What do you guys do after you hang the secondary bag and there's that little bit left?

[Marythenurse1994]

Hi there! I got a new job as an infusion nurse and it heavily involves IV bags and pumps (which I am vaguely familiar with). My question is, when infusing the secondary bag (Medication), and there's that little bit left in the chamber, but you want the patient to get ALL the med (but dont want to run the risk of embolism since there's air and little solution), what do you do? Do i back prime from the primary again? Do i just stop the medication then and infuse NS? what is recommended? i've been reading everywhere, but can't find a proper answer. Also, the nurses I work with have diffierent solutions which has confused me more! Advice would be so great! :)

[CalicoKitty, BSN, MSN, RN]

If the primary bag is properly lower than the secondary (medication) bag, the chamber should empty pretty well and sometimes have a little bit left in the tubing. Backfill when starting new secondary bag. Many newer pumps have air bubble sensors so not likely to infuse just air, especially not enough to form an air embolism. Aside from the chamber, there's the 10+ mls of fluid in the tubing set to get to the patient, too. Sometimes I add 10 or 20 mls to the pump to flush it through, but in theory that is giving fluids without a doctor's order, like the old KVO 5mls/hr.... So, follow your policy. ?

[MunoRN, RN]

Incompletely infusing the secondary is usually due to the height of the secondary bag relative to the primary. In a primary/secondary set-up, you're creating a single fluid column made up of the two bags and the tubing in between. That fluid column will empty from the top down, so if the secondary bag is not high enough then it will only empty to the point where it's level with the top fluid line in the primary bag.

Long story short, if your secondary bag is not completely emptying, raise the height of secondary or lower the height of the primary.

Since it's a single fluid column, you're not risking infusing air just because the secondary bag empties completely so long as the primary has fluid in it.

Keep in mind that programming the pump to infuse the secondary or the primary doesn't actually determine which bag is infusing since that is fully determined by the relative height of the fluid levels in each, all you're really doing when programming a secondary infusion is telling the pump to run at a certain rate for a certain amount of time then return to the original rate. (not counting manufacturers that incorrectly refer to 2 separate infusions as a primary and secondary).

[akulahawkRN, ADN, RN, EMT-P]

Assuming you're truly setting up a primary/secondary system, as MunoRN says, emptying the secondary bag completely depends upon the height the secondary med is above the primary bag. With those systems, the pump simply infuses at a certain rate and changes to another rate after a certain volume has been infused. It's otherwise "just" a gravity based system. If you want to more completely empty the "secondary" bag, just raise the height of the bag well above the height of the primary bag. You won't entirely empty the bag or the secondary tubing, but it won't suck air into the primary line from the secondary until the fluid level of the primary line drops below the port the secondary tubing is attached to. You'd see the fluid column in the secondary drop and remain level with the fluid level in the primary line. That's thanks to the way water columns work.

I've used pump systems that kind of mimic this kind of system but those require you to be a bit attentive in ensuring that air doesn't get into the cartridge. Getting air into one of those cartridges can be a real headache. Such systems can be nice in that you do have an option to use a "secondary" type tubing or a syringe to infuse a med concurrently with a primary fluid.

Bottom line is that you need to know your pump system and how you must set up your secondary infusions. Once you've done it a few times, you'll realize it's a lot easier than you think.