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Difficulty: MediumPharmacological and Parenteral Therapies

A client admitted with bacterial cellulitis is receiving a continuous primary infusion of normal saline at 125 mL/hr125\text{ mL/hr}. The nurse is ready to initiate a scheduled dose of intravenous ampicillin-sulbactam via a secondary piggyback line. Arrange the following steps in the correct order to safely set up the secondary infusion.

  1. 1Close the roller clamp on the secondary intravenous tubing.
  2. 2Spike the secondary medication bag and prime the tubing.
  3. 3Cleanse the uppermost Y-site port of the primary tubing with an antimicrobial swab.
  4. 4Attach the secondary tubing to the primary line.
  5. 5Suspend the primary intravenous fluid bag lower than the secondary medication bag.

Answer

The correct sequence is to first close the roller clamp on the secondary tubing, then spike the bag and prime the tubing. Next, cleanse the uppermost Y-site port of the primary tubing, attach the secondary tubing to this port, and finally lower the primary continuous intravenous fluid bag.
This sequence ensures patient safety, asepsis, and proper administration mechanics. Closing the clamp first prevents medication waste. Spiking and priming prepares the line and removes air. Cleansing the port maintains asepsis. Attaching to the upper Y-site ensures the pump controls the rate. Lowering the primary bag utilizes gravity to allow the piggyback to infuse entirely before the primary fluid resumes.

Step-by-Step Solution

1
Close the roller clamp on the secondary intravenous tubing.
The tubing is sealed off.
Prevents immediate uncontrolled flow of medication and rapid air entry when the IV bag is spiked.
2
Spike the secondary medication bag and prime the tubing.
The tubing is filled with the medication and purged of air.
Ensures the line is ready for connection without introducing air into the patient's vascular system.
3
Cleanse the uppermost Y-site port of the primary tubing with an antimicrobial swab.
The connection site is disinfected.
Prevents the introduction of pathogens into the central or peripheral bloodstream.
4
Attach the secondary tubing to the primary line.
The secondary line is securely connected to the infusion system.
Allows the secondary medication to be routed through the primary line so its rate can be regulated by the main infusion pump.
5
Suspend the primary intravenous fluid bag lower than the secondary medication bag.
The primary bag hangs physically lower than the secondary bag.
Hydrostatic pressure dictates that fluid from the higher bag (secondary) will infuse first. Once the secondary bag empties, the primary fluid will automatically resume.

Key Concept

Intravenous (IV) Piggyback Administration Setup
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Topics

Pharmacological and Parenteral Therapies

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