What to set VTBI to when antibiotic is the primary?

FL_Nurse92 · Aug 12, 2016

Honestly everyone sets their VTBI differently. Some set it to 250 while some set it to 225. Either way the pump isn't just going to be infusing air into the patient. Believe me it will beep and beep and continue to beep until the problem is fixed!

mmf0811 · Aug 12, 2016

Thanks for your response FL_Nurse92.. I figured but I feel more confident about it now!

FL_Nurse92 · Aug 12, 2016

No worries, I'm a semi new nurse myself (1 year)

iluvivt, BSN, RN · Aug 12, 2016

Are you using a pump with a functional air-in-line detector? What brand and type is it? You need to find out? As far as the volume to be infused: You want to set it as close as possible to the actual volume in the bag if you are running it as a primary infusion (you were doing it as a primary as opposed to a secondary). I prefer to set it just a bit under the actual volume because I could always come back and add some more volume to finish the medication. It is better than dealing with a pesky air alarm

BSN16 · Aug 13, 2016

The only reason other nurses do this is so that their line doesn't run dry. if you put in 225 instead of the 250 ml, it skips the step of having to reprime the line next time you give vanco

marigold321 · Aug 13, 2016

Don't set the antibiotic as the primary-there should always be a secondary. What if you get busy and the line goes dry? Even if it's just TKVO, you need to have that backup.

Check the drug monograph for medication specific infusion rates as well as your agency policy. We can advise you on vanc but you will need to know where to go for accurate and timely information for your next infusion.

OkieOBRN, MSN · Aug 13, 2016

I always run antibiotics as a secondary. If the patient doesn't have an IVF order, I use a 100ml or 250ml bag of NS. I set the primary at say 125ml/hr, then set that VTBI for 75 mls. Then I run the antibiotic as a secondary and set it at whatever run rate is ordered and set the VTBI for the total amount. The pump then delivers the entire abx, instead of just a partial. I am of the belief that if 200mg of Ampicillin is ordered, then I need to do what I can to run all 200 mg of Ampicillin in, not leave it in the line.

When the secondary pump is done, the line is flushed with the primary infusion. Then I saline lock. I even do this when I work ED, although I am in the minority in that area.

iluvivt, BSN, RN · Aug 21, 2016

There is nothing inherently wrong in running a IV intermittent medication as a primary infusion.I get that the terminology can be confusing but by this I mean that you have any locked venous access device.such as a PICC,PIV,or any type of CVAD and you use primary tubing to administer and then disconnect and flush your line when completed.Technically you must have an order or policy or standardized procedure (depending upon your BRN in the US) to order any additional IV fluids.

chelbell27 · Jul 18, 2019

iluvivt,

I am actually doing a project on this for my residency. When you run the IVPB on a primary line, what are your opinions on medication waste. For example, the tubing from the actual pump mechanism to the patient. Without a primary line running KVO, the pump was blaring "air in line" because the med had run out above the actual pump. I disconnected a 50 mL bag of Ancef the nurse before me ran on primary tubing and measured 18 mL of abx in the tubing from the actual pump to the PIV lock, almost 1/3 of the medication.