Please explain this concept to me!

I am a new grad in orientation and I am confused. I have run across an issue with IVPB running too fast and it was explained to me that if the primary is set faster than the IVPB then the pump will revert to the primary rate? Or gravity takes over and will pull the fluid from the IVPB faster? I am totally lost and can't find this information anywhere (was told that I should have learned this in school, but never heard of it). I really didn't understand the explanation and didn't want to keep on asking and looking even dumber. Does anyone have a clue what I am talking about and can explain this to me?

Ok. I just had a thought. I absolutely set the IV up wrong, I know this. I'm just trying to understand HOW I got the results that I got. I set up A as primary @ 100ml. B as secondary @5ml (was to run over 20 hrs) . What happened is B ran over about 20 minutes and A didn't change at all. I SHOULD have run B as primary and A as secondary (run over 30 minutes) or just run B on it's own line. But, how did B infuse over 20 minutes? Last edit by TnRN43 on Jun 5, '13
IVPB run at a specified rate, based on the medication.....has nothing to do with the rate of the primary. At our facility, the primary automatically goes on hold until the IVPB is done and then it reverts back to the primary fluids......unles we set the pump to deliver each concurrently, at which time both fluids are infusing. Nearly 30 years of nursing and I have NEVER heard of your situation, except from a nurse who was in desperate need to show up a new grad in an attempt to make herself look like she knew something that NOBODY has ever heard of. Even in that, I've never heard of what you describe.

It sounds like the pump was set wrong, it was set for :20 not 20:00. Each should infuse at what you set it for or what a smart pump is programmed for. Gravity has nothing to do with it.

I would think how the piggyback runs in relation to the mainline has more to do with the type of pump you have and what it's designed to do

That makes no sense. You have primary and secondary settings on the pump for a reason: each fluid can run at its appropriate (different) rate. My best advice is to file this little tidbit under "things I don't believe but won't ever say so."Swallow hard, smile knowingly and move on.

I agree, lol, but I am still confused HOW it happened. I had a second nurse verify the settings after this happend to see if I had it programmed wrong. I didn't. So, if I had it programmed correctly, how could this possibly have happend, that is my dilemma. I really want to understand what happened, so that it never happens again.

Was the secondary hanging higher than the primary? Regardless of what the pump is programmed to do, it will always pull from the highest hanging bag first. I learned that one the hard way as a newbie hanging a K+ replacement.

Quote from TnRN43I agree, lol, but I am still confused HOW it happened. I had a second nurse verify the settings after this happend to see if I had it programmed wrong. I didn't. So, if I had it programmed correctly, how could this possibly have happend, that is my dilemma. I really want to understand what happened, so that it never happens again.

There may be some terminology variations happening here, or I'm just dense. Regardless of the type of pump, and secondary runs through the same pump (or 'channel' of you use alaris) as the primary. The secondary is hung higher than the primary and runs in place of the primary. No pump has the ability to decide which bag it will pull from when set up as a true secondary, you're just setting the pump to run at a different rate for a designated volume/amount of time.

Quote from MunoRNThere may be some terminology variations happening here, or I'm just dense. Regardless of the type of pump, and secondary runs through the same pump (or 'channel' of you use alaris) as the primary. The secondary is hung higher than the primary and runs in place of the primary. No pump has the ability to decide which bag it will pull from when set up as a true secondary, you're just setting the pump to run at a different rate for a designated volume/amount of time.

I'm a big fan of pumps that have a secondary port on a cassette on a primary line just for this reason! You can actually have it set to run your primary bag and your secondary bag concurrently through the same line. I believe it's also possible to pause the primary to change out that bag with those kinds of pumps. Something I also do is make sure I know the ml/hr so that when the pump runs, I can check that the pump is running each line at the correct rate. Positioning (physical) of each bag isn't an issue with that setup.Otherwise, you have to make sure that the bags are positioned correctly and the pump "knows" the correct rate, and all that. Unfortunately, this setup doesn't allow you to run fluids concurrently. That's the kind of pump system we were using most recently and it's really just a gravity-based system with a pump for flow control instead of using the roller clamp. I'm not a fan of that system, but I can certainly use it reasonably well.

Quote from MunoRNThere may be some terminology variations happening here, or I'm just dense. Regardless of the type of pump, and secondary runs through the same pump (or 'channel' of you use alaris) as the primary. The secondary is hung higher than the primary and runs in place of the primary. No pump has the ability to decide which bag it will pull from when set up as a true secondary, you're just setting the pump to run at a different rate for a designated volume/amount of time.

Sounds like an error somewhere to me! But I think what they are getting at is this. For example you primary is running NS at 250/hr. the you hang a ivpb to run at 50cc/hr. When the ivpb is done, the primary kicks in. All the meds left in that line will now run at 5x the rate it should be,until it clears. Most stuff that must run slow I used the concurrent setting and then do a flush of 5-10 cc at the same rate to clear the line. Great for drugs like lasix gtt that run at 1cc/hr. run a tko with a lasix chaser on the b-port(hospira).