What is ivpb

When considering minimum inhibitory concentration MIC -dependent medications, medications with narrow therapeutic index, and medications given in the curative setting, the potential for clinical impact is concerning, especially in the setting of small-volume infusions.

The Oncology Nursing Society ONS recognizes underdosing of chemotherapy as a type of medication error, and the Infusion Nurses Society INS states that the standardization of drug administration is a recommended strategy to minimize the risk of errors.

Because of the absence of evidence supporting optimal infusion practice related to small-volume infusions, a large academic health care system in the Midwest had withheld from establishing standard infusion protocols. As a result, technique was found to vary within the health care system. The interprofessional chemotherapy safety committee identified the potential for standardization of practice regarding the infusion of small-volume chemotherapy and biotherapy.

The aim of this study was to determine the amount of drug that remained in the administration set following various ancillary administration techniques used by nursing staff throughout the system to minimize residual drug left in the administration set. Additional aims were to evaluate the implications of each ancillary technique and recommend a standard ancillary technique for the administration of the residual volume of select small-volume infusions.

Ancillary administration techniques were defined as the methods used to infuse the residual drug remaining in the secondary administration set at the completion of IVPB infusion. A thorough search of the literature revealed a lack of evidence or published guidelines for the administration of residual drug following an IVPB infusion.

An assessment of current practice in the oncology unit, where many critical drugs are administered as small-volume infusions, was performed through direct observations and discussions with staff. It was observed that because of lack of standardization, practice varied throughout the system. Manipulation of the administration set is limited because of the hazardous nature of chemotherapy, but 2 prevalent ancillary techniques were identified: 1 occlude the primary administration set until the majority of the drug in the secondary administration set entered the primary tubing, and 2 lower the secondary bag below the level of the primary bag and allow fluid from the primary bag to flow into the secondary administration set, then infuse the diluted residual medication.

For the purposes of this study, these ancillary techniques are referred to as the pinch technique and the backflush technique , respectively. After identification of the 2 most prevalent ancillary techniques, 10 oncology nurses were observed using the pinch technique, and 10 different oncology nurses were observed using the backflush technique.

Nursing practice was observed to be consistent with the pinch technique, with each nurse occluding the primary tubing until the fluid in the secondary tubing was within 1. The amount of nursing time required to pinch the administration set was timed during the study, with an average of 2 minutes 9 seconds.

In contrast, variability was observed among nurses using the backflush technique. The amount of fluid used to backflush ranged from 14 to 52 mL with an average volume of The amount of nursing time required to backflush was also recorded.

Time ranged from 5. A preliminary dye study was performed to visually evaluate efficacy of each ancillary technique. This qualitative study suggested that the pinch technique was more effective than the backflush technique based on visual assessment of improved dilution.

A follow-up quantitative analysis using the ancillary techniques identified was performed using vancomycin. Residual vancomycin volumes and concentration levels were assessed to determine the amount and percentage of drug remaining. An in vitro quantitative analysis was conducted using 15 IVPB infusions.

Because of the variability of backflush volume noted during preliminary nursing technique observations, 2 separate volumes were assessed for the backflush technique. Vancomycin IVPB infusion procedure: 1 0. Each ancillary technique was completed 5 times.

After each infusion was completed, the remaining fluid in the secondary administration set was drained into an empty medicine cup via gravity. An empty syringe and needle were used to draw up the fluid to measure the volume recorded. This fluid was then injected into a laboratory tube Vacutainer REF ; BD, Franklin Lakes, NJ and sent to the hospital laboratory to determine the concentration of vancomycin in the remaining volume. The amount of drug remaining in the administration set post IVPB infusion was summarized by a technique using mean and standard deviation.

This means they're sent directly into your vein using a needle or tube. The accepted explanation for why the piggyback flows and runs out before the main one starts intentional is gravity. To say the higher one has higher gravity.

When you use the backpriming method, administration sets remain connected after you've infused a secondary medication, eliminating the need to repeatedly connect and disconnect the secondary set. You can't use backpriming when the primary fluid contains medication that's incompatible with the secondary set medication. Change primary administration sets and any piggyback secondary tubing that remains continuously attached to them every 72 hours to minimize breaks in the closed administration system.

The first technique, the IV push, involves the nurse pushing medication from a syringe directly into the patient's vein. The second, the IV piggyback , uses gravity to allow a secondary infusion to go before the primary infusion.

Potassium solutions should never be given as an intravenous push and should be administered as a dilute solution.

Place one hook at the top of the IV fluid pole. Remove the primary fluid bag from the pole and hang it from the bottom hook of the plastic extension arm. Hang the secondary fluid bag from the IV pole. Inspect the secondary tubing for air. Primary IV tubing is used to infuse continuous or intermittent fluids or medication. Secondary IV tubing: Shorter in length than primary tubing, with no access ports or backcheck valve; when connected to a primary line via an access port, used to infuse intermittent medications or fluids.

According to the Infusion Nurses Society INS , for an intermittent infusion , a drug is added to a small amount of fluid 25 to mL and infused over 15 to 90 minutes at prescribed intervals.

Although intermittent infusions can be given in many ways, they're commonly administered as a secondary I. Intravenous IV push is the rapid administration of a small volume of medication into a patient's vein via a previously inserted IV catheter. This method is used when a rapid response to a medication is required, or when the medication cannot be administered via the oral route.

Explain the procedure of hanging an IV piggyback. Understand intermittent use of IVPB. Describe proper labeling of fluid bags and tubing. Discuss IV fluid compatibility. IVPB is a method of medication administration commonly used for medical treatments, especially antibiotics.

In an IV piggyback setup, small volumes of intravenous solution are given by intermittent infusion. Medication is administered via secondary IV tubing connected to the primary tubing.

Solutions used in intermittent infusion are typically prepared in the pharmacy before administration. Medication is administered and the full IVPB setup is always performed by a trained nurse. It is important to administer many medications slowly via a secondary line to ensure the complete delivery of the prescribed dosage of an IVPB. If abx are infused through the primary line only, then nurses cannot administer a flush.

Without flushing the line, part of the abx dose stays in the tubing. However, when the IVPB is connected to a primary line , it allows the nurse to fully flush out the meds from the line. A full IV piggyback setup with secondary tubing connected to primary tubing and secondary container positioned higher than the primary container to ensure proper and complete medication administration. Primary IV Tubing.

Secondary IV Tubing. Clean Gloves. Alcohol Pads. Lower down the secondary set to let fluid flow into it from the primary set. Figure 1: Lowering the secondary set to let fluid flow into it from the primary set. Figure 2: Moving excess fluid into the secondary medication container. Figure 3: Attaching the new secondary medication container. This back flushing method is used between doses and the existing secondary IVPB tubing is utilized here not new tubing. Back flushing allows for one secondary set to be used for all intermittent meds.