When to piggyback This

Sun0408, ASN, RN · Jan 5, 2015

When you y something in, it is on it's own pump and has it's own primary tubing. So what ever you programmed in is what it will run at. When you y it is the pt will get both fluids. When you piggyback the primary fluid is stopped and the secondary runs in, once it is finished the primary fluid will resume. This works if you have the pump programmed correctly. Also with piggybacking you need to mKe sure the secondary is compatible with primary fluid. Same as checking when you y something in. Hope this helps.

nurseprnRN, BSN, RN · Jan 5, 2015

Imagine you have two IVs, side by side, running into a bucket. One, NS maintenance, is on a pump at 20cc/hour. The other, the antibiotic, is on a pump at 100cc/hr. How much fluid goes into the bucket in an hour? Right, 120cc/hour. How much of it is antibiotic Right, 100cc. How much is NS? Right, 20 cc.

Now, plug the ends of those two IVs into a Y connector or somewhere else, but don't change their settings and drop the end of the Y connector into the bucket. How much antibiotic runs into the Y connector and into the bucket in an hour? Still 100cc. How much NS? Still 20cc. Total? Still 120cc.

Now, pretend that the bucket has been sterile all along and you can pick up that Y connector and plug it into an intravenous line.

How much fluid goes into the patient in an hour? 120cc. How much antibiotic goes in in an hour? 100cc. How much NS? 20cc.

Moral of the story: What a pump puts into the tubing goes in at its own rate regardless of where in the line it's plugged in, what else is running in the same line, or how fast. One pump does not influence the rate in the other pump's bag of responsibility.

Editorial Team / Admin · Jan 5, 2015

Birdy, you have asked a lot of IV related questions in a short amount of time. I really think you would benefit from making an appointment with your educator and getting some in-depth review of IV therapy and how the pumps your facility uses work, especially as you are a new nurse.

Editorial Team / Admin · Jan 5, 2015

When you piggyback the primary fluid is stopped and the secondary runs in, once it is finished the primary fluid will resume.

Depending on the brand of pump, some will continue to infuse the primary fluid while other medications are infusing. This is why I suggest the OP sit down with the educator- he/she needs to be familiar with the mechanisms of the pump he/she is using in every day nursing tasks.

Birdy2 · Jan 6, 2015

Thanks. I know that's how it works but someone else on a different post said that if something were y'd in below the pump to a ns line then it would all flush in at the rate the saline was set to. Maybe they meant if it weren't set to its own channel. I think I got confused by that.

And I was just wondering why some nurses give antibiotics as an intermittent infusion with no fluids even attached to the pt, some piggyback it for saline to flush after (primary and secondary programmed), and some y it in below to run at the same time as the ns. I always thought any antibiotic should be piggybacked to ns because that's what it says when u look them up, but some nurses don't run it with anything if the patient isn't ordered fluids. If they are getting fluids continuously then I get y'ing in below the pump to the basic infusion and setting both channels as primary so they still get the fluids and the med. I have also seen nurses infuse antibiotics as a piggyback (above pump) when the pt is supposed to be getting continuous fluids (wouldn't this be a time when u y it in below). So it's easy to get confused about what's right and wrong.

SierraBravo · Jan 6, 2015

The concept of running a secondary or y-siting something together is rather easy to understand once you've been taught how to do it; but as Rose Queen said, it really depends on which brand of pump you are using. For example, if you are using Alaris pumps then by running a secondary the primary will automatically stop while the secondary is infusing, as opposed to y-siting the two lines together whereby both infusions will infuse simultaneously. If you y-site 2 infusions, the effective rate going into the patient will be the sum of the two infusion rates so you need to take that into account (consider the gauge of the IV if it's a peripheral IV). I agree 100% with Rose Queen, please make an effort to speak with your charge nurse, your nurse educator, or your nurse manager to clarify your concerns.

nurseprnRN, BSN, RN · Jan 6, 2015

I know that's how it works but someone else on a different post said that if something were y'd in below the pump to a ns line then it would all flush in at the rate the saline was set to. Maybe they meant if it weren't set to its own channel.

That person was wrong, or perhaps you misunderstood. If the saline and the piggyback are both running on separate pumps, the saline is going at its own rate and the piggyback is running at its own rate. The saline is "flushing" at its own rate, but that doesn't change the rate the piggyback runs at.

And I was just wondering why some nurses give antibiotics as an intermittent infusion with no fluids even attached to the pt, some piggyback it for saline to flush after (primary and secondary programmed), and some y it in below to run at the same time as the ns. I always thought any antibiotic should be piggybacked to ns because that's what it says when u look them up, but some nurses don't run it with anything if the patient isn't ordered fluids.

An intermittent IV, like an antibiotic or other that's only given sometimes, doesn't need any more backup fluid to carry it along than it has in its own little baggie. That can be plugged into a locked catheter, run, and flushed with a syringe briefly at the end to clear the residual med out of the IV device, which is then capped until next time. This is perfectly appropriate for someone who is not prescribed maintenance or supplemental IV fluids.

If they are getting fluids continuously then I get y'ing in below the pump to the basic infusion and setting both channels as primary so they still get the fluids and the med. I have also seen nurses infuse antibiotics as a piggyback (above pump) when the pt is supposed to be getting continuous fluids (wouldn't this be a time when u y it in below). So it's easy to get confused about what's right and wrong.

If someone is on a fairly strict fluid limit, it may be appropriate to count the volume in the piggybacks as part of the hourly total IV rate to avoid overload, in which case what you describe makes that happen(which is the effect of what you describe-- the piggyback runs first, then the maintenance bag resumes). Conversely, if somebody is on maintenance fluids just to keep a line open and it doesn't really matter how much IV fluid he gets, it's also OK to turn off/pause the maintenance line. This is a matter of nursing judgment and critical thinking.

I hope this helps you think about it. I agree that you need to spend some time with your clinical educator fooling with this hands-on with the pumps you have so you can really see how it works. If she has a set-up with the piggyback with colored water in it so you can visualize what's happening clearly, so much the better.

Birdy2 · Jan 6, 2015

Thanks everyone! I thjnk i understand better now how it works. I'm still going to ask someone to confirm I've been doing things correctly.

SierraBravo · Jan 6, 2015

Thanks everyone! I thjnk i understand better now how it works. I'm still going to ask someone to confirm I've been doing things correctly.

Birdy, I think that is a good idea. Don't take this the wrong way, but if I were your nurse manager I would prefer that you check with someone on your unit to make sure you're doing things correctly BEFORE you do it, not after the fact.

champagnesupeRNova · Jan 6, 2015

Thanks. I know that's how it works but someone else on a different post said that if something were y'd in below the pump to a ns line then it would all flush in at the rate the saline was set to. Maybe they meant if it weren't set to its own channel. I think I got confused by that.

I can see how that would be confusing. Basically, the only way the antibiotic would be flushed in at the rate the NS going at was if the antibiotic wasn't on it's own pump and just flooding into the line; essentially, getting pushed into the line by the NS.

The fact that the antibiotic is on its own pump and programmed to a specific rate means that the amount of fluid (antibiotic) is being controlled and it's only letting a set amount of fluid into the tubing in the first place. Hope that helps.

Karou · Jan 7, 2015

Everyone has given you some fantastic information! I don't have much to add, except for some advice on when to piggyback with continuous IVF, versus when to use a second channel.

We use Alaris pumps so when you program a piggyback (secondary) bag into the same channel as continuous IVF, the continuous IVF automatically stops while the piggyback runs and resumes when it is finished.

I have seen newer nurses piggyback antibiotics like zosyn (which runs slowly over 3 hours) when the patient has a high rate of Continuous IVF ordered (like 150cc/hr). I always correct them on that because that is three hours that the patient is not receiving the 150cc\hr fluid. It adds up to 450cc missed. So if an antibiotic needs to run for more than an hour, I get a second channel with primary tubing and run it separate, y-site connecting it at the port closest to the patient below the pump. This way the Pt gets the antibiotic and continuous fluid.

That's all I rally have to add.