NS wide open and IV infusion

[Loo17]

Let's say you have a patient with an 18G in the LAC and the doctor orders NS 1L bolus wide open and Zosyn 3.375G over 30 min. Starting a second line is not an option. Would you hang the NS and connect it directly into the patient, programing the Zosyn into the IV pump and Y connect it in to the NS (below the pump) or connect the Zosyn (via the pump) directly to the patient and Y connect the NS bolus (below the pump)? I have been doing it the first way but yesterday I was helping another nurse and she told me it needs to be done the second way. Maybe I am tired but I just can't wrap my head around it. The pump is controlling the Zosyn rate and we want the fluids to go in fast. It seems like both ways would work as long as the wide open fluids were attached below the pump.

[VANurse2010]

I always put the slower on top of the faster. Example: if you ever have had to y-site a heparin drip on normal saline (not ideal but it sometimes must be done) putting the usually-faster saline on top of the heparin drip is a fine way of getting critical PTTs on lab draws.

[Loo17]

I always put the slower on top of the faster. Example: if you ever have had to y-site a heparin drip on normal saline (not ideal but it sometimes must be done) putting the usually-faster saline on top of the heparin drip is a fine way of getting critical PTTs on lab draws.

When you put the saline on top of heparin isn't the putting the faster on top of slower?

[morte, LPN, LVN]

just to be clear, are both on a pump? or ins NS genuinely "wide open"?

[RNsRWe, ASN, RN]

When you put the saline on top of heparin isn't the putting the faster on top of slower?

Yes, which is why she worded it to mean if you put the fast one on top, you are likely to get a poor outcome (critical PTTs because of a much-too-fast infusion).

[Loo17]

Yes which is why she worded it to mean if you put the fast one on top, you are likely to get a poor outcome (critical PTTs because of a much-too-fast infusion).[/quote']

Told you I was tired! Lol

[Loo17]

just to be clear are both on a pump? or ins NS genuinely "wide open"?[/quote']

The NS is not on a pump.

[Loo17]

I think I have been doing it correctly. Just doubting myself sitting at home.

[dudette10, MSN, RN]

I agree with you. NS to patient, pump-controlled infusion Y-sited below pump. If done the other way, only the first few cc's of the pump-controlled infusion would go in fast due to priming the line with it, then it would go in at the same rate as the other way. It wouldn't be that big of a deal with Zosyn, but with very slow drips like heparin or morphine, it could make a big difference initially. Better to be safe and do it your way.

[Lev, MSN, RN, NP]

I would get a separate channel for the zosyn if possible, run that at the ordered rate, connecting it to the tubing from the NS bolus, running from channel #1 at 999ml/hr. If I didn't have a second channel, I would probably wait for the bolus to finish and then give the antibiotic. If the antibiotic needs to go in now and only had 1 channel, I would let the NS hang wide open and run the antibiotic in through the pump.