Published Feb 4, 2017
New nurse. I am on a renal unit.
I was in an isolation room. Patient was not on a drip, just needed ATB. My nurse for orientation... leaves a lot to be desired. My first job as an RN and, after the second day she basically leaves me alone. When I ask questions she basically dismisses them, or gives answers that are not clear. I do know there have been a few times when she simply does not know the answer, e.g., Lasix a K-wasting diuretic, but... I digress.
I was in a contact isolation room, spiked the ATB with primary tubing. I realized what I did after I had line primed, but I figured, "he's only getting this ATB, so I can use this tubing. I can flush the rest through to ensure he gets the full dose, discard tubing to ensure sterility."
I checked with my trainer and she said "no, can't be done like that." I said I don't understand why not, she looked at me like I am a moron and said "that's the point of IVPB; the ED can infuse ATB like that, but not us."
I had some lag time before I could take my NCLEX, i.e., it's been a while since I graduated (May) took my NCLEX (October), and started work (January). My understanding is that IVPB is used when infusions are already under way. The secondary bag is hung, primary dropped. So I still don't understand why I could not have done that. I used guardrails on the pump.
Could anyone educate, please and thanks. I'll review IVs when I have time (SO much to review), but would appreciate extra input and different explanations.
There is absolutely NO reason why you couldn't have run it as you spiked it. We do it that way all the time on my unit. You say there wasn't an infusion already running, so in order to run your ATB as a piggy-back you would have had to spike a bag of saline or dextrose to Y-connect to which makes no sense to me at all. I would have done as you did, using guardrails and set the infusion volume for slightly less than the stated volume on the bag (accounting for the dead space in the tubing) so it didn't go dry. When the pump indicated that volume had gone in, I would then have checked to see what was still left in the bag, which would be a minimal amount, reset the pump for that last little bit while I got my flush ready then spiked a mini-bag of saline or dextrose as a flush. No harm, no foul.
RNrhythm, BSN, RN
We do that all the time on my unit.
HouTx, BSN, MSN, EdD
Check your employer's policy & procedures for the right answer. Just like on NCLEX, you're always going to encounter situations where there is not just ONE RIGHT ANSWER. When this happens, your first step is your P&P manual. Remember, if you violate the P&P, you'll most likely face disciplinary action - and ignorance is no excuse because "look it up" is so basic.
If there's no nursing policy, check with the pharmacy to see if they have one, because in many organizations, they have authority over all med admin processes. If there's no policy, you can proceed into critical thinking mode - and suggest to your boss that there should be a policy to eliminate the guesswork.
Been an RN for 25 yrs. You did nothing wrong. I'm sure nurses discretion. I've known many nurses, myself included, that would even hang mini bag of saline at TKO, even 10ml/hr just to piggyback antibiotics, more convenient than actually a flush before and after, that way the pump does all the work, especially if the pt has multiple IV meds. That's also easier on the patient like at night so you don't have to wake them every 20-30 min. As long as you're not overloading the fluid.
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