piggybacked to death

penelopejane · Jul 29, 2005

Most hospitals have a policy and procedural manual that states their specific policy regarding this and other issues. Don't be put in the middle, look up the policy, copy it and follow the policy regarding this issue. This keeps you out of the line of fire and the push pull of two varying opinions.

Ok, so here is the delema. I have several charge nurses that are telling me different things about piggybacking meds. I'm a new nurse and trying to do everything right which is impossible since we are all human, but I am getting frustrated by this piggyback issue. One charge tells me that each med needs it's own secondary tubing. Another charge tells me that if you back flush the tubing, there should be no reason to use more than one secondary tubing line no matter how many meds you piggyback in a night. I'm feeling like I'm caught in the middle because the multiple line charge is a very strong personality that makes me feel stupid as if it is her mission in life, and the single line charge is my manager.
So, here is the question. how do you piggyback in your facility? Multiple or single lines? backflush or not? I'd like to hear from some other nurses so I can understand this issue without feeling in the middle of an arguement that should be taking place on the management level.
Anna

pricklypear · Jul 29, 2005

Our place used to be just a free-for-all regarding this issue. I have always used the same tubing (that is how I was taught at my first job) - never had any compatability issues arise. But recently, we came up with a written policy (didn't have one specific to this before) because it was noticed that we were going through a huge number of secondary sets. Now we are advised use secondary sets numerous times up to 72 hours. I don't always back prime unless there is air in the tubing. Like I mentioned, I've never had anything precipitate in the drip chamber.

UM Review RN, ASN, RN · Jul 29, 2005

We always use new secondary tubing for each piggybacked medication. We can use that same tubing for 3 days if we label it.

For instance, Pt. B needs Zithromax and Zosyn. Zithromax goes on one secondary line, Zosyn on another. We only hang subsequent Zithromax on the Zithromax line, and subsequent Zosyn meds to the Zosyn line, and change each whole tubing set every 3 days.

The thought behind this is that it keeps different meds from mixing and possibly precipitating in the line.

(I also backflow the IV fluid to prime the secondary line as it causes more medication to get to the patient.)

suzanne4, RN · Jul 29, 2005

I work PICU aand we use the same micro-tubing. It gets flushed after each med is given, then we can use it for the next and have never had a problem.

barefootlady, ADN, RN · Jul 29, 2005

Where I have worked we have and do use the policy described by Angie O Plasty. Labeling the tubing with the change date is essential. While many drugs are compatable, this ensures the nurse and the physician if a patient develops a reaction to any med, then it is the med, not some weird reaction between meds.

I agree with the advice to copy policy and keep it with you until you "know" what your facility demsnds. :)

allnurses Guide · Jul 29, 2005

I do the same as Angie described . . .. and I agree that getting out the policy of the hospital is your best defense.

steph

Binkey, BSN · Aug 5, 2005

RN Anna,

Whenever you have a questions regarding IV Therapy, your best bet is to check and see what INS standards are. If the facility that you are working for has policies and procedures that greatly deviate from "norm" you may want to approach your risk management team and review the standards from INS with them.

In this case, and in general, if compatibility isn't an issue and you can keep from disconnecting the secondary from the primary by back-flushing then that tubing can last 48-72 hours. However, If you are disconnecting from the primary set, then the secondary set should be seen as a 24 hour tubing change. (The greater the manipulation, the greater the infection risk).

In addition, statements are made by INS regarding tubing changes and your phlebitis rates ie. if your facilities phlebitis rate are less than 5%, you tubing interval changes can be extended.

Hope this helps! :)