piggybacking?

ohmeowzer RN, RN · Oct 19, 2008

i use a mainline or TKO bag and second set ( piggy back) for my iv antibotic, then i set the pump to run the iv antibotic and then when the anitbotic is done i have the pump set so it will flush the line when the anitbotic is done...

it's easy and saves time when i have alot of iv antibotics to hang...

sweetieann · Oct 19, 2008

if you just run and antibiotic straight (say they have no maintenance fluid) how would you make sure the ABX is out of the line and in to the patient (there's no hub near the spike to attach NSS and flush through)? yet some nurses say you can run an abx in alone, but to me it seems to clear the line, you'd need a tko or at least a small bag of fluids to run in after to flush it out...

ohmeowzer RN, RN · Oct 19, 2008

if you just run and antibiotic straight (say they have no maintenance fluid) how would you make sure the ABX is out of the line and in to the patient (there's no hub near the spike to attach NSS and flush through)? yet some nurses say you can run an abx in alone, but to me it seems to clear the line, you'd need a tko or at least a small bag of fluids to run in after to flush it out...

well you would have to put it on a pump or dial a flow .. except for vancomycin which always needs a pump.... you should never let a antibotic free flow into a patient... they could have a reaction.. you have to be careful with antibotics... i rarely not second set an iv antibotic... it's safer....

well , you know it's done and in the patient when the bag is empty.. i always second set iv antibotics with a flush bag... there's alot of different ways to do things ....

iluvivt, BSN, RN · Oct 19, 2008

Yes you can administer antibiotics,antifungals,antivirals or just about anything through a locked lumen of a venous access device (VAD) It is not necessary to hang a flush bag and set it up as a secondary,though some do this for ease.Say the patient has a dose of Vancomycin q 12 hours and you have a locked PIV or PICC.......you would use a primary tubing administer the dose usually over one hour until the bag is empty and then flush. Think of home care patients that are on antibiotics for weeks and weeks they do not run around with a flush or maintenance bag attached......everything is locked so the patient can live a normal a life as possible. Also think about patients that are on a strict fluid restriction and do not need the extra fluids. As another example think of rehab patients on intermittent medications that are receiving PT and OT all day long. You get the picture,so as you can see it is a perfectly acceptable practice and within the standard of care for infusion therapy.

sweetieann · Oct 19, 2008

thanks for your reply! I am just curious though, if after the ABX is done infusing and I flush the hub with say, 10 cc NSS, what about the ABX that is left in the IV line? Won't it remain there and not infuse into the patient, since no other fluid is "coming in behind it" to push it along?

woknblues · Oct 19, 2008

thanks for your reply! I am just curious though, if after the ABX is done infusing and I flush the hub with say, 10 cc NSS, what about the ABX that is left in the IV line? Won't it remain there and not infuse into the patient, since no other fluid is "coming in behind it" to push it along?

After a 10cc flush, I can't imagine there being anything left worth worrying about. I have been wrong before....

Pat_Pat RN · Oct 19, 2008

To get every bit of the fluid out of the bag through a pump you would have to have some other source of non-medicated fluid for the pump to push behind the medicated fluid. We have Abbott Plum+ pumps, and the secondary hook-up is just like the needleless adaptors on the tubing. So we can run an IV ABX through the mainline, put a 10mL syringe of NS on the secondary and use that to push the ABX through.

Or just use straight tubing, no pump and let it run till dry.

Hilinenursegrl · Oct 19, 2008

I was taught to never hand a med without a NS or some bag of fluid.

CABG patch kid, BSN, RN · Oct 19, 2008

I would just go ahead and hang a primary bag of NS, then add my antibiotic as a secondary. There is nothing wrong with that, even if you have a renal pt. Set up your antibiotic to run and then make sure you set up your NS as a primary on the pump, to run for 25cc or so to flush the line after the antibx.

blondy2061h, MSN, RN · Oct 19, 2008

If we run something without secondarying it or running it on our special pumps that automatically flush, we hand a 50cc bag of whatever it's mixed in behind it.

Virgo_RN, BSN, RN · Oct 19, 2008

thanks for your reply! I am just curious though, if after the ABX is done infusing and I flush the hub with say, 10 cc NSS, what about the ABX that is left in the IV line? Won't it remain there and not infuse into the patient, since no other fluid is "coming in behind it" to push it along?

Yes, some of the med will remain in the tubing. Just disconnect it and cap it off. It can be used again for the next dose of the same med. At my facility, tubing for intermittent infusions must be changed Q24 hours. Most IV meds have a little bit of overfill in them anyway, so if you infuse the prescribed amount, there will be some med left in the bag.