Hello all,
We will soon change our IV pumps and at the same time our IV tubings. A discussion with our pharmacists, when building the drug library open a can of worm.
Currently, intermittent antibiotics are given either with a secondary set or a primary set - depending on the settings and the patient condition.
The new IV sets that we will get are longer thus contain more volume.
Currently, at the end of the infusion, if given with a secondary set, the secondary set is backprimed and the bag discarded before the new one is connected. This leads to lost of 8.8mL of medication. For a 50mL bag, this is roughly 15% of the dose.
If given through a primary line, if the line is not flushed with a second minibag (with no medication) that 22 mL of medication would remain in the tubing, roughly 45% of the dose.
According to our pharmacist, this is likely too much of the dose that is ending up in the garbage.
Options are being discussed including, letting the pump run dry then flushing 10mL at the Y port just after the pump segment (for primary administration), backpriming the secondary bag then infusing the diluted solution (for secondary administration) and using a second minibag (with no medication) to flush the tubing after administration.
I was curious to see what others are doing since all of the options we are looking at are either costing more or will require significantly more time for the nurse.
Thank you!
When set up correctly, the volume remaining in the secondary tubing should be much less than the full priming volume of the tubing. The total priming volume of Baxter secondary tubing for instance is 8.8 mls. The fluid level in the secondary tubing will equalize with the fluid level in the primary bag. Nurses will often use only half of the hanger that is used to lower the primary bag by hanging both the loop and the hook on the IV pole with the primary bag hanging from the half-way point of the hanger. This will usually leave the primary bag fluid level near the top of hte secondary tubing, leaving 6 or more mls uninfused. When the primary bag is lowered using the full length of the hanger there should only be a few mls left uninfused. Some manufacturers such as alaris use larger volume/length secondaries up to 16mls but they also have 10ml available. But no matter what the length, so long as the extra length is kept above the primary bag it will still empty during the secondary infusion.
Changing set lengths that are used. Are you piggybacking above or below the pump? Some antibiotics can be given in a smaller amount of fliud such as cephalosporins in 10 mLs. This could be given with a syringe pump but this would involve changes for pharmacy compounding and must be involved. The system you engineer should have the fewest amount of connections and needleless connectors. Your goal is to reduce the manipulation of the entire system to as low as possible (INS SOP). You could consider backpriming only to remove the air in the secondary set, so that the 8 mLs would not be lost but given with the next dose (stability of drug must be considered so pharmacy involvement again). This would mean that the 1st dose is a little shortchanged but the entire dose is infused with each subsequent dose. Manual syringe flushing adds manipulation, reliance on human compliance factors, and could increase the contamination risk. This would become a factor requiring input from infection prevention. Additional minibag flush adds costs and some risk also. Also, I would contact the clinical dept at the pump/set manufacturer for their input. Tough decision. Please let use know the decisions you make. Lynn
Lynn Hadaway, M.Ed., RN, BC, CRNI
Lynn Hadaway Associates, Inc.
126 Main Street, PO Box 10
Milner, GA 30257
Website http://www.hadawayassociates.com
Office Phone 770-358-7861