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Old 04-15-2013, 08:23 PM
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Default To piggy back or run concurrently

I have a question for all you knowledgeable nurses out there. When you hang a secondary bag and it is compatible with the primary fluid, how do you decide if you are going to run it separately (putting the primary on hold) or run it concurrently with the primary.

When I was working this weekend I was confused about this and the nurse I was with really did not give me reason she chose one over the other. She did say that she would run them together when the secondary ie. piggyback was behind schedule.

This in turn increases the ml/ hr that the fluid is running. She had one at one point that was running 280 ml/hr. I thought this was fast as we were infusing and antibiotic along with the 0.9ns.

Would anyone be willing to explain why you would choose to either run it alone or infusing with the primary. If I confused anyone just let me know.

Thanks in advance.
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Old 04-15-2013, 09:25 PM
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I would run piggy back first because I want all the med in and working as fast as possible.

I used to run my pt's feeding pump at 145ml/hr [250 ml cans]. But since my hrs got cut, I will run 500ml in at 120 ml/hr over 4 hours. He is active so he wears a backpack with his pump and feeding in it. When he lays down to sleep or play I take the backpack off so the alarm doesn't sound.
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Old 04-16-2013, 04:07 AM
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I hope the infusion is on a pump. the pump is programmed to infuse the piggy back first .
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Old 04-16-2013, 05:11 AM
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Quote:
Originally Posted by Nurseforever View Post
I hope the infusion is on a pump. the pump is programmed to infuse the piggy back first .
yes it is on a pump but you can set it to run them concurrently.
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Old 04-16-2013, 08:54 AM
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We teach in school only to infuse one unless someone hemodyamically unstable and you need to infuse to titrate the BP.
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Old 04-16-2013, 01:47 PM
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typically run it as a piggyback first. I only run concurrently (and will long line the medication into the lowest y port) if it is a med that will take several hours to infuse and I dont have a second line available. For example, if my patient has a peripheral IV and I need to have KCL infuse, (that usually burns an irritates the heck out of the vein and patients cant typically tolerate it), the KCL is supposed to run over an hour. It wont. Sometimes it runs over like 6 hours. I will long line it in do a lower rate and infuse at the same time. If I know its a large volume that the two combined will make, like you said 280ml/hr, I will cut back and lower the primary IVF like NS to a lower rate and tell the MD. Most are cool with it and dont want to overload the patient. Just my two cents...hope it helps
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