Please help as my clinical instructor won't answer my questions...

[anastasia158]

1. I a student at an LTAC. The facility does not run maintenance fluids. So, IV antibiotics are run as "primaries". Should a separate IV tubing be used for each different antibiotic that is run? How does each IV tubing get labeled? Should they be labeled on the date tag that goes on the tubing or do you just leave the tubing spiked in the empty bag to identify what the tubing is for?

2. Why is flushing an IV PICC lline called "capping"? I understand that we will flush before an IV is started and after but is it also done a minimum of every so many hours?

Thank you for answering these specific questions :)

[FancypantsRN]

Hello. If I were running multiple IV abx every "x" amount of hours, I would probably just have my zosyn tubing, levaquin tubing, clindamycin tubing, etc. Then just set the pump to run in each med without getting air in the tubing. I don't generally share tubing with different meds, but that's me.... I believe you can as long as the meds are compatible but I kind of don't see the point unless there are just 2 you are running once each.

I label the tuning with the date and time they expire and need to be changed (policy specific).

If I added the abx to the fluids, I label the bag as well with what med I added, date, time, initials.

I am not sure about the capping thing, maybe that is regional. I know here where I am now working (western US) they call IV's with no fluids running buffcaps. In Florida, we just called them heplocks. So capping may be just a PICC or IV with nothing running into it.

Hope that helps!

[roser13, ASN, RN]

The biggest problem here is that your instructor can't or won't answer your questions. Why not?

[SuesquatchRN, BSN, RN]

I run everything as a primary unless fluids are running. Separate lines. I initial, date and time the tubing and leave the bags as identification - you wouldn't remove them, anyway, so as to keep the spike aseptic.

[MunoRN, RN]

We run all antibiotics as a secondary with a carrier fluid, even if they don't have continuous fluids running. This is to ensure that the proper dose is given, and to reduce infection risk. We use the same tubing on multiple antibiotics since even incompatible antibiotics can use the same secondary tubing with a backflush. Using a carrier fluid (primary fluid) allows you to prime the line, flush the line, and flush the secondary without wasting medication, using a primary only will wast at least 15cc, which can be a third of the total dose depending on the volume of your antibiotic. It also allows the system to remain connected for multiple infusions, decreasing the number of tubing manipulations which can contribute to infection.

[ErinS, BSN, RN]

It is called 'capping' because they are referring to the 'heparin cap'. Usually you will hear "hep cap the iv', but this is probably a regional wording. Hope this helps.

[Mrs. SnowStormRN, RN]

I can see why the instructors would not answer these questions (if it was based on an assignment given) she was probably thinking it was too direct and you haven't given it any thought. I know when I was in school I always had to tell my instructors what I could find related to the subject and then she would lead me in the right direction, but I would still have to find the answer on my own. Anyhow, looks like youve been helped. Good Luck in your studies.

Also, please come back and thank the nurses that have helped you. I notice several times here when an answer was given, the student never came back to the post to say thank you. Well, good luck again.

[honeykrown, MSN, NP]

Different tubing for each antibiotic (as secondary), then a flush bag (as primary) if they are not on fluids. The flush bag is changed every 24hrs but each tubing changed q72

[linearthinker, DNP, RN]

The institution should have their own policy and procedure manual. Ask for it.

[carolmaccas66, BSN, RN]

One way we do it is with multiple IV ABx running, you can use a divided IV line. One bag has the ABx, the other has the saline. You just run the ABx thru, flush with the saline bag, then hang ur other ABx ready to go. Also we label the bag with all details, not the line, as you change the bag but keep spiking the bag using the same line.

Is this what you mean? We only label lines with the date so we know when to change it (ie: after three days continuous use).

[carolmaccas66, BSN, RN]

Also, please come back and thank the nurses that have helped you. I notice several times here when an answer was given, the student never came back to the post to say thank you. Well, good luck again.

What an excellent point SnowStorm! We seem to give a lot of help, but not many come back to thank us. Like dealing with patients!

[anastasia158]

Thanks all. My facilitty does not hang any IVS other than antibiotics ( no maintenance fluid). So, I now understand why they just leave the empty IV bags hung with the tubing for no more than 72 hours.

I am still wondering about what the difference is between "flushing" a PICC line and "capping" a PICC line. They do no use heparin just normal saline. Thanks!