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Discussion

Piggyback Problems!

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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  • Author

morte,

If use use the Baxter Collegue then you already know. You prime the primary tubing, slide the slide clamp closed, put some tension on the tubing, and slide it into the channel. The slide clamp looks sort of like a key when it's closed, so it makes it easy to remember how it goes. Press the "primary" soft key and program in your rate and volume, then press "start". Don't forget to unroll the roller clamp.

To set up a piggyback, you get a secondary tubing set, place the blue hanger on the primary to lower it, prime the secondary tubing, then connect it to the port on the primary tubing that comes before the pump. The guy in the video primed the tubing using the med, but what I do is backflush by spiking the secondary bag with the roller clamp closed, then hold the secondary bag lower than the primary, open the roller clamp, and let the primary fluid flow up the secondary tubing and fill the drip chamber. On the main display, press the "piggyback" softkey and program in your rate and volume. Press "Start".

The primary infusion is supposed to stop while the piggyback drips in, then when the piggyback is done, it switches back to the primary infusion.

The guy in the video didn't seem very accomplished with this pump, but he had the basics.

I'm a little confused....

I'm with Virgo on this one...if you Y a piggyback into the primary line above the pump than the primary bag has to be lowered in order for the piggyback to run in. The pump doesn't know which bag its drawing from but the principles of physics still apply and the fluid from the higher bag will always go in first...Am I totally off base with this?

As a side note...our pumps (alaris I think) have that little magic "eye" that clips onto the primary drip chamber so if it drips when the secondary is supposed to be running you will be alerted right away...saves you from coming in an hour later to find that only half your piggyback has gone in.

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