IVPB Disaster

[greatgoku81]

I need help please.

I was supposed to hang an IVPB med. Well the IV med from earlier was gone but the squeeze chamber was all the way full. Ive never seen that before because normally the chamber is only half full or something. Well I pulled the spike out of the empty old IVPB med and the spike starting spurting fluid out of it. I quickly got open the new drug and spiked it on the new bag. My scrubs got wet and I know I messed up big time. She said I am supposed to remember to close the clamp. I guess I didnt do that. What im wondering is what should I have done to do that correctly. Should I have closed the clamp, flip the old bag over and squeeze the extra fluid in the chamber until its empty and then spike the new bag? I am also confused on priming the tubing part. Should I have dropped the piggy back line below the primary line and then open the clamp? my instructor was saying something about lowering the secondary bag below the primary and then flipping it over and squeezing. I just feel like I have no clue what Im doing. I get the new tubing spiking a new bag but the respiking a new med with tubing all hooked up confuses me. Please help:(

[Sterren, BSN, RN]

In the future I would close the clamp on the piggyback tubing before taking off the old bag and hanging the new bag if you have a full drip chamber like that. To have it squirt out on you seems unusual to me and my 4 1/2 months of experience - but clamping the piggyback tubing would prevent that from happening and I don't think it's anything you did wrong (maybe a more experienced nurse can offer insight).

If you have no fluid in the drip chamber and there is air partway down the piggyback tubing, you can lower the piggyback bag and tubing - with the clamp open - below the level of the pump and it will fill the tubing and drip chamber back up. Don't fill it all the way, of course, but this can help save on changing out tubing that is perfectly good otherwise.

And please don't beat yourself up. You got the piggyback hung, the patient got their meds on time, and they got a full dose. Your scrubs will dry. It's okay and really not a big deal.

[Daytonite, BSN, RN]

Actually everything you posted was correct. IVs work by principles of physics. They are a closed system. When the roller clamps are open, even a little bit, any pressure in the line will push fluid downward. When you pulled the spike out of the old IVPB bag two things were happening: (1) the roller clamp on the IVPB line was open and (2) the main IV bag was higher creating more pressure in the system and pushing fluid downward by gravity. The consequence was that when you pulled the spike, you created an opening to the atmosphere that opened the flood gates, so to speak. The way to stop the flood immediately is to simply pinch off the IVPB tubing with your fingers or you could have raised the tubing higher than the main IV bag to equalize the pressure so the fluid would have stopped spurting.

Many times when changing IVPB bags when I was too lazy to mess with the roller clamps, I simply folded the tubing in half so it was pinched off and I squirted any excess fluid in the drip chamber back into the old IVPB bag before pulling the spike out of the old bag and spiking the new IVPB bag.

Don't beat yourself up over this. After you do this a couple of times you will get the hang of it.

[greatgoku81]

Thanks so much for the replies all! Ever since that day and reading up all the relies and info I feel more confident. Before I do anything with a new bag I just close off all the tubing before I do anything. I also try to make sure my drip chamber is only half full by squeezing fluid out of the drip chamber into the old bag first. Also if there is not enough fluid in the chamber just lower the bag and tip it a bit to allow some to fill it back up. Ive done a few bags since then and they went much smoother. I think that by each bag im getting more confident. thanks again all.

[corgimomRN2b]

As I am in the evening/weekend ADN program the chances that I get to hang IVPB can be far and few depending on my patient. I always have to review w/ the instructor/classmates and seem to fumble through. My mom (retired CCU RN of over 40 years) told me not to beat myself up about it. If I was doing it everyday it would go like clock-work. I think as one of the other folks replied that the more you do it the easier it gets! Just hang in there...