Should secondary tubing for incompatible meds be back flushed or change the tubing?

[kawatts22]

Hi, I'm new to Allnurses! I'm currently working on my residency project and my hospital has no policy in place for the use of secondary IV tubing. I was looking for input or for resources about flushing the secondary tubing for incompatible medications. At this point some nurses on my floor just back flush the secondary tubing with the primary fluid (which is usually sodium chloride). I was wondering if this is best practice if the meds are not compatible and if we should be changing out the secondary tubing when administering a different medication. Thank you!

[LovingLife123]

I’m confused then as to what the point of secondary tubing is then? Why would you constantly have to change the tubing?

My hospital runs everything as primary. We flush after each transfusion. We only had secondary when flushes were on shortage due to the hurricane. The whole point was we could then hang the 250mL NS and run our piggybacks.

Am I missing something?

[kawatts22]

When running a medication like zosyn, at my hospital, we set up a primary normal saline flush bag of 250 mls. So when the med is done running the infusion pump is set to flush the primary line with 30-50 MLS of saline. My question is if I would have another medication such as a vancomycin strength that is not compatible, should I back prime the secondary tubing to rid of the incompatible zosyn or clamp it off, disconnect it, and get new secondary tubing for the incompatible vancomycin. I was taught both ways in nursing school.

[MunoRN, RN]

11 hours ago, kawatts22 said:

When running a medication like zosyn, at my hospital, we set up a primary normal saline flush bag of 250 mls. So when the med is done running the infusion pump is set to flush the primary line with 30-50 MLS of saline. My question is if I would have another medication such as a vancomycin strength that is not compatible, should I back prime the secondary tubing to rid of the incompatible zosyn or clamp it off, disconnect it, and get new secondary tubing for the incompatible vancomycin. I was taught both ways in nursing school.

If flushing the primary tubing is sufficient to clear the primary tubing between incompatible meds, which it is, why would it not be sufficient for the secondary tubing as well?

[kawatts22]

Good point. When the secondary med is done running there is some still sitting in the chamber. When I back prime to flush it, the chamber fills with saline and mixes with the med and push it back into the med bag. I guess I was just questioning if this was sufficient enough to rid all of the med in the chamber. And putting it in that perspective it would seem like it is sufficient enough. Good point. Thanks!

[lovingtheunloved, ASN, RN]

On 8/25/2019 at 12:34 AM, kawatts22 said:

When running a medication like zosyn, at my hospital, we set up a primary normal saline flush bag of 250 mls. So when the med is done running the infusion pump is set to flush the primary line with 30-50 MLS of saline. My question is if I would have another medication such as a vancomycin strength that is not compatible, should I back prime the secondary tubing to rid of the incompatible zosyn or clamp it off, disconnect it, and get new secondary tubing for the incompatible vancomycin. I was taught both ways in nursing school.

Zosyn and Vanco are compatible, just FYI.

[mmc51264, BSN, MSN, RN]

I was just going to reply the same lol. We use so much Vanc/Zosyn that I named my cat Zosyn (the next will be Vanc)

We run a second piggy back set for incompatible IV meds. Flushing in between if there is not a second IV access available

[kawatts22]

The cats name is amazing! And it's weird maybe it's just my floor, but no one ever runs zosyn and vanco together! I did learn recently (only been a nurse for a year) the strengths we use are compatible, but there are some strengths that aren't. That's just why I used it as an example. Thanks for your input on flushing the tubing!

[Swellz]

I've done it both ways at different facilities. I've also been told by pharmacists at different hospitals that I can't run vanco and zosyn together because the information is "inconclusive" as opposed to them being definitively incompatible. Just depends on where they are getting their information.

[kawatts22]

Yes, I was always told different things too! That's why I always ran them separately. I use a resource now called micromedics, I believe. I breaks it down to every strength of vanco and zosyn together. The most common ones we use at my facility the website said was compatible. I still have yet to run them together, still makes me nervous! Thanks for the input!