› IV Piggyback Set Up

IV Piggyback Set Up

Rarely is a patient only on one IV medication when in the hospital. There are usually multiple antibiotics or cardiac meds that are not mixed in the same bag. They must be administered separately. When this is the case, there is usually a primary fluid running 24/7 with the intermittent administration of other meds through the day and night. 

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Rather than connecting and disconnecting this main line, an IV piggyback (secondary line) is added to disrupt the first just long enough to infuse. Then the primary fluid picks up automatically when it is done. 

With use of a pump, the elevation of the piggyback med isn’t important since the pump can turn each line on and off as needed. When using only gravity as the means for determining which med is being administered, the piggyback needs to be higher than the primary one.

It’s a matter of gravitational force. You can experiment in your clinical lab if you want by having two bags hooked together into one main line and play with the heights. The bag that is higher will show drops flowing in the chamber while the other bag doesn’t. 

Why not just shut off the primary bag and open up the piggyback? Because if you aren’t there just when the piggyback med finishes that means the IV has totally stopped until you get back. And we all know there are twenty other things on your to-do list besides sitting and watching a bag of meds drip. 

With the two fluids positioned correctly, the IV piggyback will run and when it is finished the primary IV setup will pick up where it left off without any further adjustments. You can then go back any time to remove the empty IV piggyback.

the end of an IV lineThe end of an IV Piggyback line that gets attached to the main line

This is an extreme closeup of the end of any IV line that gets screwed into an IV cap. The little center of the line with the drop of fluid is what gets pushed into the center of the IV blue cap to allow flow. The outer portion is what actually screws onto the blue cap. That little outer screw portion can slip down the IV line if you don't watch and when you get ready to attach it you will wonder what the heck happened. Just check down the line and you will find it has just slipped out of place. 

Sometimes, IVs get jammed and difficult to unscrew, so having a few kelly clamps handy to grasp the ends in order to twist them apart can help. Having the ratchets to lock them can sometimes be annoying, soon option is to have the clamp without the lock, as below:

IV Piggyback Demonstration

When you are administering a second medication, you need to be sure that whatever is in the primary bag is compatible with the new medication. Because if they aren't it could cause precipitation of one or the other and that is NOT good for your patient. 

The tubing you are looking for will either say "secondary IV tubing" or "Piggyback tubing" or something similar. It is NOT the same as the primary tubing.

When you prime the tubing, you can't afford to lose medication by letting it drip out the end. Some meds are in mini bags of only 50 to 100 mls. That is not much volume. So it may be better to "back prime" as shown in the video.

The instructor says at 3:51 "I know this is .9"

What she means is, that she knows the fluid is 0.9% Normal Saline Solution which is compatible with any medication so mixing the two liquids would not be a problem.

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Remember to clean the IV port with alcohol and wait for it to dry. Sometimes if you hook up the IV before it is dry, the two ends get really stuck together and then when you try to disconnect you can't unscrew it. Or, maybe someone else hooked up a line that had some medication on the end and that caused it to stick. In any event, at some point in time you will be working up a sweat to try to get them apart. 

Get yourself 2 kelly clamps (hemostats) to keep with you at all times. You can use them like mini pliers. Just grasp the blue cap with one and the portion that screwed onto it with the other to get them to unstick. Just do not put the kelly clamp on the soft line itself as it could shred it. Here's a variety to choose from at a very reasonable cost.

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