Priming/Hooking Up secondary lines

RNsRWe, ASN, RN · Apr 6, 2012

Absolutely. Just be careful about not losing precious atx when doing the priming, as some of them are very expensive, and the bags are small, so the dose is crucial. Pet peeve of mine is seeing PB atx with like a third of the bag still filled and the primary is flipped back on again.

At some point, you'll need to get that hang of backpriming, as you'll likely encounter a bag that's hung, you need to replace it with a new bag, and the line is still good...and hospitals are pretty cost-conscious, so they won't want you tossing the line each time you need to hang an atx (like four times a day, for instance).

wish_me_luck, BSN, RN · Apr 6, 2012

I think the only time I have seen a little bit of the antibiotic not infused is when it was in the drip chamber and a new bag was ordered anyway. The rational behind it was to keep the drip chamber from becoming bone dry and getting air in the line.

I have changed the bags out before and my preceptor just told me to take the spike out of the old one and spike the new one...am I misunderstanding what you are saying as far as one hung and needing to replace it? I will say this, to remove the spike, I have to take the bag down and it ends up being lower.

RNsRWe, ASN, RN · Apr 6, 2012

No, you're doing it just fine. I WISH I had seen more bags with just the fluid in the drip chamber...which is exactly right. While the FIRST bag of an atx didn't get the "full" amount exactly, the second and subsequent ones do. You'd set it for the total number of cc's in the bag, starting with the second bag. The first bag you'd have to set for say about ten cc's less (depending on the style of pump you're using). That way the drip chamber stays filled until the next dose.

Too often, though, the following nurse(s) will ALSO set it for a lower amount, and instead of a 50cc bag infusing and having just the drip chamber full, there will be a shallow amount in the bag. And sometimes more than shallow...which, in my rather conservative opinion (which you're aware of!) becomes a med error. If a patient is to get 50cc's of a med q4h, it shouldn't become 40 or 35.

But as I said, as long as you're letting the bag run out and the drip chamber still has fluid, you're fine--and the bag is still primed :)

MunoRN, RN · Apr 6, 2012

I would urge you to become familiar with backpriming since it could be argued that it's the only acceptable way to hang intermittent infusions when patient are getting multiple intermittent infusions.

I came across a Nurse once who refused to backprime and claimed that her method of priming the secondary line into the sink didn't waste more than "a couple of cc's" so we measured it and it was 18cc's, out of a 50 cc bag. That's a full-on med error, particularly when you consider that under-dosing of antibiotics is a significant cause of resistant strains of antibiotics.

The other issue is infection risk. As a general rule a closed system should remain closed unless you have a really good reason to break the closed system. Depending on the volume of the primary bag and how much lower you hang the secondary, the drip chamber and the part of the secondary line can empty after an infusion, which without backpriming would require you to disconnect the secondary to prime, offering an opportunity to introduce bacteria. Always backprime' it's easier, safer, doesn't waste medication, and there's no benefit to not doing it.

wish_me_luck, BSN, RN · Apr 6, 2012

I guess my concern with backpriming is not necessarily not know how to do it rather than concern that air would get into the line due to the secondary bag being lowered below the primary. Would it cause air in the line or would it just go up into the secondary bag?

MunoRN, RN · Apr 6, 2012

When the secondary bag is lowered fluid from the primary will flow through the secondary line, pushing the air into drip chamber/bag of the secondary.

wish_me_luck, BSN, RN · Apr 6, 2012

okay. Thanks. I always get scared as far as air being in the lines. Is it the bag being lower than the pump that I am thinking about that would get air in the line?