[Brewerpaul]

Hi all-- I had this semester's clinical competency exam last night, and ran into a bit of a quandry. I had to hang a mini-bag piggyback into an existing primary line and regulate it manually. I tried to do this using the roller clamp on the mini-bag line, which I KNOW at least one instructor told us to do, and which always worked fine in lab. Last night though, I had it wide open and couldn't get it up to the right drip rate!! The examiner asked me what I would do "in the real world" and I told her I'd regulate it with the primary roller clamp, but would rather not since that would necessitate re-regulating the primary once the mini-bag ran out. As I understand it, the primary would normally go back to it's previous rate once the mini is exhausted.
That answer was acceptable, and I passed but I'm curious about how other's do this. Thanks.

[smbrn]

I would never regulate a piggy back rate with a primary clamp. Suppose you couldn't get back in time and the primary line infused much faster than it should have? Actually, it has been a very long time since I have used gravity drips anyways. I don't work in intensive care or anything; just med/surg and oncology. We always use pumps on all our IV's and can program a secondary to run alone or concurrently with the primary line.

[Brewerpaul]

Originally Posted by smbrn

I would never regulate a piggy back rate with a primary clamp. Suppose you couldn't get back in time and the primary line infused much faster than it should have? .

That was my thought exactly. Thanks

[hupnurse]

Same here I would hang it as a piggyback and run it off the pump as a secondary. Why free flow when you have pumps

[NavyJim58]

this must be nursing school stuff because you should "never" gravity flow medication.

[onetraveler]

Originally Posted by Brewerpaul

Hi all-- I had this semester's clinical competency exam last night, and ran into a bit of a quandry. I had to hang a mini-bag piggyback into an existing primary line and regulate it manually. I tried to do this using the roller clamp on the mini-bag line, which I KNOW at least one instructor told us to do, and which always worked fine in lab. Last night though, I had it wide open and couldn't get it up to the right drip rate!! The examiner asked me what I would do "in the real world" and I told her I'd regulate it with the primary roller clamp, but would rather not since that would necessitate re-regulating the primary once the mini-bag ran out. As I understand it, the primary would normally go back to it's previous rate once the mini is exhausted.
That answer was acceptable, and I passed but I'm curious about how other's do this. Thanks.

Did you have the mini bag high enough. If you had it level with the primary it wouldn't run. I've seen nurses plug a mini bag in past the pump i.e. close to the patient and have their primary pump right into the mini bag. One nurse almost blew up a Gram of Vanco that way. Looked like a basketball..........:houra: :houra:

[cassioo]

Originally Posted by NavyJim58

this must be nursing school stuff because you should "never" gravity flow medication.

I wouldn't say never we do it all the time with Amp and PCN in labor we usually don't have primary fluids to a pump since we do lots of wide open boluses (ok some labor patients have primary on pumps but not most) and anesthesia doesn't want to mess with pump tubing if we go to OR and in an emergency there isn't time to switch up. I would as said before make sure it's hanging high enough and being I'm 1 on 1 (or 2 or 3) adjust the primary line even if you shouldn't in general but I also have to check on my patients minimum of every 30 minutes.

[AmandaWIRN]

Originally Posted by NavyJim58

this must be nursing school stuff because you should "never" gravity flow medication.

I agree with cassioo- while a lot of medications should never be run via gravity, there are plenty of meds that, in the ER, we run via gravity all the time- such as rocephin or ancef (to name a couple). I run these in over approx 30 minutes. Now, if the pt. has renal issues, fluid overload issues, or is a child, then I always use a pump. Same with IV fluids- I run LR & NS "wide open" all the time (as long as there are no renal or fluid overload issues, like CHF), however, fluids with dextrose or KCl should be on a pump.

[intensive1]

Working in the ICU.. I would tend to agree with other... always use a pump.
As for working in the ED.. I have also seen gravity drips with some of the maintenance fluids as well as bolus doses of antibiotics.
So I guess it all in what arena you are working in... and why you are adminstering this specific drug/fluid.