I am searching for data to confirm safe practice. I am new to my facility which has a practice of utilizing one IV tubing to administer all antibiotics. I have been practicing 20+ yrs, with a primary focus in IV therapy. It has always been my practice to utilize one IV tubing per antibiotic being administered. I believe I was taught a long time ago we not only have to worry about the immediate precipitate, but the "non-visible" incompatibles and possible drug leaching into the tubing that can cause degradation / potentiation of the  the drugs that follow...I am in search of written data, a study, best practice...something I can reference as best practice. Personally, I would feel best if the practice was to use 1 tubing per drug but I need to confirm & establish what really IS best & safest practice.I would love to hear both from nursing & pharmacy. I feel the answer will lie in the pharmacotheraputic aspect.Looking forward to a response

Kathy thanks for the

Kathy thanks for the information.  I realize I went off on a tangent from your original question.  We use one line for each, considered backpriming but are concerned with individual nursing technique and incompatibilities of the medications.

Carole, Based on INS

Carole,

Based on INS standards of practice YES, if you use one line for each antibiotic medication, and disconnect each time, is this considered "primary intermittent" and is changed every 24 hours.

Yes, if you use one line and back flush, and disconnect after each infusion, this is also considered "primary intermittent"  if it the only line and changed every 24 hours. If it is connected intermittently to a primary then it is considered a secondary intermittent & changed every 24hr.

 Your question: If you keep the line connected, then can it be changed every 72 hours, regardless of one line for each or one line for all? Yes, basically that correct based on standard of practice. As long as your secondary intermittent tubing stays connected to the primary line and is back primed to "clean" the tubing between meds then it can remain handing for 72 hrs.

My search is for the data on the tested efficacy of back priming.

Kathleen Hartman, RN BSN

If you use one line for each

If you use one line for each antibiotic medication, and disconnect each time, is this considered "primary intermittent" and changed every 24 hours?

If you use one line and back flush, and disconnect after each infusion, is this also considered "primary intermittent" and changed every 24 hours?

If you keep the line connected, then can it be changed every 72 hours, regardless of one line for each or one line for all?

Thanks,

Carole

1 IV Tubing for IV administration of multiple medications

We use a  dedicated tubing for each med.  The issue of back flusihing  has come  up on several occasions and is resoundingly  rejected. We are concerned that inadequate  backflusing will occur.  Also of concern is the lack of data to support  this. I know... I know.... data to support either practice doesn't exist  right?  

Jose Delp RN BSN

Clinical coordinator IV Team

Upper Chesapeake Health

Jose Delp RN BSN

CliClinical Nurse Manager IV Team

Upper Chesapeake Health

Backpriming is acceptable practice

Backpriming a secondary set to use it for multiple meds is an acceptable practice as long as any medication in the primary fluid is compatible with the secondary med. Leaving the secondary set attached to the primary set is much better practice because you are not manipulating the tubing on both ends with each dose.

Lynn Hadaway, M.Ed., RN, BC, CRNI

Lynn Hadaway Associates, Inc.

126 Main Street, PO Box 10

Milner, GA 30257

Website http://www.hadawayassociates.com

Office Phone 770-358-7861

follow-up coment on 1 IV tubing

My concern regarding using one tubing stems from a study that indicates Azithromycin is not compatible with Rocephin & Levaquin (among many drugs). These are our standard drugs administered for our pneumonia protocol. The study indicates that these drugs are not compatible using the Y site method.

I can not find evidenced based data to support or NOT support the back-priming method.

If Azithromycin is not compatible then should it be given in the same tubing as other drugs?

Does the back-priming method REALLY 'clean' the tubing so well that no residual drug is left in the tubing or on the drip chamber?

Are staff REALLY performing the complete back-priming method correctly? DO they empty the bag & tubing completely of the 1st drug?

Do they back-prime NS from through out the entire tubing, the drip chamber into the empty bag, before hanging the next drug?

These are the questions I pose. I really would like to find studies or evidenced based data  using the  back-priming method.

Please share your thoughts....Kathy

Kathleen Hartman, RN BSN

Tubing

We use the same tubing as long as the meds are compatible and have been for many years at the Unversity of Pittsburgh.  Apparently this policy was initiated jointly by our Infection Control Department and Pharmacy along with members of an IV committee.  

I am very interested to see what you all in cyberl IVland are doing.

Lisa

Lisa Y., RN, BSN University of Pittsburgh Medical Center/Horizon IV Therapy

This is open and shut, "Not

This is open and shut, "Not Aceptable Practice" for many reason, including the mixing of drugs not documented to be compatible, and excess manipulation as an infection risk.