Secondary IV med (piggyback)

[flip/flop]

New policy on my unit is to hang all ATX using secondary tubing, back flowing the tubing, then setting the volume to 20 ml greater than the volume in the spiked med. The rationale is that this will insure the patient receive the total volume of the antibiotic, rather than leave some of the infusion sitting in the secondary tubing. It is ok to use the same secondary tubing for antibiotics that are compatible. If running incompatible ATX, a second primary solution, and piggyback would need to be set up. Though there is no official policy yet, on using secondaries, I have heard that in the ICUs in my hospital they have been using the back flow technique for years, but even take it a step further. In the ICU, they only use one (1) secondary tubing set, and infuse all meds through it, compatible or not, as long as they are compatible with the primary solution. Once the secondary med is empty they back flow the primary solution into the empty piggybacked bag, thus flushing the secondary tubing. This allows the RN to administer any medicine, compatible or not, even colored infusions such as iron, using the same secondary tubing, as long as the med is compatible with the running primary.

We run all drips, heparin, insulin etcetera separately. This practice is only used for intermittent infusions. Do you agree, or see any issue with using the same secondary tubing for all medicines?

[morte, LPN, LVN]

I would wonder if there aren't a few meds that this would be contraindicated for, d/t "coating" the tubing that doesn't come off with the back flush? and this may indeed preclude this method for that med at all, it would need its own set up, completely....

[flip/flop]

Yes, I believe there is research that insulin is about the only drug that adheres to the tubing, requiring a second flush. It is a high alert medication, and requires its own line per our protocol anyway.

[iluvivt, BSN, RN]

Backpriming is an acceptable procedure. Although the INS standards do not specifically use this term, the standards for tubing changes do support the use of backpriming. When a secondary set is connected and disconnected multiple times, it should be considered an intermittent set and therefore changed every 24 hours. So if you have a secondary but are connecting and reconnecting it functions as a primary intermittent and thus would need to be changed q 24 hrs per INS. This is because of the excessive manipulation on both ends. When a secondary and primary set remain connected, they can both be changed no more frequently than every 72 hours.

Regarding compatibility - you will have 2 issues. Compatibility between the secondary med and anything admixed in the primary fluid. This is the most important issue because this fluid is what will remain in the secondary tubing after you connect the next dose of the secondary med. So in other words your secondaries need to be compatible with the primary. Compatibility between 2 secondary medications is the other issue but it is a lesser concern if you are backflushing properly. The secondary tubing will be filled with fluid from the primary bag instead of the secondary medication after the backpriming procedure has been completed. .

[OleMissRN]

I've been doing this since I started out of school. Its what I was taught as a student during rotations. As iluvivt said, if you back-prime properly, there shouldn't be any issues. There are some medications, as previously mentioned (like insulin) that require their own primary tubing, but backpriming both saves money/utilities and prevents possible infection (related to keeping the end of the unused secondary sterile/not sterile).