Running the pump dry

[usethehaldol]

TL;Dr

Is it okay to not run the pump dry?

So I work in an ICU and a number of people have complained about pumps being run dry.

For newbies like me who don't know; Running a pump dry is using up all the volume in a hung medication.

Opposed to leaving just the right amount of in the drip chamber/tubing so you don't have to prime the tubing when you hang the medication again. You just spike the new bag with the old tubing and hop to it.

I get it in continuous medications (duh)

What about other medications? Isn't there 20 cc of medication in the drip chamber/tubing that you aren't giving each time you stop a med short? Is it somehow okay to not run medications dry?

I only ask because the experienced nurses are the ones not running the pump dry and they probably know something I don't. I didn't ask yesterday because dude seemed genuinely pissed and I was trying my best not to drown.

[JPnewACNP, BSN]

Honestly, this usually isn’t a big deal and I don’t run anything dry unless I’m there with another bag. For continuous drips, I leave myself about an hour or so of volume to remind me to get another bag. For intermittents, I do 5ml less than the total volume because on some pumps it’s a pain to get air out of the main line and shouldn’t make much of a difference to the pt. Use discretion though, somethings (tpa, amio bolus, etc) I prefer to run it dry.

[MunoRN, RN]

Using a primary / secondary set-up would be a better way of making sure the patient is getting the full dose, if that is your concern.

In my experience, running the tubing dry to the pump if the there will be subsequent infusions through that tubing is generally considered to be a severe nursing sin and is adequate reason for nurse-on-nurse homicide, so I would avoid it if possible even if you don't see the big deal with it.

If your concern is making sure the patient gets the full dose, then it wouldn't make sense to run the infusion dry to the pump since then next person will have to re-prime the tubing to clear that air which will waste far more of the medication than you will have infused by running it dry to the pump. At least after the first infusion through that tubing the line will be primed and the patient will get the full dose, so long as you don't run it dry. But again, a primary / secondary set-up would be the preferred way to ensure the patient gets the full dose with each infusion.

[HappyCCRN1, BSN]

Agree with the above. If you are giving an antibiotic or electrolyte replacement, etc., they need the whole bag. Use a secondary in this situation. I see infusing those medications with a primary set instead of a secondary as a nursing sin—it drives me crazy.

[TheLastUnicorn]

Depending on the pumps used, it really doesn't matter. I've used pumps with a back prime feature, so you can hook up a 250 of NSS and use that to back prime the secondary tubing and hang a new bag. I've also had pumps with out that feature, that have only a secondary option and learned that when you unclamp the secondary while the primary is running, it will back flow up the secondary line, essentially back priming it when you unspike the old bag (be ready to clamp quickly). Spike the new one and good to go.

Also, depending on the medication and the pharmacist; most our IV meds have an extra amount of fluid to prime the line with.

[buckchaser10]

I'd have to understand the set up you are talking about but traditionally medications would be piggy-backed into a primary solution. The piggy back eventually won't run any further and primary will take over, leaving you a line that is always primed. You can then back prime the secondary to remove air. If you are talking primary fluid then no just waste the little bit of fluid in the bag and re-spike the new bag. This keeps the tubing as one closed system rather than introducing increased risk for sepsis do to continuously disconnecting the line to prime primary fluid.

[Kayla.01123]

@HappyCCRN1 YES- not only does it drive me crazy, are nurses who do this contributing to the development of those resistant organisms?? There's enough fluid in those IVs to be considered a substantial amount missed, especially if the patient is getting multiple doses a day for multiple days. As a former traveler- I saw this in every one of the 15 facilities I worked in... One facility even stopped stocking smaller IV bags and secondary tubing with the expectation that nurses were going in and flushing the IV line to be sure the patient got the whole dose. Ya sure...

[MyAimIsTrue, BSN]

What if there are no fluids ordered? Is it okay to hang a bag of NS as primary? What if they are on fluid restriction?

[Kayla.01123]

@MyAimIsTrue The order is for IVPB, so I feel like that means hanging it on a primary is technically not going by what the order says. Hanging a primary is solely for the purpose of ensuring the line is fully flushed to ensure the entire dose of medication is given. So the patient should not be getting any more than maybe 10 mL of fluid outside of the antibiotic- based on just setting the pump to infuse an extra 30-45 mL to help flush the tube. And if the patient is on a fluid restriction, maybe PO medications would be better.

[MunoRN, RN]

16 minutes ago, Kayla.01123 said:

@MyAimIsTrue The order is for IVPB, so I feel like that means hanging it on a primary is technically not going by what the order says. Hanging a primary is solely for the purpose of ensuring the line is fully flushed to ensure the entire dose of medication is given. So the patient should not be getting any more than maybe 10 mL of fluid outside of the antibiotic- based on just setting the pump to infuse an extra 30-45 mL to help flush the tube. And if the patient is on a fluid restriction, maybe PO medications would be better.

IVPB, or IV piggyback, is specifying that it be infused by a secondary set-up, which by definition requires a primary set-up to function.

[MunoRN, RN]

3 hours ago, MyAimIsTrue said:

What if there are no fluids ordered? Is it okay to hang a bag of NS as primary? What if they are on fluid restriction?

The role of the prescribing provider is to specify the medication, the dose, the route, and the frequency.  The order for the medication includes the practices necessary to administer the medication.  For instance, an order for IV morphine doesn't include an order to flush the medication through the IV, nor does it need to.  The same goes for the equipment, devices, and fluids needed to appropriately administer the ordered medication.  Taking into account the amount of fluid that the medication will be reconstituted in, and the amount required to infuse the full dose is part of what's expected of the ordering physician, if they aren't aware of the total volume of fluid required then some education is indicated.

[Jennifer,RN]

I personally use a primary and secondary set up for these situations. I like this set up because the primary can then flush whatever medication is left in the tubing after the secondary is complete. There are certain situations where medications must be primary. For instance; a cardiac drip, Insulin, or some other critical drip. With these, I don't run them dry. I'll wait until the bag is empty, but that there is still medication in the chamber. It's a PAIN to deal with air in the line and like other people stated, you will just waste more of the medication.