Piggyback meds

[ernurse77]

I have recently switched to a cardiac cath lab and was told there is never anything except ATB that should be hung as a piggyback. When I worked in other units everything was done as a piggyback above the pump. The person who told me this was in disbelief that i would hang anything other than ATB above the pump but also has never worked anywhere besides the cath lab. They said i would never have learned that in nursing school. I Did though. I do realize that the high risk meds I now work with are y'ed in close to the pt on their own pumps. But even in the floor high risk meds such as heparin and nitro were piggyback with NS...any thoughts as this person made me feel super dumb. Thanks!

[Sun0408, ASN, RN]

I would not piggyback heparin or nitro or any other type of gtt. I piggyback things that will run in an hour or less, usually antibiotic or things like mag or K if the pt has a central line. Depending on your pumps, if you piggyback everything the pt is not getting their fluids as ordered.

[ernurse77]

Thanks for your reply. I mean if fluids are not ordered I would ask the doc for a tko and hang with NS so my lines wouldn't run dry. I was taught to always have nitro with NS in case the pt needs a bolus of fluids? If fluids are ordered than I would run them simultaneously if my PIV cold handle it or start an additional line. Thinking about it I wouldn't run heparin as a PB, I think I was confused since it has been awhile for running this a maintenance. But otherwise, is this unheard of?

[Sun0408, ASN, RN]

I still wouldn't run nitro as a piggyback. If the pt needed a bolus then set one up. If u bolus through the same line you mentioned the pt would also get a bolus of the nitro still in the line. With gtts, I don't do them as a piggyback for that reason. If you set your pump to less than the total amount of fluid in the bag, it shouldn't run dry. If would alarm before the bag was empty.

[ernurse77]

Good point. Thanks!

[kalycat, BSN, RN]

I work cardiac ICU stepdown. We don't *ever* piggyback meds like nitro, heparin, etc, but we hang a ton of high risk vasoactive meds. the only things we ever piggyback are abx or maybe a K rider. We use separate pumps and y site in close to the patient, with everything labeled properly. I don't know what they do at other facilities but we typically frown on piggybacks unless it's one of the items mentioned above.