IVPB Question

For school purposes your instructor is correct. And if you cross hairs then yes giving even 1ml of the NS would be without an order, however, how many ml's of the antibiotic would be wasted by priming the tubing to get the air out? I personally, will piggyback the ABX to a bag of NS and set the VTBI for the primary at 1ml as I'd rather my patient get the full amount of ABX as opposed to having to waste 10ml's of the flagyl just to get the tubing primed. Yes, they are getting 1-2ml's of NS but they get that anyway when I have to flush their IV before and after the infusion.

That's just my opinion and how I was taught, we're all taught to do it differently and neither way is poor nursing practice.

The policy at my facility is to hang intermittent infusions as a primary/secondary set-up. This avoids wasting medication, which can be 1/3 or more of the dose depending on the size of the bag. This also allows for additional intermittent infusions to be given with fewer manipulations of connections, which decreases infection risk.

It can be hard to convince Nurses of this, but you don't need an order for the flush bag of NS, just as you don't need an order for NS flushes. A drug is defined as a chemical substance used in the treatment, cure, prevention, or diagnosis of disease or used to otherwise enhance physical or mental well-being. The flush bag of NS, as well as NS flushes, are for device maintenance and do not require an order, although having a policy that addresses this will help prevent any confusion.

I would hang it with a NS as a primary and infuse the Flagyl as a secondary. Just due to the logic of wanting to get all that antibiotic infused to my patient. I am not sure what kind of IV access you had, such as PICC, PIV, central line, etc. Usually there is order to flush the lines, that is why I wouldn't be worried about infusing the NS you could run at it 10ml an hour (think of this as your flush) and shut it off after the Antibiotic is done.

Also if you really want you could call the doctor to get an order for fluids at KVO, but consider the history of your patient too, renal dialysis, CHF, etc

Were they getting other IV meds in addition to the Flagyl? If that was the only med they would get, I'd hang it as a primary and then run a 10 cc syringe of NS as a secondary to flush the the line. Hep lock when done. If they're getting other IVPB, I'd hang a 100 cc bag of NS as a primary and then run all other PB as secondary, with a primary rate of 5 or 10 cc/hr to flush between infusions.

Me personally, I would call the Dr. and get a correct Order. Whatever fluids as your primary and then the Flagyl as your secondary. Never run fluids without a doctors order. AND thats the correct order in Nursing school and in the real world.

Good Luck

We can order a 250 bag of NS "per protocol" for use with intermittent IVPB. Our protocol dictates that we set up the flush bag.

Me personally, I would call the Dr. and get a correct Order. Whatever fluids as your primary and then the Flagyl as your secondary. Never run fluids without a doctors order. AND thats the correct order in Nursing school and in the real world.

Good Luck

What's the difference between running NS as a primary at what is essentially a flush rate, just a little slower, and flushing a heplocked IV before and after pushing a med? Why would we need an order for one and not the other?

For the most part we always run our IV meds as IVPB and use primary as NS (or whatever other fluid is compatible with the med). We program that IVPB to infuse (as piggyback), then set our primary line to run at the same rate as our med was for 20 mL since this is about how much med remains in the primary tubing. The pt barely receives any of the primary fluid since it is essentially just flushing the remainder of the med from the tubing to the patient. :)

By ordering the med as an IVPB, isn't the MD essentially ordering NS as a primary? I would set it on a pump, and set the main line of NS to a very small amount, like only 10-20cc's. That much NS never killed anyone... I guess it would also depend on the size of the bag of the med. 500mg of Flagyl is usually in 100cc's so if the tubing is approx 10cc's then you are wasting 1/10th of the med which is pretty significant.

Bring this to the attention of the MD and get an order for NS.

Im a student as well and my CI informs me to run NS as the primary line when running IVPB. This actually just happened last week. There was no order for the primary line, just the order for the piggy back. So I was told to run some NS with it (by my clinical instructor).