*This got 5000% longer than I thought it would be. Here's a tl;Dr version =_=
tl;Dr version (all scenarios use alaris pumps)
-How do you set up two compatible meds to run at the same time into the same peripheral IV without losing meds in your tubing forever? Is it worth doing instead of hanging one med after another?
-Similar question as above, except running a med and a bolus at the same time. Also though, does the speed of the bolus affect the speed of the med being administered (my understanding is it doesn't?)? Are there times where you have to be cautious about the differing pump speeds?
-Any thoughts on adding a med straight into a (labelled) 500/1000cc bolus?
-What to do about meds from a secondary that get stuck in the line after the primary takes over? Don't bother since it's so small?
-Problems with backflow from your secondary ending up in your primary. I saw this happen severely with a coloured secondary med once. What happened? Any solution? Does that happen all the time and you just can't tell because everything's clear/colourless?
tl;Dr version ends. Feel free to skip over the rest of this entire post which I think is mostly just details and rambling.
Lets say I have two IV meds to give along with a 1L NS bolus. Both meds are in 50ml NS minibags and are compatible with each other. I want to run both these meds at the same time using the same peripheral IV using 2 Alaris pumps.
Trying to set it up in my mind, I have one primary bag of 1L NS for the bolus hanging under a secondary (Drug A) which is y-sited above Pump A, which then attaches to the patient. That's not a problem. Then for Drug B, I have it attached and primed through a primary infusion set hooked up to Pump B, which is then Y-sited with the primary from Pump A below the pump.
With that, I have the problem that once the end of Drug B hits Pump B, it will complain of air in the line and will no longer infuse, meaning I've got maybe close to 10cc of diluted drug out of a 50cc bag not getting to my patient (let's assume there's no extra in the bag to compensate). Is there a solution for this? Is the solution to piggyback Drug B off of a another 50cc NS and get pump B to infuse 10-15cc NS at the same rate that Drug B is supposed to be infused at to flush the line?
Give the time and trouble used to set up an extra primary and secondary then, is it just more efficient to hang the next bag of meds when the first is done using pump A?
Alternatively, what if you need to run meds at the same time as a bolus? Bolus goes through pump A, and then med goes through pump B? Do you run the med as a primary, or as a secondary so you can flush your med after? Also, when is there concern over the infusion rates when you y-site below the pump? Say you're bolusing at 999cc/hr through line A, and running meds at 100cc/hr in line B, which is y-sited to line A below the pumps. Am I correct in saying that line B is depositing meds into line A at 100cc/hr, so therefore even though line A is running at 999cc/hr, the patient is still only getting the meds at 100cc/hr? Is there a time when different rates of y-sited lines becomes a problem?
On another note, a nurse once suggested to me to utilize 500ml and 1L boluses to administer a NS compatible med over that time by adding it straight to the bolus. Labelled of course. Any thoughts on this?
Couple more questions! In general with secondaries and minibags, since the pump can't know which bag to pull from and simply goes off of whatever fluid is at a higher elevation, isn't there typically some meds from the secondary bag still stuck in the secondary line once the primary takes over considering part of the secondary line will always be beneath the primary bag of fluid? I presume in most cases this amount is negligible?
Also how do you know your secondary isn't just backflowing into your primary bag? Most secondaries are the same colour as the primaries, but I distinctly recall seeing somebody hang a secondary bag with yellow tinged antibiotics (pretty sure it was ABX), then looking later and seeing plumes of it wisping up into the primary bag. The lines are the same lines that I've always used and seen, so I presume there are no backflow valves. I'm not sure if that happened while pump was actively running, or if it just happened that somebody removed the lines from the pump with the secondary unclamped, thereby allowing backflow into the primary. Do you actually have to clamp your primary line above the first y-site to prevent any backflow every time you run a secondary?
As an aside, I stopped to watch that particular situation as the pump ran, and I was surprised to see the only thing filling the drip chamber was the clear colourless primary solution. The primary had actually flown a little bit up the secondary tubing, and as the secondary fluid flowed down its own tubing, once it hit the bifurcation with the primary tubing, it flowed upwards towards and into the primary bag, and primary solution kept flowing down. Maybe density and solubility was at play here? I'm not sure.
Sorry for the massive wall of text full of questions? I mean, I can set up simple piggybacks just fine, but nobody has ever shown me how to properly y-site two pumps together, and then I find that nobody can particularly explain how any of it works, other than it just does and don't worry about it. Fluid dynamics isn't really my strongpoint so I'm having some difficulty self learning it =/