Piggyback regulation (student question)

[brewerpaul]

I just took (and passed!) a set of clinical competencies. One of the things I had to do was set up a piggyback mini-bag and regulate the drip rate manually. I got it hung and dripping, but couldn't get the drip rate high enough for the calculated flow rate.

I'll SWEAR that at least one clinical instructor told us to regulate the mini using the roller clamp on the secondary line, leaving the primary clamp alone. In this way, once the mini runs out the primary resumes at it's proper flow rate. Otherwise, when the mini runs out the primary may not be running at the right rate which could be dangerous if you weren't there exactly when the mini ran out to re-regulate the primary. In my case, this was impossible. The examiner asked what I would do in the "real world" and I replied that I'd have to regulate using the primary line, which was acceptable.

How do all of you do it? I've had some people tell me to open the mini bag all the way and then regulate with the primary. My son, who's a paramedic, suggested in all seriousness putting a BP cuff on the mini bag and inflating it a tad!

Thanks for any advice.

[willtm]

But the secondary is only going to run as fast as the primary is set to run because it is going through that tube to get to the patient. The only way around that is to attach the secondary below the primary roller--in this case the secondary would run according to it's own setting. I don't think the secondary tubing is long enough to reach below the primary roller.

I always attach the secondary above the primary roller, open the secondary roller all the way and regulate with the primary roller.

I just took (and passed!) a set of clinical competencies. One of the things I had to do was set up a piggyback mini-bag and regulate the drip rate manually. I got it hung and dripping, but couldn't get the drip rate high enough for the calculated flow rate.

I'll SWEAR that at least one clinical instructor told us to regulate the mini using the roller clamp on the secondary line, leaving the primary clamp alone. In this way, once the mini runs out the primary resumes at it's proper flow rate. Otherwise, when the mini runs out the primary may not be running at the right rate which could be dangerous if you weren't there exactly when the mini ran out to re-regulate the primary. In my case, this was impossible. The examiner asked what I would do in the "real world" and I replied that I'd have to regulate using the primary line, which was acceptable.

How do all of you do it? I've had some people tell me to open the mini bag all the way and then regulate with the primary. My son, who's a paramedic, suggested in all seriousness putting a BP cuff on the mini bag and inflating it a tad!

Thanks for any advice.

[SharonH, RN]

In real life, I haven't had a primary bag of IVFs running to gravity in years and years so I can't see this scenario actually occuring. Having said that, I do run piggybacks to gravity sometimes because they may not be compatible with the primary fluids which should always be run on a pump in this day and age. When they don't run well, there is nothing you can do but check on the bag frequently and readjust the drip rate prn.

[nursenatalie, ADN, RN]

In real life I program it on a pump and run it as such. In a couple of emergency situations when I had a patient crashing and primary wide open x two lines and need to get abx before OR I have put abx on a primary tubing and piggybacked into primary line and regulated them this way.

[TazziRN, RN]

Depends on where the mini is plugged in. If it's above the primary roller, use the primary roller and keep the mini roll open wide. If it's below, use the mini roller, but you'll then have to use primary tubing because secondary tubing will not be long enough to reach below the primary roller.

Or use a pump!