2, 2009

Regardless of the amount of overfill, any overfill in the bag would still contain an equal amount of antiobiotics, still leaving it un-infused. The extra 10 to 15 ml a renal failure patient would get is worth the fact that they would actually get all of their ordered antibiotic, I doubt 15 ml of fluid will require an additional round of dialysis, but it will help prevent them dying from an infection. As for using the same tubing, that's my point exactly, we shouldn't be manipulating intermittent tubing more than necessary, which I why I disagree with the Infusion Nursing Society that these set-ups should be changed every 24 hours since that only increases the port manipulations. But according the Infusion Nursing Society, even a intermittent set-up with a primary and secondary set-up would still need to be changed q 24 hours.

INS standards are to change continuous IV tubing no more than every 72 hours. However, if it is intermittent tubing connected to the primary and you are connecting and disconnecting thru-out the day, or if you do not have a primary fluid, but are hanging antibiotics via a primary set, then all those manipulations require a q 24 change of the IV set. I previously wrote about the back-priming method. If using this method with the IV antibiotic and the primary liter fluid, then both of these tubings become 72 hour changes.

HamsterRN, ADN, RN · Sep 14, 2009

So I've finally figured this out (I think). The INS based their terminology on an (old) textbook in which defines IV set-ups without a pump (the book actaully refers to IV pumps and even plastic IV bags only as a sidenote, as though they are only passing fads). Back in the day when infusions were titrated using the drip chamber, it didn't really matter which port your secondary was plugged into. Today of course, a secondary can only be connected above the pump to work properly. This meant that really any second line was a secondary, but with the use of IV pumps there is an important difference between lines connected above and below the pump.

Not being aware of this difference, the INS thought that the CDC did not address intermittent infusions when the advised that primary and secondary tubing be changed no more often than every 72 hours. Although using modern, pump-based terminology, all secondary infusions are by definition intermittent.

Even so, the logic of the INS falls short. The INS correctly points out that uncapped tubing tips, poorly scrubbed hubs, and potentially non-aseptic manipulation of connections are potential sources of contamination. Because of these three factors, they advise changing intermittent tubing every 24 hours. Changing the tubing does not change the port on the IV and still requires that the connection be manipulated, although it does give you a presumably clean tip. But since an intermittent setup should include a primary flush bag (according to the INS and every hospital policy I can find), then changing the intermittent setup requires that the connection between the secondary line and the aligator clip be manipulated, as well as the connection between the aligator clip and the primary line, resulting in adding two potentially contaminating steps all for the sake of removing only one factor for contamination.

I agree, manipulations of connections are a potential source of contamination, which is exactly why intermittent set-ups should not be changed every 24 hours.