solumedrol IV

You *can* do either, but consult your instructor, pharmacist, P&P etc. The hospital might have a preferred method.

Sometimes the patient will have a TKO (10 ml/hr as a carrier for meds) running -- in that case piggybacking is easiest.

Otherwise you can run it as a primary, and then spike a 50 ml bag of NS (or D5W if med is incompatible with NS -- a few are) and run 30 ml through it to flush ALL of the med from the tubing and into the patient.

If you run it as a piggyback with no TKO, again keep the primary running for 30 ml so that the med gets flushed in.

1). Solumedrol must be given over specified period of time as prescribed by provider. It really depends on circumstances but in "acute" situations generally load has to be given over 1 - 2 hours. If you care for patient with anaphylaxis, for example, loading over 3 hours will be pointless. On the other hand, running it wide open (more than 0.5 g in less than 30 min) is associated with severe bradyarrythmias.

2). Solumedrol is not compatible with some other IV meds, being it in line or at Y-site.

3). You must give all the prescribed dose.

Counting these three things, I would not run Solumedrol dose as primary line, especially if other drugs might be administered through it. You can either hang it separately or call for piggyback order with some NS to keep the vein open and flush your system through. Just be careful if your patient doesn't need additional fluid ("flushing" piggybacks tend to get forgotten and then 30 cc X 24 h equals 720 ml - not enough to get standard 1000 cc bag empty and the pump beeping but just enough to cause problems in someone with BP already high or heart/kidneys already in bad shape).

I almost always run meds with piggyback. If the pt has no maintenance fluid running, I would run the primary at TKO (NS at 10-20 ml/hr). It's especially useful if the pt has multiple piggyback meds, I just switch out the secondary lines.

Another thing to consider is the time/intake lost with running piggybacks with the maintenance fluid. Some piggyback meds (i.e. Antibiotics like zosyn) run over hours, so your pt will not get the maintenance fluid during that period of time. I would hook up the primary line with piggyback meds to the lowest port of the primary maintenance line so my pt can get both at the same time. Of course check the compatibility of each fluid, and ask your instructor/pharmacy if you're not sure.