Concurrent IVS

  1. If you had an order for two IV fluids that are compatible and it state that both IV fluids are to be run not just one or the other and they are to be run concurrently, would you consider that two mean two separate lines or would you think you could piggyback them together?

    My view point is it's two sites, two lines but I've run into some confusion about it so I'm curious for other opinions
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    About Kaltia

    Joined: Dec '13; Posts: 45; Likes: 61

    16 Comments

  3. by   SoldierNurse22
    If you piggyback them, only one will run at a time. You need two separate pumps, not two separate sites if the fluids are compatible. Y-site the IV and you can give them both at the same time.
  4. by   danceyrun
    Two lines
  5. by   annie.rn
    If compatible, I would agree w/ the first response. One I.V. site would be o.k. if they are compatible fluids and the I.V. is in good shape and can handle it. I've personally never seen an order like that. You would need two pumps and Y-site them. However, if you have a pump that will run two things concurrently then you only need one.
  6. by   ~PedsRN~
    Quote from SoldierNurse22
    If you piggyback them, only one will run at a time. You need two separate pumps, not two separate sites if the fluids are compatible. Y-site the IV and you can give them both at the same time.
    Our pumps have the ability to piggy back, and run concurrently. Which means I can continue my IVF at the same rate it was previously going while the piggyback med runs at it's prescribed rate. So in my instance, I would hang one fluid, piggy back the second, and run the pump concurrently. UNLESS - I didn't think the IV could handle the infusion rate.
  7. by   iluvivt
    The trend in IV therpay is leaning toward venous preservation and protection. In this case I would have one IV site and either piggyback into a Y-site below the level of the pump. The bag of IVFs that you are attaching to a Y-site below the pump will need to have have another pump or added channel if you want to use a pump as I suspect most clinicians do in the hospital setting. This is subject to,of course, to the type of pump you have and its features. You can also add a bi-fusion extension minbore extension set or even a triple onto the cannula. If you add it using a minbore double ext set triple extension set or a T-extension it is NOT considered mixing so you would not even have to wory about compatability. You will preserve the vein(s) you do not use for future use or no use at all depending upon several factors such as the duration of therapy.
  8. by   SoldierNurse22
    Quote from ~PedsRN~
    Our pumps have the ability to piggy back, and run concurrently. Which means I can continue my IVF at the same rate it was previously going while the piggyback med runs at it's prescribed rate. So in my instance, I would hang one fluid, piggy back the second, and run the pump concurrently. UNLESS - I didn't think the IV could handle the infusion rate.
    That's cool. As long as the rates are the same, you're golden. Otherwise, a second pump would be necessary.
  9. by   dudette10
    Quote from ~PedsRN~
    Our pumps have the ability to piggy back, and run concurrently. Which means I can continue my IVF at the same rate it was previously going while the piggyback med runs at it's prescribed rate. So in my instance, I would hang one fluid, piggy back the second, and run the pump concurrently. UNLESS - I didn't think the IV could handle the infusion rate.
    i can't wrap my mind around this if you're using only one channel. How do you get the primary (the bag that's lower) to drip while the piggyback is running?
  10. by   IVRUS
    If you have a pump which requires you to hang the primary lower, then you will not be able to run them concurrently. But some pumps don't require this, and they both can infuse at the same time.
    As far as the infusion rate... C'mon peeps, look at your package that the IV catheter comes out of. A 22 gauge catheter allows for a flow rate of 35mls/minute. 35 x 60 is over 2 liters an hour. (2100 cc/hr to be exact)
  11. by   annie.rn
    Quote from dudette10
    i can't wrap my mind around this if you're using only one channel. How do you get the primary (the bag that's lower) to drip while the piggyback is running?
    Sorry if I am hijacking your question to the quoted poster but since I answered pretty much the same thing, I think I can clarify. We use the Abbott Plum X pump (picture here: http://www.isismedical.net/Infusi1.jpg) and it can run two things concurrently, one being on the "A" (primary) line and one being on the "B" (typically "piggyback") line. You program the "A" side and press START. Then you attach the second IV using secondary tubing to the port on the cartridge (after flushing the line) and run it on the "B" line. The pump allows the user to select "Concurrent" instead of "Piggyback" as the MODE and when you press START, both will run at the same time instead of B running as a piggyback.

    We use it mainly for TPN with lipids. We run the TPN on the primary tubing with the lipids on the secondary tubing running in "CONCURRENT" mode instead of "PIGGYBACK" mode so you only need one pump and only one IV port to plug the line into. We also use CONCURRENT a lot when a patient is on Ocreotide or a continuous antibiotic gtt and they also have IVF. The IVF run on the "A" line and the Ocreotide or ABX run on the "B" line in Concurrent mode. I love it. I've never used pumps that can do this until working at the hospital I work at now.

    There is no need for the primary bag to be higher than the secondary bag. In fact, we always throw away the hanger that comes in the bag with the secondary tubing.

    As I said in my original response, I have never seen an order like the original poster is asking about. I have never had to program a concurrent IV for more than 50cc/hr so I am not sure if there is an upper limit on the rate if the Concurrent IV. If I were to try to program it as a Concurrent and the rate was too high, I'd grab a second pump and Y-site it or use a pigtail.
  12. by   annie.rn
    Quote from IVRUS
    As far as the infusion rate... C'mon peeps, look at your package that the IV catheter comes out of. A 22 gauge catheter allows for a flow rate of 35mls/minute. 35 x 60 is over 2 liters an hour. (2100 cc/hr to be exact)
    Thank you! I've never noticed that on the IV package. It's great to know! I'll definitely file that away. I've never not used a 22 to run something going at a high rate but when I do, I've always felt a bit over cautious and have hovered a little to keep a good eye on the site. I've never had problems and I guess now I know why. I feel better now about having to use a 22 for a bolus. Of course I'll still keep an eye on the site :-)
  13. by   Kaltia
    Good to know, I was frankly concerned about getting the amount of fluid through the same tubing, but the packaging info does make sense. I went with two sites two lines as the IV pumps I'm working with do not run concurrently. And I frankly didn't know before now that some pumps could. at least I'll know for next time.
  14. by   wooh
    Quote from iluvivt
    If you add it using a minbore double ext set triple extension set or a T-extension it is NOT considered mixing so you would not even have to wory about compatability. You will preserve the vein(s) you do not use for future use or no use at all depending upon several factors such as the duration of therapy.
    Please clarify this. So if I have one IV, with a Y (or triple or whatever) going into it, I don't have to worry about compatibility? Is this only if the Y is directly screwed into cannula, or can I have (what we usually end up with) a cannula to extension to Y to whatever is hooked to it?

    Even if the Y has to go directly to cannula, this is mind blowing if I'm understanding you correctly. I always thought it had to go separate cannulas (or at least separate lumens on a CVL.)

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