Question about priming tubing

[aship, BSN]

Hey everyone,

When you hang an ABX through a primary line how to prevent the line from going completely dry so that you can hang the same ABX a little later?

It seems like most people use the same tubing but I have found that when I try to reprime it there's air mixed with leftover medication and I feel like I am just wasting the meds when I try to prime the line again.

This might be a super obvious answer but I'm a new nurse!

[klone, MSN, RN]

1) why are you doing it through a primary line? Is it saline locked, other than for abx?

2) If the bag of fluid is 100ml, for example, then program 95 ml in the pump, and it will stop before it goes completely dry

[aship, BSN]

Yes it is saline locked other than for abx.

So if it's 3 rounds of 50 mL of zosyn would you program the first two rounds at 45 VTBI and then the last round 50 VTBI?

[klone, MSN, RN]

aship said:

Yes it is saline locked other than for abx.

So if it's 3 rounds of 50 mL of zosyn would you program the first two rounds at 45 VTBI and then the last round 50 VTBI?

In answer to your question, yes.

[AceOfHearts<3]

I don't agree with running an antibiotic through a primary line- I believe it should always be run as a piggyback so a flush can be run. Let's say the antibiotic is 50ml and 10ml is left in the tubing- the patient is not getting 20% of the needed medication. One hospital I worked at said there needed to be at least a 13ml flush to ensure the patient received the entire dose of the iv medication.

[aship, BSN]

So what's the general consensus? Is it specific to the hospital to run primary or not?

[mmc51264, BSN, MSN, RN]

we usually run antibiotics as a secondary and then saline lock when they are done. Change tubing Q24H

[iluvivt, BSN, RN]

Yes you can run an antibiotic or any IV med on a locked VAD .This is a perfectly acceptable practice and we do it all the time when no IV fluids are ordered. Is it easier to hang a flush bag and run it as a secondary...some may think so.What if your patient just has an antibiotic.once a day? I think it's so much easier to administer as a primary intermittent....that is the correct terminology.All you need to do is not let the drip chamber go dry and then there is no air to worry about and just spike and prime out the minimal amount left over. Primary intermittent tubing,according to INS should be changed every 24 hours anyway so if you do have a q 24 hr dose you can get a new tubing.If you have the desire to know why this is the INS standard I will be happy to explain.

[applewhitern, BSN, RN]

The package the different tubings come in will have how many cc's it holds. The kind we use holds 27 cc's, so I have to flush at least 27 cc's to make sure the patient gets the entire dose. Some hold only 15cc. I use a primary bag of plain saline to give piggybacks with, to flush the entire dose in.

[akulahawkRN, ADN, RN, EMT-P]

It depends upon how I'm going to run the medication. If I'm just using the IV intermittently, I'll just prime a primary line and not worry about running the drip chamber dry. If I have a maintenance running, I'll hang a secondary line, placed above the primary bag, and program a "secondary" med into the pump. This way the med runs until it's gone and the primary bag takes back over and flushes the line. With that setup, very little medication is left in the tubing, and if I want it ALL I can just backprime the secondary set, spike a new small bag of NS (or whatever maintenance fluid) and hang that as a secondary for a few mL to push all the med firmly into the primary tubing and into the patient. Then I'm left with a primed NS secondary set... That being said, that's a lot of work for what's usually just a couple mL of a medication from a bag that's usually slightly overfilled to compensate for whatever is left in the dripset when the infusion is done. Most of the Abx I run will "finish" with the bag still having a little left in it and the tubing still primed. It's rare for me to have a dripset run dry to the pump before the infusion "completes".

[aship, BSN]

Thanks everyone. I just found out our hospital policy when running primary ABX is to change the tubing each time a new bag is hung. So looks like I'll just be going through some tubing.

[turtlesRcool]

I don't agree with running an antibiotic through a primary line- I believe it should always be run as a piggyback so a flush can be run. Let's say the antibiotic is 50ml and 10ml is left in the tubing- the patient is not getting 20% of the needed medication. One hospital I worked at said there needed to be at least a 13ml flush to ensure the patient received the entire dose of the iv medication.

I agree it's better run as a piggyback. Unfortunately, after Hurricane Maria wiped out one of the factories in PR that makes saline, there has been a national shortage. We have very few small bags stocked. Our current (temporary) hospital policy is to run IV ABX as primary lines unless the patient already has fluids we can piggyback off of. We are even administering some as IVP over 5 minutes.