IVPB question

[PreemieNurse]

Hi everyone, I have a question for you all. I teach in an ADN program in the skills lab. We teach IVPB via the flush bag and the backpriming into the old bag thing...if pt has a hepwell...

We just heard that an area hospital is not permitting the use of flush bags when giving PBs through a well... just manual flush before and after... but hanging the PB with a primary line and connecting to pt. So, my question is..does anyone else have this practice at your facility? Is this a safe practice? We are amazed because we have never seen this before. Are there studies that back this practice up? A primary line holds 20mls..so there is old med in that line... you can't backprime to get the old med out of the line.. so the patient gets the old med too?

Can someone explain this to me?

Thanks!

[UM Review RN, ASN, RN]

It's almost harder to write it all down than it is to do it, but I'll try:

We get the IVPB, spike it to a primary line, flush the reseal, prime the line, hang the med, and let it run. When it finishes, we then take the line off the reseal, cap the line, and flush the reseal.

So you wind up with an empty bag of medication that is hanging on a capped, already-primed line. My hospital protocol says we can use that same line for three days, but since we're using the same exact med each time, it's a good thing that the line is primed with med and ready to go.

The next time you hang the med, you just spike the bag, flush the reseal, and hang it. No priming or backpriming is necessary. I've come to appreciate this technique because it keeps our volume-sensitive patients safer, and the reseals tend to hold up just as well either way, so there's really no justification for running a flush bag.

Hopefully that makes sense. Hopefully I'm reading the question right.

[PreemieNurse]

Thank you. This is what I am trying to understand...but excuse my ignorance and tell me what a reseal is... so you are saying the old med remains in the line and is used when the new bag is spiked? Even though it may be an every 8 or 12 hour med...it's ok in the tubing.

What was the thought behind this practice? To decrease the amount of fluid given?..because we're only talking about 30 mls or so of the flush...I can understand your fluid sensitive example but on the general med-surg floors you don't find this so much...

thanks for your help!

[Texas Tornado]

We hang separate tubing for each piggyback. The med stays into the tubing until the next dose.

What is a reseal?

[UM Review RN, ASN, RN]

Reseal = heplock

[mamato3]

Ok what if they have a fluid, let's say NSS at 125. And you have to run levaquin as an IVPB. I spike the antibiotic the first time and prime the line. When I give another dose do I have to let what is in the line run out or can I simply start the antibiotic? I heard that what is in the tubing is comtamiated (sp?). Thanks Shannon

[PreemieNurse]

Not contaminated, but old. Why are we teaching backpriming to our students when it doesn't seem all that important if we're not doing it when hanging PB on a primary line. This just goes against my beliefs (it takes 20 ml to flush a primary line and if the patient never gets this, he is missing his entire dose. I am hearing that even though the hospital is having this as policy, a lot of nurses are not following it. I say you have to go with what you know as best practice.