Chapter 7: Parenteral Medication Administration
7.7 Administering IV Medication via Mini-Bag (Secondary Line) or Continuous Infusion
Critical Thinking Exercises: Questions, Answers, and Sources / References
- Explain your thinking about whether or not the same secondary IV tubing can be used more than once and for more than one kind of medication.
Answer: using the same secondary IV tubing more than once and for more than one kind of medication depends on the nature of the medication and the frequency. Back flushing is one practice with secondary lines that may be sufficient for cleansing the line of remnants of the previous medications. Replacing the secondary line entirely is another (though more expensive) option. The nurse should always consult an IV medication resource to learn about compatibility / incompatibility. Because a secondary tubing system is generally opened frequently (ie. the minibags are changed frequently thus exposing the spike to room air) it is recommended to be changed every 24 hours.
2. What is the purpose of hanging the secondary (piggyback) IV medication higher than the primary IV solution?
Answer: physics principles apply. The solution that is the highest will infuse first as long as the clamp is opened.
Source: Perry, A., Potter, P., & Ostendorf, W. (2017). Clinical skills and nursing techniques (9th ed.). St. Louis, MO: Elsevier-Mosby.
3. Your patient has an IV antibiotic infusing via a mini-bag and requests analgesic. The analgesic is IV route and not compatible with the current antibiotic. Explain your next action(s).
Answer: if the patient only has 1 IV access, the nurse will have to decide if they will stop the IV antibiotic and administer the analgesic or wait until the antibiotic is completely infused before administering the analgesic.
Either way the nurse will have to note incompatibility between the 2 meds and ensure that the line is free of one drug before administering the other.
If the analgesic is to be given via minibag then the secondary line will have to either be back flushed with a compatible primary solution or the line flushed with an appropriate solution attached to the secondary spike / drip chamber.
If the analgesic is to be given IV direct the nurse can stop the IV antibiotic, flush the line at the port closest to the IV insertion site with an appropriate compatible solution, administer the IV medication followed by an IV flush with an appropriate compatible solution. At this point, the IV antibiotic infusion can be resumed.
Note: always follow agency guidelines for IV medication administration practices.
- A 100 ml minibag of Cefazolin 2grams is to be infused in 20 minutes. What is the ml/hour?
Answer: 100 ml x 60 minutes = 300 ml
20 minutes 1 hour hour
2. You are administering a new IV antibiotic to a patient. 20 minutes into the infusion, the patient calls you to show you his rash on his arms and torso. What is your next action?
| Action | Answer | |
| a. | Call the prescriber | Incorrect. The prescriber must be notified but the first action is to stop the antibiotic infusion. Suggest quickly repriming a new IV administration set and continuing the IV infusion. To use the existing set….even with stopping the antibiotic there is still medication in the primary IV line which would enter the patient. |
| b. | Slow down the IV infusion | Incorrect. The first action is to stop the antibiotic infusion. Suggest quickly repriming a new IV administration set and continuing the IV infusion. To use the existing set….even with stopping the antibiotic there is still medication in the primary IV line which would enter the patient. |
| c. | Stop the antibiotic | Correct. Suggest quickly repriming a new IV administration set and continuing the IV infusion. To use the existing set….even with stopping the antibiotic there is still medication in the primary IV line which would enter the patient. |
| d. | Administer an antihistamine | Incorrect. Suggest quickly repriming a new IV administration set and continuing the IV infusion. To use the existing set….even with stopping the antibiotic there is still medication in the primary IV line which would enter the patient. The prescriber will need to be notified. |