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.
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.
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.
Again, what are you trying to say here?
I have seen patients with more than one IV lines. Tell me if I'm imagining things. ?
Read the original post. It's about IVPB. However, this is a specific answer to her question, NOT all IVBP and infusions. Do I have to reiterate everything here?
I haveseen patients with more than one IV lines. Tell me if I'm imagining things. ?
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No, you aren't. Patients frequently have multiple IV lines. In my experience, this has more to to do with multiple medications and nothing to do with the fact they are receiving IVPB medications; unless they have multiple lines dedicated as medication lines.
7 minutes ago, Honyebee said:
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Readthe original post. It's about IVPB. This is specific to her question, NOT all IVBP.
I have, several times. And, please explain how you see the scenario posted as a unique situation?
And told me I was wrong because two primary lines y-sited are still considered IVPB.
This is kind of the crux of the issue here I think. I would not consider that ^ to be IVPB. To me, IVPB is a situation where the "secondary" medication is the only thing being actively pumped into the line, with the "primary" med not actively pumping at that time. In other words, I wouldn't consider anything running concurrently to be piggy-backed.
On 9/26/2021 at 6:54 AM, Lvl4andcounting said:
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.
I'm glad you have a good perspective about it. You are right.
However--and I probably shouldn't say this--if I had do-overs the situation you describe would serve as a red flag. How ridiculous when dumb people try to trick other people at a level that is above their own heads. The question in your OP could've easily been made more clear by using terminology such as "running concurrently," or even primary and secondary. I'm not exaggerating when I say I think that I have some degree of undiagnosed PTSD related what I consider to be an outrageous level of stupidity in nursing. The outrageous comes into play because when you ask questions about the very obvious and basic discrepancies you are made to feel like the one who is off-kilter.
You have some life experience to be able to call a spade a spade and just navigate right around it. ??
What does your textbook say? Do they want you to demonstrate manual versus pump? We use manual setups when we do not have IV pumps available. In addition, you should be able to calculate the drip rates correctly; pumps can malfunction also. Where are you getting the list of secondary lines that are must not share?
The only textbook we have that talks about IVPB is our clinical calculations book that says IVPB is a secondary line that overrides the primary line. Didn’t help me though when I pointed that out and seemed to annoy this professor who later told me adamantly I was taught wrong and the IVPB run together.
I agree we need to know how to calculate drips manually. I’m not concerned with the math. I can do the math if it’s set up simultaneous or not I just need to know how it is to be set up. If both are to run simultaneously, I would set them up on primary lines and y-site them. Whether or not they are y-site compatible is in my IV meds book, or I would look it up in the hospital reference manual online or I would ask the pharmacy if I were unsure.
At the end of the day, my concern here is how to be a safe nurse, not whether I can do a simple math problem (because I can) though I find it irritating I got docked for this. Oh well. Life goes on… as long as I know how to set up IV meds appropriately! LOL
At the end of the day, my concern here is how to be a safe nurse, not whether I can do a simple math problem (because I can) though I find it irritating I got docked for this. Oh well. Life goes on…
Can't even tell you how much grief your mindset is going to save you. Knowing someone is wrong (when they claim you are wrong) is only half the battle. The other half is having the wherewithal to not expend emotional energy on them unless it is a major serious issue. ??
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.
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.
Again, what are you trying to say here?
I'm making sure that I also got the IVPB concepts correct.
Specializes in Physiology, CM, consulting, nsg edu, LNC, COB.
I'm going to disagree here. I think this question isn't just about whether you can add up three liters plus 500cc, or do you subtract it or not, or which 4 1/2 hours are we talking about here? The main IV is NS, normal saline. There's nothing in it that would react with a piggy-back of vanco, and it may be that he needs that full three liters of saline (the physician must have thought so, or wouldn't have written it that way) so you would run them both. Besides, no physician know how much fluid IV abx are mixed in, anyway. So your question has two components: Simple addition, and recognition of no incompatability. Besides if the vanco is q12, you could have four and a half hours with nothing but the saline running, so.... Poorly written question. Ought to have times on it so you could check that.
Although, in all fairness, it's not a sure thing whether the faculty who wrote this question really thought about either of those, either...
iNurs5, CNA
471 Posts
I have seen patients with more than one IV lines. Tell me if I'm imagining things. ?
Read the original post. It's about IVPB. However, this is a specific answer to her question, NOT all IVBP and infusions. Do I have to reiterate everything here?