When to piggyback This

Ok so Ive noticed a lot of nurses to this differently and I'm just trying to figure out a rule to go by. I never know when I should piggyback something with iv fluids or y it in under the pump to run with fluids. I know some things are better diluted and running with fluids, but I'm also confused about how that works. If u y an antibiotic into the port below the pump with ns running at say 75, then won't the antibiotic be going in at that rate instead of say 12.5/hr? I don't get how it could run at its kwn rate unless it's piggybacked. this may sound like a stupid question but I never really fully understood how this works, especially since we had so very little practice with IV pumps in school. So anyways, can someone explain this and how I know when to do what. I use a drug book, but often times I don't even understand the administration instructions and there isn't always someone there to ask.
When you y something in, it is on it's own pump and has it's own primary tubing. So what ever you programmed in is what it will run at. When you y it is the pt will get both fluids. When you piggyback the primary fluid is stopped and the secondary runs in, once it is finished the primary fluid will resume. This works if you have the pump programmed correctly. Also with piggybacking you need to mKe sure the secondary is compatible with primary fluid. Same as checking when you y something in. Hope this helps.

Imagine you have two IVs, side by side, running into a bucket. One, NS maintenance, is on a pump at 20cc/hour. The other, the antibiotic, is on a pump at 100cc/hr. How much fluid goes into the bucket in an hour? Right, 120cc/hour. How much of it is antibiotic Right, 100cc. How much is NS? Right, 20 cc. Now, plug the ends of those two IVs into a Y connector or somewhere else, but don't change their settings and drop the end of the Y connector into the bucket. How much antibiotic runs into the Y connector and into the bucket in an hour? Still 100cc. How much NS? Still 20cc. Total? Still 120cc.Now, pretend that the bucket has been sterile all along and you can pick up that Y connector and plug it into an intravenous line.How much fluid goes into the patient in an hour? 120cc. How much antibiotic goes in in an hour? 100cc. How much NS? 20cc.Moral of the story: What a pump puts into the tubing goes in at its own rate regardless of where in the line it's plugged in, what else is running in the same line, or how fast. One pump does not influence the rate in the other pump's bag of responsibility.

Birdy, you have asked a lot of IV related questions in a short amount of time. I really think you would benefit from making an appointment with your educator and getting some in-depth review of IV therapy and how the pumps your facility uses work, especially as you are a new nurse.

Quote from Sun0408When you piggyback the primary fluid is stopped and the secondary runs in, once it is finished the primary fluid will resume.

Thanks. I know that's how it works but someone else on a different post said that if something were y'd in below the pump to a ns line then it would all flush in at the rate the saline was set to. Maybe they meant if it weren't set to its own channel. I think I got confused by that. And I was just wondering why some nurses give antibiotics as an intermittent infusion with no fluids even attached to the pt, some piggyback it for saline to flush after (primary and secondary programmed), and some y it in below to run at the same time as the ns. I always thought any antibiotic should be piggybacked to ns because that's what it says when u look them up, but some nurses don't run it with anything if the patient isn't ordered fluids. If they are getting fluids continuously then I get y'ing in below the pump to the basic infusion and setting both channels as primary so they still get the fluids and the med. I have also seen nurses infuse antibiotics as a piggyback (above pump) when the pt is supposed to be getting continuous fluids (wouldn't this be a time when u y it in below). So it's easy to get confused about what's right and wrong.

The concept of running a secondary or y-siting something together is rather easy to understand once you've been taught how to do it; but as Rose Queen said, it really depends on which brand of pump you are using. For example, if you are using Alaris pumps then by running a secondary the primary will automatically stop while the secondary is infusing, as opposed to y-siting the two lines together whereby both infusions will infuse simultaneously. If you y-site 2 infusions, the effective rate going into the patient will be the sum of the two infusion rates so you need to take that into account (consider the gauge of the IV if it's a peripheral IV). I agree 100% with Rose Queen, please make an effort to speak with your charge nurse, your nurse educator, or your nurse manager to clarify your concerns.

I know that's how it works but someone else on a different post said that if something were y'd in below the pump to a ns line then it would all flush in at the rate the saline was set to. Maybe they meant if it weren't set to its own channel.

Thanks everyone! I thjnk i understand better now how it works. I'm still going to ask someone to confirm I've been doing things correctly.

Quote from Birdy2Thanks everyone! I thjnk i understand better now how it works. I'm still going to ask someone to confirm I've been doing things correctly.

Quote from Birdy2Thanks. I know that's how it works but someone else on a different post said that if something were y'd in below the pump to a ns line then it would all flush in at the rate the saline was set to. Maybe they meant if it weren't set to its own channel. I think I got confused by that.

Everyone has given you some fantastic information! I don't have much to add, except for some advice on when to piggyback with continuous IVF, versus when to use a second channel. We use Alaris pumps so when you program a piggyback (secondary) bag into the same channel as continuous IVF, the continuous IVF automatically stops while the piggyback runs and resumes when it is finished.I have seen newer nurses piggyback antibiotics like zosyn (which runs slowly over 3 hours) when the patient has a high rate of Continuous IVF ordered (like 150cc/hr). I always correct them on that because that is three hours that the patient is not receiving the 150cchr fluid. It adds up to 450cc missed. So if an antibiotic needs to run for more than an hour, I get a second channel with primary tubing and run it separate, y-site connecting it at the port closest to the patient below the pump. This way the Pt gets the antibiotic and continuous fluid.That's all I rally have to add.

Well thank you karou. That does help. I was wondering why some nurses do that. I also thought that If I needed to keep the pts fluiss running and give an antibiotic that I was supposed to y it in right below the pump to further dilute the antibiotic, like if it's vanc or something. Another thing I wasn't aware I could do is run two antibiotics at once with no fluids fluids running, like two primary's, one y'd into the other closest to the patient. They were compatible, but I had never heard of giving them at once. It was in the middle of a blood transfusion that was overdue and so were the antibiotics. I gave one unit, the two antibiotics, then hung the other unit. My charge nurse said that was fine. Anyways, thank you all for the help. I do talk to my nurse manager or someone more experienced before doing these things, but then I still question certain things. I'm always looking things up if no one is there to help, but sometimes what u read is different than what people are really doing.