IVPB simultaneous or not?

Updated | Posted

Specializes in ICU Hopeful.

So I took a math exam yesterday and I'm confused on the result. 

32 yo male admitted for leg wound that cultured +MRSA

Provider orders: Vancomycin 1g/250mL over 2 hr IVPB q12hr

1 Liter Normal Saline over 8 hr IV x 3

What is the total volume infused in 4 1/2 hours? 

As we're talking about an IVPB, I set up my problem with the Vanco IVPB infusing first on the secondary line, and then when it finishes, the normal saline starts infusing.  

This gives me 250ml in the first 2 hours (of Vanco) + 312.5 Normal Saline in the subsequent 2.5 hours for a total of 562.5mL

I was told this was wrong because they would infuse simultaneously. I made the case that normally IVPB infuse separately but I conceded it is possible to infuse simultaneously; however, nothing in this problems defines that so it's "more correct" to assume they are infusing separately. 

No dice. Still wrong. 

Am I incorrect in my logic/knowledge of IVPB infusions or are there really two possible ways to set up this problem given the information provided? Thanks.

amgRN, ASN, BSN, RN

Specializes in pediatrics, ER, education. Has 24 years experience.

IVPBs and primary fluids do not infuse at the same time, which is why you can run them on one channel of an IV pump.  The piggyback runs then it kicks over to the primary. 

You can run a secondary line that connects in below a pump, but that would not be a piggyback.  You may want to take another look at the wording and see if this was a secondary line or a IVPB.  

Lvl4andcounting

Specializes in ICU Hopeful.

8 hours ago, amgRN said:

IVPBs and primary fluids do not infuse at the same time, which is why you can run them on one channel of an IV pump.  The piggyback runs then it kicks over to the primary. 

You can run a secondary line that connects in below a pump, but that would not be a piggyback.  You may want to take another look at the wording and see if this was a secondary line or a IVPB.  

The wording above is the exact and complete wording. It specifically says IVPB... which is why I am so confused that I was told the problem was wrong. Trying to sort out how I may have misread the question as my professor claims. I certainly couldn't claim to know everything about IVs, but I was pretty certain I understood this fundamental concept, and I don't know how other schools work, but we are REQUIRED to get 100% on our math exams, so this is kind of a big deal and the first I've not passed.

The explanation I was given of how an IVPB can run simultaneously was to consider what I am currently seeing in the ICU clinicals where Versed, Fentanyl, and Levaphed are being run on separate lines through separate pumps that all eventually converge via stopcocks to a central line. Am I just confused about the definition of an IVPB? Did I do something else wrong with the math that I'm just not seeing? Thanks for your help!

41 minutes ago, Lvl4andcounting said:

[...]

The explanation I was given of how an IVPB can run simultaneously was to consider what I am currently seeing in the ICU clinicals where Versed, Fentanyl, and Levaphed are being run on separate lines through separate pumps that all eventually converge via stopcocks to a central line. ...

If your instructor used this as an example of an IVPB running concurrently with the primary IV line, he or she is mistaken as these are primary infusions y-sited into the primary IV line.   

41 minutes ago, Lvl4andcounting said:

[...]

... Am I just confused about the definition of an IVPB? ...

No, based upon your comments in the original post, you seem to understand.

1 hour ago, Lvl4andcounting said:

[...]

... Did I do something else wrong with the math that I'm just not seeing? Thanks for your help!

No, based on the information provided, your math is correct.  There is at least one IV pump that will allow you to run both the primary and secondary infusions concurrently.  

Best wishes.

Lvl4andcounting

Specializes in ICU Hopeful.

Thank you so much for taking the time to respond. I’m not going to get credit for this problem - I could probably fight it but I don’t think it’s worth it in the long run… I’ll just have to take another math exam. But it was driving me crazy that I may have misunderstood the difference between IVPB and y-sites.

The professor is always right even when they are wrong. Ha ha 

Edited by Lvl4andcounting

amgRN, ASN, BSN, RN

Specializes in pediatrics, ER, education. Has 24 years experience.

You are correct.  About the problem and about your professors.  Sorry they did not acknowledge the mistake, but at least feel confident that you have a good understanding of the different IV line types.  🙂

Honyebee, CNA

Specializes in Customer service.

On 9/24/2021 at 1:43 PM, Lvl4andcounting said:

So I took a math exam yesterday and I'm confused on the result. 

32 yo male admitted for leg wound that cultured +MRSA

Provider orders: Vancomycin 1g/250mL over 2 hr IVPB q12hr

1 Liter Normal Saline over 8 hr IV x 3

What is the total volume infused in 4 1/2 hours? 

 

As we're talking about an IVPB, I set up my problem with the Vanco IVPB infusing first on the secondary line, and then when it finishes, the normal saline starts infusing.  

This gives me 250ml in the first 2 hours (of Vanco) + 312.5 Normal Saline in the subsequent 2.5 hours for a total of 562.5mL

I was told this was wrong because they would infuse simultaneously. I made the case that normally IVPB infuse separately but I conceded it is possible to infuse simultaneously; however, nothing in this problems defines that so it's "more correct" to assume they are infusing separately. 

No dice. Still wrong. 

Am I incorrect in my logic/knowledge of IVPB infusions or are there really two possible ways to set up this problem given the information provided? Thanks.

Did your teacher specified it in the test that it was infuse at the same time?

Read this https://allnurses.com/running-maintenance-ivpb-simultaneously-t559659/

amgRN, ASN, BSN, RN

Specializes in pediatrics, ER, education. Has 24 years experience.

2 minutes ago, Honyebee said:

Did your teacher specified it in the test that it was infuse at the same time?

Read this https://allnurses.com/running-maintenance-ivpb-simultaneously-t559659/

The pumps don't work like that if you are using one channel and I believe connecting above a channel with a second pump would just cause pump errors.  There was just a mistake.  Professors make mistakes too.  🙂 

Honyebee, CNA

Specializes in Customer service.

Just now, amgRN said:

The pumps don't work like that if you are using one channel and I believe connecting above a channel with a second pump would just cause pump errors.  There was just a mistake.  Professors make mistakes too.  🙂 

Understandable. Hopefully another teachers will look at it.

Lvl4andcounting

Specializes in ICU Hopeful.

8 hours ago, Honyebee said:

Understandable. Hopefully another teachers will look at it.

I could push the envelope on this, but the politics at this small school are pretty remarkable. I’m an older student changing from a 25 year career with enough of years of experience to know better than to fight those politics. Not worth filing a grievance to achieve that. And besides, I spoke with another professor who explained to me that Vanco would have to be on a separate pump to be sure it infused at the correct rate, that you would never use gravity for this drug …. And told me I was wrong because two primary lines y-sited are still considered IVPB. I was also told I’m thinking about this concept “too black and white.” Which I suppose would be helpful criticism if it were true, but since you’re all telling me this is incorrect, I’m not oblivious to what appears to be shutting me down. I’m guessing if I pushed it, I wouldn’t win the battle anyway. Better to just know what I need to know to be a nurse and get through nursing school in one piece. 

It is however ironic and unfortunate one of the most important qualities that will make us good nurses is to remain teachable, admitting error when it occurs, but it’s often not demonstrated by those teaching us. Ah, life. LOL

I do appreciate the clarity offered here so I have a good understanding of these concepts, which is the most important point for me. 

Honyebee, CNA

Specializes in Customer service.

10 hours ago, Lvl4andcounting said:

I could push the envelope on this, but the politics at this small school are pretty remarkable. I’m an older student changing from a 25 year career with enough of years of experience to know better than to fight those politics. Not worth filing a grievance to achieve that. And besides, I spoke with another professor who explained to me that Vanco would have to be on a separate pump to be sure it infused at the correct rate, that you would never use gravity for this drug …. And told me I was wrong because two primary lines y-sited are still considered IVPB. I was also told I’m thinking about this concept “too black and white.” Which I suppose would be helpful criticism if it were true, but since you’re all telling me this is incorrect, I’m not oblivious to what appears to be shutting me down. I’m guessing if I pushed it, I wouldn’t win the battle anyway. Better to just know what I need to know to be a nurse and get through nursing school in one piece. 

It is however ironic and unfortunate one of the most important qualities that will make us good nurses is to remain teachable, admitting error when it occurs, but it’s often not demonstrated by those teaching us. Ah, life. LOL

I do appreciate the clarity offered here so I have a good understanding of these concepts, which is the most important point for me. 

 

10 hours ago, Lvl4andcounting said:

I was also told I’m thinking about this concept “too black and white.

 

I don't know what it means about IVPB at your school. I'd like to watch the NS0.9% and vanco infusing at the same rate 125mL/hr.  However, yes, there are medications can't be infused with gravity, must be with a separate line, and pump device. I'll check my IVPB, secondary lines, medications that are must not share with IV lines,...etc. 

Thank you for sharing.

Edited by Honyebee

30 minutes ago, Honyebee said:

I don't know what it means about IVPB at your school. I'd like to watch the NS0.9% and vanco infusing at the same rate 125mL/hr. ...

To clarify, there is at least one IV pump, the Plum 360, that would allow you to run the  maintenance IV fluid and the vancomycin concurrently, at separate infusion rates.

33 minutes ago, Honyebee said:

... However, yes, there are medications can't be infused with gravity, must be with a . ...

What exactly are you trying to say here?  If you have an IV solution infusing via an IV pump and infuse a medication using a secondary infusion set, with the appropriate settings on the IV pump and the you are not infusing "with gravity" and you do not require a "separate line, and pump device."  You do need to ensure that the primary bag is hanging lower than the secondary bag, and drols are falling in the secondary bag.

41 minutes ago, Honyebee said:

I'll check my IVPB, secondary lines, medications that are must not share with IV lines,...etc. 

Again, what are you trying to say here?