Simple IV/tubing questions

EmergencyNrse · Nov 2, 2009

09newgrad;3951103 hey guys, im a new nurse here and these questions will seem hilariously simple to many of you, but i'd just like them to be clarified please. i'm just trying to be as safe and competent as i can be, thanks!

no such thing as a dumb question.

1. say for example my pt's 1000 cc bag of ns is empty and i just need to hang a new bag. do you spike the new bag, unhook from the pt and re-prime the tubing to get rid of any air, or just spike the bag, set the rate, and start the infusion without removing from the pt?

it depends. did you bleed it dry and there is air in the tubing? if you have it is easier to spike a new bag, disconnect it on the patient side and bleed the air out of it and reconnect. this will save you many return trips for "air in the line" alarms.

if there is no air in the tubing just spike a new bag.

also, check with your hospitals policy on when iv tubing expires and needs changed. 24/36/48 hrs. different medications will need tubing changes sooner than others.

i've seen some nurses do it both ways which has led to my confusion.

whatever gets the job done. no right or wrong way here. ultimately the pump will let you know by screaming at you

2. the pumps at the hospital where i work have the option of doing the backpriming of secondary tubing for you, as opposed to manually doing it yourself. how far up into the chamber do you backprime with the ns before starting the secondary med?

just prime your secondary set before you connect and you will minimize having to backprime anything. i find that option is for ultra-sensitive pumps to "air in the line" alarms. you will find out by just trying different methods... hopefully the one that doesn't set of the alarm as often. (god i hate those alarms. they haunt me in my sleep)

3. if the pump wasn't there to hook my secondary tubing into, would i hook the secondary tubing into the closest port to the patient?

your "secondary" or piggyback can run on shorter secondary iv tubing connected to a proximal port nearer your primary solution. yes, you can run a piggyback in primary tubing but you would connect that infusion to the distal port (near the patient).

be careful not to run sensitive medications in piggybacks without a pump. never microdrips. simple solutions are okay but i would always defer to your hospital policies on iv therapy. some new nurses can't calculate gtt-rates and i see more hospitals moving to pump only infusions.

4. if ns is currently infusing and i push an iv med, i don't need to flush before/after correct?

if it's a simple ns infusion you are correct. no need to flush before but you may want to give a bolus in order to flush the line of medication and ensure you have delivered the appropriate dose. you can also use a flush after the medication but opening the line a little is easier.

sajules · Nov 2, 2009

Kudos for trying to be safe and competent. I am a new nurse as well and trying to do just the same thing. No questions is too simple or silly to me. I ask questions all the time and I will try my best to answer yours.

1. Say for example my pt's 1000 cc bag of NS is empty and I just need to hang a new bag. Do you spike the new bag, unhook from the pt and re-prime the tubing to get rid of any air, or just spike the bag, set the rate, and start the infusion without removing from the pt?

``I never unhook the bag. I usually pause the pump, spike the new bag and then continue. If you have let the line begin to run dry, you can hook up to the new bag and use a syringe, hook it to a side port, and draw back to get any air out of the tubing and just have NS in the line. Does that make sense?

2. The pumps at the hospital where I work have the option of doing the backpriming of secondary tubing for you, as opposed to manually doing it yourself. How far up into the chamber do you backprime with the NS before starting the secondary med?

--Our pumps do not have the option to backprime, so I am used to hooking up the secondary line and letting gravity do the work for me. Just hold it below the primary infusion and let the NS fill the secondary tubing, clamp, and then hook up the secondary med.

3. If the pump wasn't there to hook my secondary tubing into, would I hook the secondary tubing into the closest port to the patient?

--Our secondary lines go into the port on our tubing above the pump to help ensure that there are no med administration errors.

4. If NS is currently infusing and I push an IV med, I don't need to flush before/after correct?

--This is a judegment call and should be based on the med you are infusing. The way I look at it is if you just let the infusion run, you may bolus a patient very quickly with a med. For my own practice, I like to clamp the line, infuse the med, and push it slowly through so I ensure that I do not harm the patient with a rapid bolus of any med. Just my own practice, but as I'm sure you've figured out, there are many ways to do almost any of the things we do!

Hope this helps!

~Julie

Aaron86 · Nov 2, 2009

All good questions that I too would like to know the answers to.

It is incredibly frustrating trying to learn things when you see 50 different nurses doing it 50 different ways.

I've had preceptors tell me I need to stop the saline when doing IV psuh because I don't want it going in too fast, but this makes no sense to me. Wouldn't that just mean your injection would fill the line and just sit there till you restart the saline? Wouldn't that just give them a concentrated amount as soon as you unclamp the line?

nkenn04 · Nov 2, 2009

I think that is why you do a 3ml flush with NS after you push the med. One flush before, then the med, then another flush at the same rate you pushed the med. And as you push, you are kinking the tubing with your other hand above the port you are using. After the final flush, unpause and restart your line.

Ayvah, RN · Nov 3, 2009

1. Say for example my pt's 1000 cc bag of NS is empty and I just need to hang a new bag. Do you spike the new bag, unhook from the pt and re-prime the tubing to get rid of any air, or just spike the bag, set the rate, and start the infusion without removing from the pt?

-When you are doing the initial set up of the maintenance IV, set the pump to 900 or 950ml. Then when it starts to beep that its done, you can just pop off the old bag and pop on the new one and reset it to 900/950. You only need to reprime if, as the earlier poster said, the bag was completely emptied and now there is air in the line, or if the tubing is more than 72 hrs old or per policy.

2. The pumps at the hospital where I work have the option of doing the backpriming of secondary tubing for you, as opposed to manually doing it yourself. How far up into the chamber do you backprime with the NS before starting the secondary med?

-This is per preference. I like to backprime so that I can ensure that the patient gets every last drop. If I were to prime it normally, it seems like I'm always a couple cc's off and the pump beeps incessantly when its done instead of switching over to maintenance.

3. If the pump wasn't there to hook my secondary tubing into, would I hook the secondary tubing into the closest port to the patient?

-If for some reason the pump is unable to piggyback, simply get another pump, hook it into the line, and set the additional pump to go, and you'll run both lines together via the two pumps. Please do make sure both iv fluids are compatible, especially if you are doing this.

4. If NS is currently infusing and I push an IV med, I don't need to flush before/after correct?

-Correct, you don't need to flush as the IV is doing it for you. I very much prefer to push IV meds into lines that already have saline infusing. It helps dilute the med, I can give it incredibly slow if I want to without disturbing the patient. And if you are worried about it being bolused, think of it this way:

If you push 0.01ml in and then wait 5 seconds

-if you do it in a SL, you have given it directly into the bloodstream, and then you wait 5 seconds for the body to adjust

-if you do it in a running IV, it is diluted in saline before going into the bloodstream, and flushed before, during, and after with saline over the 5 seconds. Even if the IV is going at 500ml/hr, it is still preferable, than going directly into the vein, which is instant as soon as you push it into a SL. I'd take 500/hr over instant. If I'm overlooking something concerning that, someone please let me know. It seems gentler on the system to push IV meds into running saline lines whenever possible.

So no, you don't need to stop saline when you are giving IVP meds.

Aaron86 · Nov 3, 2009

4. If NS is currently infusing and I push an IV med, I don't need to flush before/after correct?
-Correct, you don't need to flush as the IV is doing it for you. I very much prefer to push IV meds into lines that already have saline infusing. It helps dilute the med, I can give it incredibly slow if I want to without disturbing the patient. And if you are worried about it being bolused, think of it this way:
If you push 0.01ml in and then wait 5 seconds
-if you do it in a SL, you have given it directly into the bloodstream, and then you wait 5 seconds for the body to adjust
-if you do it in a running IV, it is diluted in saline before going into the bloodstream, and flushed before, during, and after with saline over the 5 seconds. Even if the IV is going at 500ml/hr, it is still preferable, than going directly into the vein, which is instant as soon as you push it into a SL. I'd take 500/hr over instant. If I'm overlooking something concerning that, someone please let me know. It seems gentler on the system to push IV meds into running saline lines whenever possible.
So no, you don't need to stop saline when you are giving IVP meds.

Thanks!

This makes a lot more sense to me than the kink/flush/push/flush/unkink way.

I really wish I had a set of IV tubing around that I could push colored dye into. I wonder how much diffusion actually moves the meds up or down the line once a little bit has been pushed.