The administration of intravenous (IV) medications often requires a secondary line, commonly called a “piggyback” infusion. This technique allows for the intermittent delivery of a smaller volume of medication into a patient’s bloodstream through an existing primary IV access point. The secondary setup temporarily interrupts the continuous flow of the larger primary bag to infuse the drug over a specific time period. This method ensures precise control over the drug’s delivery rate and duration, which is necessary for the safe and effective use of many pharmaceuticals. Correctly setting up the secondary tubing with an infusion pump ensures the patient receives the correct dose at the intended rate.
Preparing Supplies and Verifying the Medication Order
Before manipulating the IV system, necessary supplies must be collected and the physician’s order thoroughly reviewed. Gather the secondary medication bag, the designated secondary tubing set, and antiseptic wipes. Confirm that the primary IV line is running consistently before introducing the secondary setup.
Verification of the medication order is a foundational step in patient safety, requiring confirmation of the right patient, drug, dose, route, and time. The secondary medication label must be cross-referenced with the primary IV solution to ensure chemical compatibility. Incompatible solutions could cause precipitation or inactivation of the medication.
A final check of the secondary medication label confirms the total volume to be infused (VTBI) and the prescribed infusion time. These parameters are used to calculate the necessary flow rate.
Priming and Connecting the Secondary Tubing
The physical setup starts by adjusting the relative heights of the two IV bags on the pole. The secondary medication bag must be positioned higher than the primary bag, typically using the short hanger on the IV pole. This height difference ensures the fluid pressure from the secondary bag is greater, allowing the piggyback solution to flow first.
The secondary tubing must be meticulously primed to remove all air, preventing air emboli. After spiking the medication bag, open the roller clamp to allow fluid to flow slowly through the entire tube. Stop the flow immediately once the fluid reaches the distal end, ensuring the line is filled but the end connector remains sterile.
The primed secondary tubing connects to the proximal port on the primary line, located above the infusion pump. This placement ensures the secondary medication is delivered directly to the pump for rate control. Before connection, vigorously scrub the access port with an antiseptic wipe for the prescribed dwell time to reduce pathogen risk.
Connect the end of the secondary tubing to the disinfected port using a sterile technique. This secure connection allows the pump to accurately control the flow of the secondary medication.
Programming the Pump for Piggyback Infusion
Interacting with the infusion pump translates the prescribed order into an automated function. First, navigate the pump to the specific function for dual infusions, often labeled “Secondary” or “Piggyback” mode. This setting alerts the pump that a temporary change in the infusion schedule is occurring.
In secondary mode, the pump prompts the user to input the medication parameters. This includes entering the total Volume To Be Infused (VTBI) and the required infusion rate in milliliters per hour (mL/hr). The correct rate is calculated by dividing the VTBI by the total prescribed infusion time in hours.
The pump’s secondary function manages the primary infusion. When the secondary infusion begins, the pump automatically slows or temporarily pauses the primary rate. This prevents fluid overload and ensures the secondary medication is delivered as a concentrated dose.
After parameters are entered, initiate the pump, which draws fluid solely from the higher, secondary bag. The pump monitors the volume delivered, ensuring the entire prescribed VTBI is infused over the programmed duration. Once the secondary VTBI is completed, the pump automatically executes a transition.
This transition involves closing the secondary line and seamlessly reverting the infusion back to the original, programmed rate of the primary IV solution. The pump’s ability to manage both lines and transition without manual intervention makes this method efficient and accurate for intermittent dosing.
Completing the Secondary Infusion
After the programmed infusion duration, the patient must be assessed and the setup managed. Check the infusion pump to confirm the secondary infusion finished and successfully reverted to the primary IV solution’s prescribed flow rate. This ensures the patient’s continuous therapy has resumed.
Monitor the patient for any immediate adverse reactions, such as changes in vital signs or skin reactions. This assessment is important following the administration of new or high-alert medications.
The secondary tubing must then be safely disconnected from the primary line. Clamp the secondary tubing shut using its roller clamp to prevent backflow. Carefully detach the tubing from the access port, maintaining sterility of the primary port.
The completed infusion, including medication name, dose, time of administration, and any observed patient reactions, is then documented in the medical record. This documentation provides a clear timeline of the patient’s treatment.