The pharmacist and I were talking about hospital policy: hang NS on primary tubing for tko and flushing, use one secondary set for all antibiotics. Backflush to clear the secondary set prior to spiking the next antibiotic. We discussed using an inline filter if the patient is receiving several different antibiotics to catch debri and microcrystals/precipitate. (is that clear so far?)
The pharmacist disagreed with this policy stating that all flow in the tubing should be forward only. He mentioned there is danger in backflushing chemo agents and then emphasized that all flow should be forward only.
Have you ever heard of this? Is there a practice in oncology that he is applying to all infusion? am I missing a piece of information? teach me!
The pharmacist needs to provide you with evidence to support his/her position. I have never seen anything in any oncology guidelines about this. The practice of backpriming a secondary piggyback set comes from the administration set manufacturers and has been used since their introduction in the early 1970's. I do not understand his/her rationale for only forward flow at this point of piggybacking. I can understand the need to avoid causing backward flow on the male luer end that may have blood in it. Just because you do not see red does not mean that blood cells are not present. We also discourage the practice of looping which is the male luer tip of the set being attached to an injection port higher on the same IV set, which would also be a form of backward flow. This is because that male luer tip could easily be contaminated. There is no evidence to support this practice of looping and therefore it could easily contaminate the entire length of the set. However, the backpriming procedure is done at the injection port on the IV set located just below the backcheck valve on the IV set. If using an infusion pump, this piggyback site could be at the pump cassette, depending upon the pump design. This backcheck valve prevents backward flow of fluid from the secondary set into the primary container. There should be no precipitate formation inside the IV set because the nurse must assess the presence of documented compatibility between the secondary medication and any medication that may have been added to the primary fluid container. As with every compatibility issue, you should always assume that there could be incompatibility unless you find documentation that 2 drugs are compatible. At least 1 compatibility resource book (King) is issues quarterly, so this information is constantly changing. The recommendation for backpriming is based on the fact that it decreases the excessive manipulation of the IV set by eliminating the practice of connecting and reconnecting the piggyback sets. The risk of introducing organisms with this practice is of greater concern than the risk of infusing drug precipitate. But this does take pharmacists who have a thorough knowledge of drug compatibility information, adequate resources to keep up with this data, and a nursing staff who will investigate each combination. The backpriming method also decreases cost by using fewer piggyback secondary sets. If disconnected after each dose, these secondary sets should be treated as an intermittent set and changed every 24 hours. Again, the issues is infection prevention AND drug compatibility, so you must consider both. 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
thank you Lynn, as usual a very thorough and clear explanation. I was afraid there was some new info out there I'd missed. So thanks!