IV Piggyback: Benefits of Its Administration

**Kellie Norris**, MSN, RN

The intravenous piggyback (IVPB) infusion is a method of giving intravenous (IV) solutions to patients. IVPBs are smaller doses of medication that "piggyback" off the central IV line.

Table of Contents

IV Piggyback (IVPB) Overview
When to Use
IVPB System Equipment
Step-by-Step Process

What Is an IV Piggyback (IVPB)?

Nurses have used IV piggybacks since the 1970s as the standard medication administration method of antibiotics. An IVPB is usually a smaller volume of fluids than the primary IV fluid infusion. The IVPB is set up and administered by a trained nurse. IVPBs are given intermittently over minutes or hours, once or multiple times daily. Using an IVPB, the nurse can infuse multiple medications and IV fluids into a patient, and it does not require multiple IVs, which is safer and more comfortable for the patient.

When to Use an IV Piggyback?

IVPBs administer smaller doses of medication, including antibiotics, electrolytes, and other medications that require multiple doses through IV lines to the patient. The IVPB method of administration allows the nurse to flush the IV tubing to ensure that the patient receives all of the medication and that none is left in the IV line.

Differences Between IV, IV Push, and IVPB

There are different methods of giving IV medications. Each form of administration is essential for the nurse to know.

Nurses infuse large volumes of fluids such as Normal Saline, Lactated Ringers, and Dextrose 5% in water through IV tubing via a catheter placed inside a vein. This method allows for volume replacement when patients are sick or have decreased blood volume.
The IV push method is similar to IVPB. It is a way to give medications in smaller doses and allow less fluid use if the patient is fluid overloaded. In addition, using the IV push method enables you to provide medicines over a shorter time.
Another way to infuse smaller amounts of fluid is to use the IVPB method. This method ensures the primary fluid restarts after the IVPB completes the infusion.

IV medication instructions direct nurses to infuse the medication over a specific time. The decision of which method to use depends on the IV solutions and the dose and volume the nurse will infuse. Infusion pumps allow the nurse to time the IVPB infusion. Pumps also enable the fluid to switch back to the primary fluid without the nurse having to change the tubing physically.

IVPB System Equipment and Overview

IV medication administration is one of the main tasks for nurses. The nurse should know how to set up the IV lines for primary and secondary infusions. IV line setup is taught in nursing school and during orientation to the unit. The nurse should not be afraid to ask for help to set up infusions properly.

The equipment needed for setting up an IVPB infusion includes the following:

Clean Gloves

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Alcohol Pads

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Flush Syringe

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Primary Tubing

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Primary Fluids or Flush Bag

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Secondary Tubing

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IV Pole with Infusion Pump

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While collecting equipment and medications, nurses should also check the IV line compatibility of the IV solutions they will administer to the patient. Medication compatibility is also important. IV medications and fluids must be compatible when hung to avoid complications. Hospital systems commonly use Lexicomp to check IV medication and fluid compatibility. The pharmacy is also a great resource for checking compatibility.

IVPB Labeling

Labeling medication bags, flush bags, primary tubing, and secondary tubing is essential. Protocols are in place in hospitals instructing how long IV tubing can hang and how to change it out. Most hospitals have medication and tubing stickers for labeling, and nurses should follow their hospitals' protocols. The nurse should write the date and time they hung the tubing and medication on the label and when to change it. Some hospitals have color-coded tags for different days of the week.

Step-by-Step Process

The nurse should explain the IVPB procedure and obtain consent from the patient before hanging the IVPB medication. In addition, before administering the medication, the nurse should check the "Five Rights of Medication Administration":

Right Patient
Right Medication
Right Dose
Right Route
Right Time

The nurse should also inspect the IVPB solutions' color, clarity, turbidity, and if there are any particulates. After these steps, the nurse should wash their hands and don clean gloves.

Hanging and Connecting the IVPB

Assess the patient's IV site or central venous catheter for patency using a flush syringe to aspirate blood and flush the line.
Be sure to close the roller clamp on the IV tubing.
Spike the IVPB solution with the secondary tubing using an aseptic technique. Squeeze the tubing chamber to release the solution.
Scrub the Hub of the primary tubing port directly above the infusion pump with an alcohol pad for at least 15 seconds and connect the secondary tubing.

Back Flushing the IVPB

Secondary or IVPB should hang above the primary fluids to allow gravity to help infuse the medications. Backflushing the tubing prevents complications caused by air left inside the tubing and clears the medication from the tubing between doses.

To backflush the IVPB, lower the IVPB below the primary fluids and allow the primary fluid to fill the secondary tubing up to the secondary tubing chamber.

After adequately checking the medication and patient and setting up the infusion set, the nurse programs the infusion pump to deliver the IVPB as directed and to switch to the primary fluid after completing the IVPB.

Occasionally IVPBs are not run with a flush and can be set up like a primary infusion.

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After the IVPB

After infusing the IVPB, the nurse allows the line to flush additional fluids into the patient to ensure the line is clear and the patient has received the full dose of medication. The nurse then disconnects the tubing from the patient's IV catheter and applies sterile caps to the IV tubing and the patient's IV catheter.

Original Allnurses Post

Quote

Question:

I am a new grad trying to survive every week. I know it may sound dumb but need clarification on IVPB and primary infusion.

Answer:

The IVPB is a smaller dose of medication, usually antibiotics, that you administer with the primary fluids. Primary fluids are usually large doses, 500mL or more, of Normal Saline, Dextrose 5 or 10% in water, or Lactated Ringers. When programmed into the infusion pump, the primary fluids will stop while the IVPB runs and restart when the IVPB bag is empty.

Question:

so let's say if a pt does not have any continuous fluid order and has a new ivpb order of 25 ml/hr. With 250 or 500ml of NS as primary, what should I put for rate and vtbi? Does it have to be 25 ml/hr for rate so the ns can be infused at the same rate for the rest of abx in the tubing and how much for vtbi..? I have seen nurses just putting random 10-35 vtbi and it just really confuses me every time.. please correct me if I am wrong and how much do you guys usually put for vtbi and running rate for primary infusion?
thank you

Answer:

The reason for the 250 or 500mL of NS as a primary is to flush the line after the IVPB to ensure that the patient receives all of the medication and to clear the line if you can use the secondary tubing setup for multiple doses. Primary IV tubing holds approximately 25mL of fluid. If this tubing is not flushed, the patient does not receive around 25mL of the medication, which can be an entire dose, depending on the medication. A good rule of thumb is setting the pump for 50mL at 100mL per hour, a standard IV rate that will clear the line in 30 minutes.

References

Lee, R., Tran, T., Tan, S., & Chun, P. (2021). 602. Intravenous push versus intravenous piggyback administration of cephalosporin antibiotics: Impact on safety, workflow, and cost. Open Forum Infectious Diseases, 8(1), S403–S404. doi: 10.1093/ofid/ofab466.800
Rahbar, A., David, J., Promlap, J., Hara, J., Zitek, T., & Lee, P. (2021). 178 Safety comparison of antibiotics administered via intravenous push versus intravenous piggyback to adult patients in the emergency department. Annals of Emergency Medicine, 78(4), S71. https://www.annemergmed.com/article/S0196-0644(21)01030-1/fulltext
Wolters Kluwer. (n.d.). Lexicomp trissels IV compatibility databases. https://www.wolterskluwer.com/en/solutions/lexicomp/resources/lexicomp-user-academy/trissels-IV-compatibility-databases
Gorski, L. A., Hadaway, L., Hagle, M. E., Broadhurst, D., Clare, S., Kleidon, T., Meyer, B. M., Nickel, B., Rowley, S., Sharpe, E., & Alexander, M. (2021). Infusion therapy standards of practice, 8th edition. Journal of Infusion Nursing,44(1S Suppl 1), S1–S224. https://doi.org/10.1097/NAN.0000000000000396
Martyn, J. A., Paliadelis, P., & Perry, C. (2019). The safe administration of medication: Nursing behaviours beyond the five-rights. Nurse Education in Practice, 37, 109–114. https://pubmed.ncbi.nlm.nih.gov/31132586/
Institute for Safe Medication Practices. (2020, December 3). Hidden Medication Loss When Using a Primary Administration Set for Small-Volume Intermittent Infusions. https://www.ismp.org/resources/hidden-medication-loss-when-using-primary-administration-set-small-volume-intermittent