Different Piggyback Antibiotics, Same IV Tubing?? - page 3
Hey all, I just had a quick question about something I was taught in nursing school and was wondering if you learned the same thing, or practice this yourself. You have 2 different IV... Read More
Feb 11, '13The back-priming a few times takes a fair amount of time, and we all (should) know the wise old saying about "time is money". From a simple cost perspective, calculate the actual amount of time used to use a separate secondary tubing and switching it at the appropriate port on the pump set as needed versus back priming (several times) the tubing. Compare that with the actual cost of a secondary tubing set. By running the numbers (I tend to do that quite often... could have been an accountant ), you will likely see that using a different secondary set is less expensive.
I just checked the cost of the secondary IV pump tubing; it is $0.70/ea.Last edit by Overland1 on Feb 11, '13 : Reason: Accounting Clarification
Feb 11, '13We just use different tubing for every piggyback.
Maybe it's just a resistance to change I'll own it.
Maybe it's a safety thing. There's always going to be one person who "forgets" to back prime with the worst possible medication.
Feb 11, '13The CDC issued new guidelines as to the time a primary set should remain in use in 2011, this is the conflicting information in the cited article. Also it is noted in the 2010 Lynn Hadaway Associates Inc. link r.e. backpriming "Unfortunately, this is an area of clinical practice that has received no attention and no research." (First line of author's response). And further down in the authors response to a post "Of course there are no studies to refer to about this practice. I would recommend that your practice council consult with a pharmacist knowledgeable about IV drug compatibility information just to be sure. I just checked some recent compatibility information on Vancomycin and found conflicting compatibility information when given with ampicillin, several of the cephalosporins, nafcillin, piperacillin, ticarcillin and tigecycline. I would recommend that you assess the common combinations prescribed by physicians in your facility and then assess the compatibility of those combinations."
Additionally, per the 2011 CDC guidelines, "No recommendation can be made regarding the frequency for replacing intermittently used administration sets.Unresolved issue " (#2 under Replacement of Administration Sets).
Hence, the use of backpriming cannot be claimed to be evidence based, therefore, how can it be best practice? I don't see it as not wanting to change habits, but in following the protocols established. It seems to boil down to using the practice that your hospital or agency establishes as best practices. If your agency says a new secondary for each drug and 24 hour use for each secondary and you wanted to argue the issue, what evidence would you present? What research could be presented? At this point, per Lynn Hadaway, "The absence of studies means that we are left to base practices on general principles of infection prevention." (Paragraph 3, author's response).
It would be extremely interesting to look at the rates of blood stream infections in hospitals with varying practices to see if there is a greater incidence of infection when multiple secondaries are used vs limited access for secondaries. Perhaps a good research topic?Last edit by Serlait on Feb 11, '13
Feb 11, '13"Yes the 2004 article still applies as no new studies to prove there is a better way."
But the 2004 article was not supported by evidence based research. Again, there has been no research to support either practice. How can one claim "best practices" with a dearth of research to support such a claim.
I find it interesting that if someone is unwilling to switch to another practice, especially when there is absolutely no evidence to support the change, they are accused of being unwilling to "change their habits". Very simply, if you want me to change my "habits" then show me the evidence that supports that change. Please don't site an eight year old article that does not include the most recent recommendations of agencies cited in the article. Both the CDC and INS revised their recommendations in 2011. If I were not willing to change my "habits" in the face of research, THEN I would be deserving of your censure, until then or until I have the evidence to argue for a change, I will follow the protocols of my hospital. I can't imagine trying to defend myself if there were some sort of problem or compatibility issue by saying that I based my practice on an article written in 2004 that was not current.
Feb 11, '13Thank you everyone for all of your input! Reading all of your comments has been very helpful. I'm happy to know that others have heard of this practice, as when I asked some of my co-workers they had no clue what I was talking about! Obviously the most important thing is following the policy of our hospitals (which I don't believe mine has a specific policy for or against using a separate IVPB tube), but I did ask an IV therapy nurse what she thought and she said I should use a dedicated line for each IVPB, so I guess that is what I'll do until I'm told otherwise or any evidence-based research is done. This would certainly be an excellent evidence-based practice project for our unit if there were more evidence to support it!Last edit by Pinky89 on Feb 11, '13 : Reason: typo
Feb 11, '13I always back prime. When you do that, you technically keep the system closed. The more you plug syringes and extra tubing into the ports (despite using alcohol), the higher the chance of contaminating the line or the IV access. That also includes exposing the piggyback lines to the air every time it disconnected. The more closed the system is, the better. Not every nursesthe port with alcohol like they should. Think of how many times a PICC line has come back with a positive culture.
Feb 11, '13Someone can backprime all you want, the spike still has the previous med on it. Are the backprimers looking up compatability or just assuming since they backprimed it is as good as new? At my facility, if I heard that someone was using the same line for each PB, I would start to question their nursing standards. I have never looked at the P&P regarding this because I never thought it was an issue. Definitely food for thought.
Feb 11, '13Lynn Hadaway is a nationally-known expert in all aspects of IV therapy, testifies as an expert in court, and has authored textbooks. If she promulgates it as safe, she would have the evidence to support it, and you can take it to the bank.
Feb 11, '13Back priming is okay, however, I would never use the same piggyback tubing for two different antibiotics. That just doesn't sound right to me. And what if the different antibiotics happen to be incompatible with each other? It doesn't take that much time to grab a new secondary set and prime the line and hang it.
Feb 11, '13Regardless of her credentials, Ms. Hadaway stated on her website, Lynn Hadaway Associates Inc. Lynn Hadaway Associates, Inc.: Studies on Backpriming
"Unfortunately, this is an area of clinical practice that has received no attention and no research." (First line of author's response).
Until there is evidence based on research, I'll follow my hospital's policies so I have a paycheck to take to the bank.
Feb 11, '13Quote from Overland1Ha! You'd puke if you saw what our hospital charges the patient for them. If I'm admitted y'all can stand there and backprime and count the seconds because you're not charging me for all your wasted secondaries! lolThe back-priming a few times takes a fair amount of time, and we all (should) know the wise old saying about "time is money". From a simple cost perspective, calculate the actual amount of time used to use a separate secondary tubing and switching it at the appropriate port on the pump set as needed versus back priming (several times) the tubing. Compare that with the actual cost of a secondary tubing set. By running the numbers (I tend to do that quite often... could have been an accountant ), you will likely see that using a different secondary set is less expensive.
I just checked the cost of the secondary IV pump tubing; it is $0.70/ea.
Feb 11, '13Quote from corky1272RNI'm not assuming jack. I'm doing what I was told and following facility policy. If you "question nursing standards" of people who follow their hospital's policy, that's on you! Maybe I question your nursing standards for unplugging and plugging tubes into the primaries 4-6 times a day and exposing the line to bacteria! lolSomeone can backprime all you want, the spike still has the previous med on it. Are the backprimers looking up compatability or just assuming since they backprimed it is as good as new? At my facility, if I heard that someone was using the same line for each PB, I would start to question their nursing standards. I have never looked at the P&P regarding this because I never thought it was an issue. Definitely food for thought.
Feb 11, '13Quote from getmethisnownurseIsn't that a given? Several people have made this point but I figured that nurses were using new tubing strictly for that reason to begin with. It sounds like some people here are saying that it's okay to use the same tubing even if the solutions are incompatible because the backpriming should take care of it. What's the verdict?I use the same secondary tubing for all piggybacks, unless they aren't compatible. Backprime.
When folks are saying "backprime several times" do you mean to reinstill the secondary line with primary solution, wait for it to infuse, and repeat? That DOES sound time-consuming.
Quote from iluvivtOh, it's not the *worst* thing in the world.never use the sloppy practice of" looping",ALWAYS put a sterile new end cap on disconnected IV tubing.Last edit by Vespertinas on Feb 11, '13