A secondary intravenous (IV) infusion, often called an IV piggyback, administers intermittent medication through an existing primary IV line. This method delivers drugs, such as antibiotics, in a small volume of fluid over a specified period. The secondary fluid connects to an access port on the primary line, allowing medication delivery while the primary line maintains continuous venous access. Using an electronic infusion pump is the standard procedure to ensure precise flow rates and volumes. This guide outlines the steps for setting up a secondary IV infusion using a pump and is for educational purposes only.
Pre-Setup Checklist
Preparation begins by verifying the medication order against the patient’s identity. This confirms the right patient receives the right drug, dose, route, and time. Supplies needed include the secondary medication bag, the designated administration set, and antiseptic wipes.
Chemical compatibility between the secondary medication and the primary IV solution must be verified. Incompatible solutions can react upon mixing to form a precipitate, which is dangerous if infused. The primary solution maintains intravenous access patency between doses, making compatibility essential. After all checks are complete, briefly explain the procedure to the patient.
Physical Assembly and Priming
The physical setup requires attention to sterility and fluid dynamics. Prepare the secondary bag by removing the protective cap from the medication port. Insert the spike of the secondary tubing with a gentle push and twist, maintaining sterile technique. Ensure the roller clamp on the secondary tubing is closed before spiking to prevent fluid loss.
The secondary tubing must be primed to flush all air from the line before connection. The most efficient method is “back-priming,” which uses the primary IV fluid to fill the secondary tubing. To achieve this, the primary IV bag is hung lower than the secondary bag, often using a special hook provided with the secondary set.
Connect the secondary tubing to a designated access port, typically located above the infusion pump’s mechanism. Before connection, vigorously cleanse the access port with an alcohol wipe for at least five seconds and allow it to air dry.
Once connected, open the roller clamp; the primary fluid flows backward into the secondary tubing, pushing air out of the line and into the secondary bag. This back-priming prevents medication waste and air entry.
The drip chamber of the secondary tubing should be filled approximately one-half full during priming. After priming, close the secondary roller clamp. Reposition the secondary bag on the IV pole to hang higher than the primary bag. This height difference, known as the “head height,” ensures the secondary medication infuses first due to greater hydrostatic pressure. The primary bag is often lowered using an extension hanger to facilitate this differential.
Pump Programming and Activation
The electronic infusion pump is programmed to recognize and administer the secondary infusion. Select the correct channel and choose the “Secondary” or “Piggyback” function from the menu interface. This signals the pump to temporarily interrupt the flow of the primary solution.
The two parameters entered are the Volume To Be Infused (VTBI) and the infusion rate (mL/hr). The VTBI is set to the total volume of medication in the secondary bag. The rate is determined by the medication order, calculated to deliver the volume over the prescribed duration (e.g., 100 mL over 30 minutes equals 200 mL/hr).
After inputting secondary parameters, the pump may require confirmation of the primary line settings. The primary infusion is typically switched to a “Keep Vein Open” (KVO) rate, usually 1 to 20 mL/hr, to maintain intravenous access patency. Before activation, double-check the summary of programmed settings against the original medication order for accuracy.
Initiate the secondary infusion by pressing the “Start” button on the pump, ensuring the roller clamp on the secondary tubing is open. The pump temporarily stops the primary flow and begins the controlled delivery of the secondary medication. The pump monitors the infusion, displaying the remaining VTBI and time to completion.
Post-Infusion Transition
Once the programmed VTBI is delivered, the pump transitions to its next state. This is signaled by an audible alarm and a display message indicating “Infusion Complete.” The pump automatically reverts to the primary infusion.
The primary solution resumes infusing at its pre-programmed rate, or at the KVO rate if applicable. Visually confirm that the primary solution is dripping and the pump display reflects the correct primary rate. This transition ensures the patient’s maintenance fluid continues without interruption.
Remove the empty secondary bag and its administration set from the access port. Dispose of the empty bag and tubing according to institutional biohazard protocols. Document the completed administration, including the medication name, dose, start and completion times, and the patient’s response.