Secondary Medication Infusion: Administration (Nursing)

00:00 Welcome to administering a secondary medication or otherwise known as IV piggyback to primary fluid. Let's take a look at what we're going to need. We're going to need alcohol pads for cleaning, we're going to need that IV piggyback or secondary medication that's ordered, our secondary tubing, and our IV pole. Now notice with the secondary medication or IV piggyback that we need secondary tubing. Now this is different than our primary because it's much shorter and you'll see why here in a little bit. So before we start, we want to ensure that the roller clamp on the secondary tubing is closed. So we're going to take that out of the package and the first thing we want to do is clamp that because once we spike it we don't want that running out of our tubing. We're going to remove the cap of the bag insertion port on the secondary medication. Then we're going to remove the cap from the spike of the secondary administration tubing, and then we're going to insert that spike into the bag insertion port. Now, we're going to hang the spiked bag of the secondary medication on to the IV pole. Then we can squeeze the drip chamber until it's about half full.

01:16 Next, open the roller clamp to prime the secondary piggyback tubing. Close the roller clamp on the secondary tubing, and then you're going to scrub the needleless injection port of the primary tubing with an alcohol pad for about 5 seconds and allow to fully dry. Next, we're going to connect the secondary tubing to the primary tubing at the needleless injection port.

01:44 Now, we're going to use our infusion pump guidelines to hang the medication and program at the infusion rate. Open that roller clamp of the secondary tubing, and then inspect the drip chamber to make sure that medication is infusing. Let's take a look at how we hang that secondary medication or IV piggyback so you may hear those words interchangeably. Okay, so before we get started I'm going to do my hand hygiene and put on my gloves. So you see in front of me I've got my existing continuous infusion or primary fluids hanging. So this is why you may hear an IV piggyback because our medication's going to piggyback into our primary fluid. So that's why you may hear primary secondary or primary and IV piggyback.

02:52 So you may hear that quite commonly and those words interchangeably. Alright, so let's take a look at our medications. We got our IV piggyback here. So this is really important again about compatibility. So anytime we've got 2 medications that are going to infuse together, we need to make sure that they play nice. So how we're going to do that is we can check with our pharmacist at our facility. They're a great resource. Or typically you may have some sort of drug reference on the electronic medical record that you can refer to. And make sure what med you're hanging and your primary fluids running are compatible.

03:30 So this is really important in regards to safety of your patient. So, right now I've got normal saline and luckily almost everything is compatible with that. So that's really helpful. Okay, so now we've got our IV medication or piggyback. One thing to note as well is when you're picking out tubing, you're picking out secondary tubing. So now let me show you. When you're picking out tubing for a secondary or IV piggyback, notice a couple of things. This comes up with a hanger and will show you why we use that. Now this is the secondary tubing. Look at how much shorter that is. So just note anytime you're giving a piggyback we don't need all that extra line, we're just going to use a shorter secondary line. So this is what this looks like. Okay, so let's go ahead and get started. So, before we start anything, make sure that roller clamp on the secondary tubing is closed. And again, you're going to take this top and just roll this downward to the bottom like so. So now that we have our roller clamp closed on our secondary tubing, notice that there's a cap at the end of it to keep it sterile, but now we're going to take our IV medication. Notice this port right here is the one we're going to spike. So I'm going to take this and pull this out. So one thing to note, now if I tilt this notice I have not spiked this bag yet so none of the medication is going to come out, but as soon as I spike it, it will. So why we want to make sure we clamp our roller clamp. Okay, so now here's our medication port and here's our spike. Now we need to be really careful that nothing touches the spike or this with our hands or anything else. So I'm removing the spike, I'm taking the spike and I'm putting this into the medication port. So we're going to push this in, sometimes you got to kind of twist it and you want as close to this little lip or the hub as possible. So now that I've got this spiked, I'm going to take my medication, I'm also going to hang this on my IV pole. So now this is hung, and also this is clamped. Now we're going to take our drip chamber and we're going to squeeze this about halfway full. Now if you remember, it's always important that we at least be able to see the drip so that way we know it's infusing correctly once we start our pump. Okay, so note that this is still clamped, which is a good thing. So now we're going to take this and then we are going to slowly, I want to emphasize slowly primary tubing. So this is very important because a lot of medication that you're going to give via IV piggyback for example is maybe an antiseizure med or particularly an antibiotic. So if I open this too quick, I could spill all my medication out and lose it all and we do not want to do this. So, be really careful when we open up the roller clamp that we prime this very slowly to the end. Let me take my roller clamp, and if you remember we can adjust the flow by how much it's going so you can see, I'm trying to be really careful. See that little medication there? I can make sure I very slowly prime this to the end. Again, we want to be careful with this because we do not want to lose our medicine. So now that we see this dripping, I know it's primed all the way the end.

07:09 So I'm going to clamp this again. Okay, so now that that's clamped, one thing I want to note there are different ways to prime this but this is just a very common easy way. Just remember make sure you're really careful that you don't lose all your medicine. Okay, so now that this is primed, now we're going to take our injection port here. So notice that the injection port that I'm choosing is the one that's closest to the bag. This is the one we're going to use for secondary or IV piggyback medications. Now, if you remember, this is the one on the primary tubing that's closest to the patient for IV push meds. But in this particular skill, we're going to use this injection port closest to the primary tubing, close to the pump. Okay, so now I'm going to scrub the injection port for at least 5 seconds and allow it to dry. Okay, so once I've scrubbed this and allow this to dry I can now remove my cap. Notice I've left that on just to make sure that stays sterile and clean. I can get rid of my cap. Now this tap of the secondary tubing, this is going to go push down much like much of our medication syringes, and we're going to screw this on. Okay. So now we're attached.

08:34 So now that we're attached, I'm not worried about medication spilling out anymore so I can undo my roller clamp. So now we're attached. Now, we don't want to forget this guy. This is a hanger for gravity. Now, we want our medication of our secondary to infuse quicker and we want this to be the main one that's going to infuse so via gravity of course we want this one higher than our primary tubing. So I'm going to take my hanger, take my primary fluid, hang this on the hanger, and then I'm going to attach this back to my IV pole. So now when we're talking about infusion and gravity, you see how my secondary or piggyback is higher than my primary? That's what we want to infuse this first. So now that this is hung and this is going, we've got everything unclamped, now we can set our program infusion pumps to the guidelines that we need. Now, one thing to note, pumps have different settings and they can really help with the correct dosage of the med and there are several different types of pumps out there. Now with your infusion pump, sometimes they can tell you the area of nursing such as critical care or med surg, it also can search in the library of the pump what type of med you're using and what type of dose. This really helps to cut down on errors so make sure you get really familiar with your infusion pump of your agency. Also before you start infusion and program your pump to the right infusion rate and the volume, you can also check the label that's typically on the medicine from the pharmacy. Okay, so now that we've hung it, we have programmed our pump, make sure all of your clamps are open because we want to make sure this infuses to the patient, so make sure your secondary tubing, the clamp is open. We want to make sure our blue clamp is open. We also want to make sure our big primary clamp is open and also the one next to our patient. So key thing, make sure once you're going to infuse this all your clamps are open. Then once that's done, then we can press start and infuse our medication. One last thing, check the drip chamber and make sure this is dripping and that's how we know the medication is going for our patient.