Hi, my question is one revisited from 2010. In my practice I have always run abx on primary tubing when the patient did not have primary fluid ordered. I recently had a new RN do the opposite of what I do. I am just looking to see if there is any new evidence out there that states you should do it one way or the other. I didn't see it mentioned in the 2016 standards ( unless I missed it?) I read the postings from 2010 and it seemed there was really no consensus on best practice for either way. If tubing is being changed every 24 hours with intermittent infusions, it seems it would be more cost effective to just change primary tubing vs. changing primary and secondary tubing as well as the flush bag every 24 hours. However, I would not want to compromise the patient "not getting" all of their abx infused. Is there new information out there? Our hospital policy does not address this issue,
This is not included in the INS SOP because there was no evidence then about this question. I have not found anything since the SOP was released either. Both ways are acceptable practice and there are several considerations for each. lf using a primary continuous set and fluids, are you leaving this continuously connected to the patient or is it disconnected once the carrier fluid has flushed the admin set? If left connected, then all can be changed at 96 hours. If it is being disconnected, everything should be changed at 24 hours because of the added manipulation. If left connected, this could slow down patient discharge due to difficulty with ambulation by being constantly connected to the pump, set, etc. If there are many intermittent drugs, it would be best to use the carrier fluid and leave everything connected, secondary to primary and primary to patient with a slow infusion between doses. This allows less manipulation for frequent doses. One the other hand for patients with only one, two, or maybe 3 doses per day, intermittent infusion would be best. Lots of options, no real evidence about which is best.
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
I am reading your question, Walkerem, as, is there any reason not to use primary tubing only (less waste) vs primary/secondary&flush bag fora single drug infusion. I think there are various possibilities when using primary tubing only. My reasoning below.
If a 50ml bag of ceftriaxone is administered q 24h, then some of that 50 ml is left in the tubing and discarded. The patient is not getting the full dose. If there is overfill, is the volume known?
If order is for zosyn q6h, then it seems that the patient would get the entire dose of antibiotic with each subsequent dose after the first.
Nancy Rose
Yes, Nancy Rose is right if the medication is hung as the primary infusion on an infusion set for an electronic infusion pump. You would need to assess the internal volume of that set and determine what percentage would be left remaining in the primary set when the fluid container is empty. Most of the time, the primary fluid is a carrier fluid such as NS with the medication piggybacked into the primary line. When the medication is infused, the NS resumes flow to deliver the total dose to the patient. However, if a pump is not in use, and a shorter length primary set is used, the residual volume will not be a significant amount. This was common practice before everyone got crazy over using infusion pumps for all infusions. We commonly infused an intermittent med by gravity and did not worry about the very small residual amount because it was usually less than 10% of total volume. Pump sets can hold as much as 50% of dose though.
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