Secondary and piggyback

firstinfamily, RN · Dec 22, 2014

I can only answer your question while visualizing what system I use. Our pumps can handle two infusions, they are defined as A(primary) and B(secondary, AAL or piggyback) if I am hanging an Antibiotic IV, I have a NSS flush line or other compatible fluids as the primary and set the A setting on like 10 to provide a flush with a total volume of 20. OK so that is the primary line. Now I take the secondary line using the same pump, use the B setting and put in the total volume(usually minus 5 cc so the line will not run completely dry) and the infusion rate(say pharmacy wants it in an hour and it is a 100 cc bag) so B is set for 100. When I turn the pump on, A will infuse until 20 cc's has completed, then the secondary, B will start and continue until 95cc is infused, then the primary A will restart and infuse another 20 ccs. There is a setting for both to run congruently, but I have not used that since my return to acute care. The B or secondary line is plugged into the A line at the point above the cassette that enters the pump. However, there are other ports below the pump cassette that I could plug in another line if compatible and if needed. That line would have to have a separate pump, unless I have a triple pump set-up. In the "old days" we use to use gravity and lower the primary bag when a secondary bag was infusing, that way when the secondary completed, the primary would continue. It can be very confusing. Check with your facility, see if there is a manufacterer's booklet for the type of pumps you use(every pump is different), check with your nurse educator and even when she/he acts exasperated, tell them you need a guide. Its OK!!!

kiszi, RN · Dec 23, 2014

If I am infusing a med that is connected to the secondary tubing above the pump, I call it either a secondary or a piggyback. If I have something y'd in below the pump I say it is, um, y'd in. :) Now that we have the terminology out of the way...

I had to re-read your post to understand what was being asked, but here goes:

When a secondary (above the pump) is started, the pump will go at the secondary rate until the amount of the secondary finishes, and then the pump will restart at the primary rate. The primary bag will resume infusing when the secondary bag is empty.

When two lines are y'd in below the pump, each one (which should be on separate pumps/channels) will infuse at the rate that is set. So if line A is set to infuse 100ml/hr and line B is set at 200ml/hr, the patient will get a total of 300ml/hr running into the IV site. Y-ing in is indicated if the primary infusion should not be stopped while a secondary runs, for example with vasoactive meds. Just be aware of the total volume/hr the patient is getting in that site, in cases of fragile veins, existing CHF, etc.

SierraBravo · Dec 23, 2014

What kind of pump are you using?

Birdy2 · Dec 23, 2014

Kiszi, that answered my question. Thanks so much! I thought that's how it was, just got confused by something someone told me the other day.