Piggy Back IV order with no fluid order?

[Fruit Sucker]

I have a question, and please bear with me as I'm a student. I had a patient who had a PB order, but no order for fluids. My instructor asked if I was ready to give the med, and I said, "I can't give this, because there's not an order for fluids. What do I do?" Well, she got really frustrated with me and said when this happens, you just go get a 50mL bag of NS, run it at KVO, and give the PB med with it. I said, how can I do that when there's no order for the NS? She just said, nurses do this all the time, trust me.

I'm confused. My understanding is that fluids can't be given without an order. I don't like breaking rules because other people "do it all the time." Please give me some guidance.

[ac3070]

Was this med to be given on an Iv pump? If so you aren't really giving fluids...the tubing is there, primed with NS, and I always thought of the NS as a kind of insurance to keep the tubing from running dry and forcing me to need to waste meds/fluids by flushing out air bubbles.

As long as you are turning the NS KVO off promptly I don't think it's an issue.

[Pangea Reunited, ASN, RN]

Your instructor is right. That's the common way to do things. I've occasionally seen nurses who insist on running the piggy back on primary tubing, but half of the medication ends up left in the tubing and it can get very inconvenient if the patient has multiple piggy backs ordered.

No doctor would want to get a call asking how to give a piggy back without primary fluids running ...and not giving the medication is not a good option, either. Your KVO NS is basically flushing the patient's IV line which is perfectly acceptable.

[Fruit Sucker]

Okay, yes, it was given with a pump. I was confused about this because like you mentioned, giving it without any fluids would mean that the medication just sits there in the line. I wondered if it was correct to give it followed by a flush, but that didn't really make sense either.

So it's correct then. Thank you. I am very concerned about doing anything that could get me into trouble.

[KelRN215, BSN, RN]

Okay, yes, it was given with a pump. I was confused about this because like you mentioned, giving it without any fluids would mean that the medication just sits there in the line. I wondered if it was correct to give it followed by a flush, but that didn't really make sense either.

So it's correct then. Thank you. I am very concerned about doing anything that could get me into trouble.

You can run IV antibiotics as a primary and not waste any medication if you flush the line with NS afterwards. When I worked in the hospital, we had 25 mL bags of normal saline for this purpose. Putting up a bag of NS as a primary and piggy backing the medication into the secondary line would serve the same purpose. You are not giving fluids without an order, you're flushing a line. It's a standard of care, like flushing the IV to ensure patency prior to administering the medication.

[ProgressiveActivist, BSN, RN]

The braun smart pump tubing requires 20cc to prime. Read the package.

If you are hanging ceftriaxone or cefazolin that's nearly half the dose.

It is acceptable practice to use a NSS flush bag at kvo to ensure the pt receives the full dose

Program it to infuse 20 cc of the primary if your pt has CHF or ESRD then shut it off.

[Mr. Murse]

There are a few different meds that we have ordered at my hospital from time to time that need a carrier or something to flush them in but the doctors rarely remember to put in the order for the other fluid. Insulin drips, for example. We get those often, and the doctor will only put in the order for the insulin, but nothing else. Of course, you can't run insulin by itself at 5cc/hr (or whatever), so we usually put in a "per protocol" order for normal saline and run it at KVO with the insulin running into it.

[~PedsRN~, BSN, RN]

If you were giving a med IVP, then you would flush the line both before and afterwards, correct? So by hanging a bag of NS and running it at KVO.... you are simply flushing the line before, and afterwards. :)

[lmccrn62, MSN, RN]

You can just give through IV tubing as an intermittent infusion without a KVO. Keep in mind that additional fluids in patients may be adverse.

[~PedsRN~, BSN, RN]

You can just give through IV tubing as an intermittent infusion without a KVO. Keep in mind that additional fluids in patients may be adverse.

I just set my pump appropriately. I set it up to flush the med afterwards, and then bam. It beeps it's annoying song, and I come in and lock it up. :)

[ArtClassRN, ADN, RN]

"she said when this happens, you just go get a 50mL bag of NS, run it at KVO, and give the PB med with it."

What part of what your instructor said above didn't you understand?

[nurseprnRN, BSN, RN]

She understood it, she just didn't know that a nurse could do this without a physician prescription. She hadn't learned about flushes being standard of care and a the RN's discretion, is all. No biggie. Now she (and other students) know.