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.
When I used to work Oncolgy we had the same thing happen with the Baxter pumps so we would actually program the chemotherapy as the secondary and watch to see if the primary(usually a 250 ml of NS) would dripp also. If it did, then we would make a clamp, wrap an alcohol pad around the primary tubing, and clamp with a plastic yellow hemostat and that would stop the primary from dripping. Only problem is when the chemo was finished the pump would beep so you had to try to be in there before the primary took over.
We use Baxters, and I had the same thing...programmed a piggy, and came in to find half a bag still infusing, and both bags dripping. So, especially since it was like 3 in the morning, I'm going thru all the "stupid nurse tricks" I could have done, like not open the slide lock, did I actually hook the line up right, put the blue "hook" on the right bag, etc. I swapped out all the lines, thinking maybe there was some kind of invisible crimp in the line somewhere, still did the same thing. Finally, swapped out pumps and *presto* it worked. So, for me, I'd change out the lines, and if that didn't work, I'd get a new pump....
When I used to work Oncolgy we had the same thing happen with the Baxter pumps so we would actually program the chemotherapy as the secondary and watch to see if the primary(usually a 250 ml of NS) would dripp also. If it did, then we would make a clamp, wrap an alcohol pad around the primary tubing, and clamp with a plastic yellow hemostat and that would stop the primary from dripping. Only problem is when the chemo was finished the pump would beep so you had to try to be in there before the primary took over.
Ann :typing
Yeah, that's what I did, except I used a gauze pad and borrowed a coworker's hemostat since mine seems to have gone missing. Pain in the patootie when the whole reason I hung it this way was so I wouldn't have to go back in there at a specific time....:angryfire
We use Baxters, and I had the same thing...programmed a piggy, and came in to find half a bag still infusing, and both bags dripping. So, especially since it was like 3 in the morning, I'm going thru all the "stupid nurse tricks" I could have done, like not open the slide lock, did I actually hook the line up right, put the blue "hook" on the right bag, etc. I swapped out all the lines, thinking maybe there was some kind of invisible crimp in the line somewhere, still did the same thing. Finally, swapped out pumps and *presto* it worked. So, for me, I'd change out the lines, and if that didn't work, I'd get a new pump....
Hmmm....you know, this sounds like it might be an issue with Baxter pumps. If I have time next time, I'll swap out the pump (if not, I'll do the ol hemostat trick). I really don't think it was the secondary tubing, since this occurred with both piggybacks, for which I used separate tubing.
If you set the pump to run a secondary it has to be on separate tubing. If you add a line to the original tubing, above the pump, everything on that line will be pumped. We use the alaris pumps also, in order to run a secondary you must have two attachments on the "brain" as we call them. You can set the pump to hold the NS until the secondary antibiotic is finished or you can tell them to run simultaneously. The pump can not possibly tell which line to pull from if you just connect the secondary into the main tubing. You will in essence be pulling from one tube, that forks into two, so everything will be pumped.
if you have your fluids running through a pump, hanging a bag lower than the other one wont affect anything. did you check if your pump was set to run on piggyback? it sounds to me like it was set to run "concurrent" meaning that a line and b line run at the same time which is what we do in potassium aliquot infusions.
If you set the pump to run a secondary it has to be on separate tubing. If you add a line to the original tubing, above the pump, everything on that line will be pumped. We use the alaris pumps also, in order to run a secondary you must have two attachments on the "brain" as we call them. You can set the pump to hold the NS until the secondary antibiotic is finished or you can tell them to run simultaneously. The pump can not possibly tell which line to pull from if you just connect the secondary into the main tubing. You will in essence be pulling from one tube, that forks into two, so everything will be pumped.
That's not how the Baxter pumps work. The primary tubing goes through the pump, and the secondary is Y sited in on the port prior to the pump. The primary bag is hung lower than the secondary.
if you have your fluids running through a pump, hanging a bag lower than the other one wont affect anything. did you check if your pump was set to run on piggyback? it sounds to me like it was set to run "concurrent" meaning that a line and b line run at the same time which is what we do in potassium aliquot infusions.
our single channel pumps do not have a way of running anything "concurrent". the only way to do that would be to use a triple channel pump and have each infusion on separate tubing through separate channels.
CarVsTree
1,078 Posts
Ditto!