Question about IVPB

Intermittent infusions, particularly antibiotics, should be run as a secondary, which means it attaches to the secondary port of the primary or carrier infusion which is the one above the pump. This is so that the primary or carrier infusion (compatible with secondary) is what gets wasted in priming and residual in the line, otherwise it's not uncommon to lose up to have the dose of antibiotic. The pump doesn't control which bag it's draining, only the height of the bags controls this.

It can depend on the pump. In our ICU the pumps we use would require hanging the ABX higher than the saline and the ABX would hook into the secondary port. But the rest of the hospital uses different pumps and those ones it doesn't matter, the pump somehow runs both of them and it doesn't matter on the height.

I think the answer to this lies in the pump being used. In our facility we are able to hang the bags at the same height because the pump pulls from the secondary line when set up as a piggyback with NS as the primary line regardless of the heights of the bags.

Are you using the Plum pumps? We have those at my PRN job and it doesn't matter if one bag is higher than the other. The Plum pump can even run both lines plugged into it concurrently, so the maintenance fluid does not have to be paused for the ABX to run.

Every other pump I've used, the one running as a piggyback needs to be higher than your maintenance fluids.

We use Plum pumps as well and you can hang the lines the same height.

Sorry, should've specified that we use Plum pumps in our facility

Hi everyone, thank you so much for your responses to my question. I'm a bit confused because I was always taught that no matter if a pump is used to infuse the antibiotic, whenever giving antibiotics via IVPB-- the antibiotic is always hung higher and the secondary bag is lower.. All of your response have helped me tremendously gain more insight on this matter...

I'm a new RN and will definitely be questioning this with my workplace as I'm on orientation..

Also, your responses might explain to me WHY I have been seeing a LOT of IV antibiotics with some fluid left inside them without properly being infused all the way... This to me means that the patient likely is not getting their full dose of antibiotics. Again, thank you!!!! :)

Yes, seeing an IVAB with fluid in the vial, or even worse, when the drug and its diluent weren't mixed in the first place, frustrates me too, to no end. Also remember that a complete dose means that the ENTIRE bag is empty, but there still should be fluid in the drip chamber and the IV tubing below it. Surveyors will easily tag you if they come in to see the IV antibiotic hanging and it still has mixed drug in its diluent in the bag.