Running Abx as primaries/Not setting up NS primaries

[klarck]

I just started at a new institution and am a little puzzled by one the the practices on the floor. When an IVPB gtt such as Zosyn or Vanco is written for a pt who's not on IV maintenance fluids/heplocked, the nurses here will connect and run it without setting up a 0.9NS primary. They just put the abx gtt on primary tubing, program the pump and run it (at the correct rate) until the pump alarms IV-complete.

My gut reaction is this is not a good thing, but of course that may be because it's new and strange to me. I'm uneasy about it, but can't think of a reason not to do this. Any thoughts?

[Mimi2RN, ASN, RN]

We flush the saline lock, run the med, run a flush to clear the line before clamping. No primary line.

[IVRUS, BSN, RN]

I just started at a new institution and am a little puzzled by one the the practices on the floor. When an IVPB gtt such as Zosyn or Vanco is written for a pt who's not on IV maintenance fluids/heplocked, the nurses here will connect and run it without setting up a 0.9NS primary. They just put the abx gtt on primary tubing, program the pump and run it (at the correct rate) until the pump alarms IV-complete.

My gut reaction is this is not a good thing, but of course that may be because it's new and strange to me. I'm uneasy about it, but can't think of a reason not to do this. Any thoughts?

Well I would definetly advocate for a primary or flush line, if the IVAB was mixed in a small volume, say 50cc. One needs to know how many cc's are in their IV tubing, as ours holds 21cc which when you think about it, is almost half of the dose. In this case, hang a NS bag as your primary and piggyback the IVAB into it.

If, however, you have a 250cc bag of Vancomycin, then a "chaser" may not be needed. What does you P&P of your institution say?

[klarck]

I haven't contacted our P&P - I'm a new guy on nights and am trying to quietly acculturate to my new institution. Just trying to get a feel for whether this is weird or not.

[Penelope_Pitstop, BSN, RN]

My advice is to not worry about what everyone else does.

I've followed lots of nurses who utilize the practice of your coworkers. It isn't considered "wrong" where I am unless the patient has a central line, so there's no point in me worrying about what others are doing.

[iluvivt, BSN, RN]

Yes this is an acceptable practice. You are administering a "primary intermittent" infusion. ON Abx and other medications that have a small volume we use the microbore tubing and a syringe pump so as not to lose an excessive amt of the medication. Our primary tubing is fairly short and the priming volumes is very low. If you look at the package of the product you use it may have a priming volume listed. By the way INS recommends a 24 hr tubing change on "primary intermittent" infusions so check your policy. The frequent connection and disconnections increase the chance for infection and since there are no studies to prove this does not increase the pts risk INS takes that stance.