Piggyback Problems!

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Specializes in Cardiac Telemetry, ED.

I seem to recall a post about this same thing a while back, but I wanted to post my own experience.

So, tonight I had an antibiotic and some Flagyl to hang on an elderly gentleman with a PIV. I decided, to make things a bit easier on myself timewise, to hang a bag of NS as the primary at a TKO rate and piggyback the antibiotic so that when it was done, the NS would flush the line and I could go in and hang the Flagyl, then disconnect the line from the patient at my leisure instead of having to go in, disconnect, flush, connect the next one, then disconnect and flush again.

So, I hang a 250mL bag of NS as my primary, using the blue plastic hanger thing to make the bag lower than the antibiotic. I go in an hour later, when the antibiotic is supposed to be done, and there's still half the bag of antibiotic left. Upon closer inspection, I see that the NS is dripping too. So, I get a second blue hangy thing and hang the NS still lower. No dice. It keeps dripping. Mind you, the antibiotic is dripping too. They're both dripping. The pump is programmed correctly. The NS is lower than the antibiotic. They're both dripping. So I switch to a 500mL bag of NS, thinking maybe that might help. No such luck. It's dripping. Then I switch to a liter bag. Same thing. It's hanging by two blue hangy things and it's still dripping. When I pinch the tubing just below the drip chamber on the NS, I can feel the suction on the inside of the tubing. So finally, I just clamp the primary line with a hemostat so the piggyback will drip in by itself. Once its done, I go in and remove the hemostat and let the NS kick in to flush the line, hang the Flagyl, rinse, lather, repeat.

What the heck???? Any ideas?

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Specializes in Cardiac, ER.

Ok,.I'm going to assume this is a legitimate question. If I understand you correctly, the pump was pumping from both bags. Did you have the tubing for both bags going thru the pump? The height of the bags only works when using gravity,..ie have the 250 NS as the main line, not through the pump, then if the antibiotic needs to be on a pump it will be attached to the NS line off the pump. If both bags are attached to the pump then both bags will drip,.unless you set the antibiotic to run as a secondary.

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Specializes in Cardiac Telemetry, ED.

Yes, it is a legitimate question. I have never seen this before.

I had the main line of NS going through the single channel pump, with the piggyback attached to the port just prior to the pump. The NS was lower than the piggyback. Just like I've always done it. And they were both dripping.

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Specializes in Infusion Nursing, Home Health Infusion.

RN cardiac has it right. As long as you have your primary tubing going through the pump that is what will drip....even hanging the primary bag lower will not work. You have your primary set on a volumetirc pump.....so that IV will continue to drip at whatever rate you set,and in between the pulsatile push of that fluid your secondary med will try and drip in between the primary rate (thats why some went in and both were dripping). You need to program the pump to the secondary function and once your secondary infuses your primary will automatically take over. The system you are trying to do only works by gravity.....so once your mini-bag is infused (b/c it is higher) your continuous primary (which is lower) will resume. What type of volumetric pump are you using so I can see if you can set up a secondary....unless it is a very old style pump you should be able to do this function. Does that help?

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Specializes in Cardiac Telemetry, ED.

I was using a Baxter pump, and I programmed the piggyback to infuse. Normally, the piggyback will infuse, then it will automatically switch back to the primary. It even has a little diagram that shows it's a piggyback.

On this model of pump, on the main screen, there is a softkey labeled "piggyback". I pressed that softkey, programmed in my drip rate and volume, then pressed "start". According to the display, the piggyback was infusing. However, when I looked at the drip chambers, both were dripping.

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I was using a Baxter pump, and I programmed the piggyback to infuse. Normally, the piggyback will infuse, then it will automatically switch back to the primary. It even has a little diagram that shows it's a piggyback.

On this model of pump, on the main screen, there is a softkey labeled "piggyback". I pressed that softkey, programmed in my drip rate and volume, then pressed "start". According to the display, the piggyback was infusing. However, when I looked at the drip chambers, both were dripping.

i think i understand your issue.....the only thing i can think of is that there was something creating "drag" in the piggyback, ie making it harder to pull/pump the liquid from there in comparison to the main line.....was the spike fully into the piggy back...was the clamp partially on, etc.....good luck

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Specializes in Cardiac Telemetry, ED.
i think i understand your issue.....the only thing i can think of is that there was something creating "drag" in the piggyback, ie making it harder to pull/pump the liquid from there in comparison to the main line.....was the spike fully into the piggy back...was the clamp partially on, etc.....good luck

Yes!!! That's what it seemed like. As I said, when I pinched the primary line with my fingers, I could feel the pull there, where it shouldn't have been. I did twist the spike on the piggyback around a few times, thinking it might have been what you said, and I double checked the roller clamps, but no luck. I'm completely stumped. I had the bags and tubing set up correctly and the pump programmed correctly. I double and triple checked. Plus, this occurred with BOTH piggybacks.

The only thing I can think of is that the primary line was primed and programmed, but I hadn't started it actually *running* yet before I hooked up and programmed the piggyback. I just can't imagine that would make a difference.

Anyway, I worked around it by just clamping the primary line between the drip chamber and the port where the piggyback entered with a hemostat, but still it was irritating that something I did to save myself time ended up being a pain in the butt.

Edited to add: It's a good thing the patient was sound asleep. I think I dropped the "F" bomb during all of this.

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Specializes in medical, telemetry, IMC.

i've had that happen once. the primary was hanging lower, everything was connected right and all the clamps were open. but the piggyback would not drip, only the primary would drip. after playing with it for a while i got some new secondary tubing and everything worked fine after that.

i still don't know what exactly happened but somehow the secondary tubing was defective. from then on when i hang a piggyback i always stay a few seconds and make sure that the secondary actually drips! :mad:

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Oh man I've had these problems too. Once I REALLY actually had defective tubing where the PG didn't go in..I even had my charge nurse check it out because it was so weird. More often it's the clamp not being off all the way though. Occasionally I've had the both dripping issue also, and actually taken the primary (NS or whatever) and put it on the handle that adjusts the IV pole up and down (so it's waaaaaay below) to make sure gravity is doing 100% of it's job.

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Specializes in ICU.

We use Alaris pumps & tubing. I have actually run into this a number of times. What I have found is that the problem is generally where the piggyback tubing plugs into the primary tubing. You really have to jam the piggyback tubing into that primary tubing & twist hard. If that connection is not good, it doesn't matter how high the PB or how low the MIVF, the setup won't drip right.

HTH. :)

catshowlady

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Specializes in ICU.
from then on when i hang a piggyback i always stay a few seconds and make sure that the secondary actually drips! :mad:

i do this too! :yeah:

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Specializes in Trauma ICU, MICU/SICU.
i've had that happen once. the primary was hanging lower, everything was connected right and all the clamps were open. but the piggyback would not drip, only the primary would drip. after playing with it for a while i got some new secondary tubing and everything worked fine after that.

i still don't know what exactly happened but somehow the secondary tubing was defective. from then on when i hang a piggyback i always stay a few seconds and make sure that the secondary actually drips! :mad:

that's what i was going to suggest. get new tubing. i've occasionally come across defective tubing. i even had defective primary tubing where it kept alarming upstream problems; when in doubt throw it out (the tubing that is). that's probably all it was.

as for the posters who said what has to be in the pump, i'm sure it depends on your pump. ours is similar to yours we have bard pumps. put primary line through pump; secondary line connects prior to pump but must be higher. you had everything correct.

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