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Difficulty: MediumPharmacological and Parenteral Therapies

A nurse is preparing to administer an intermittent secondary intravenous (IV) piggyback medication using a new sterile administration set. The client is currently receiving a continuous primary IV fluid infusion via an electronic pump. Arrange the following actions in the correct sequence.

  1. 1Verify the compatibility of the prescribed secondary medication with the primary intravenous solution.
  2. 2Close the roller clamp on the secondary intravenous administration tubing.
  3. 3Spike the secondary medication bag and open the roller clamp to prime the tubing.
  4. 4Cleanse the upper Y-port on the primary intravenous tubing with an antimicrobial swab.
  5. 5Connect the secondary tubing to the primary line and suspend the primary fluid bag lower than the secondary bag.

Answer

The correct sequence is to verify medication compatibility, close the secondary tubing's roller clamp, spike the bag and prime the tubing, cleanse the primary tubing's upper Y-port, and finally connect the secondary tubing while lowering the primary IV fluid bag.
Administering a secondary intravenous (IV) piggyback medication requires a systematic approach to ensure patient safety and medication efficacy. First, the nurse must verify the compatibility of the secondary medication with the continuous primary IV fluid to prevent dangerous precipitates from forming. Next, the nurse closes the roller clamp on the new secondary tubing to prevent fluid from freely flowing out when the bag is spiked. The bag is then spiked, and the tubing is primed to expel all air, which prevents an air embolism. Following preparation of the tubing, the nurse maintains strict asepsis by cleansing the upper Y-port (the port above the infusion pump) on the primary line with an antimicrobial swab. Finally, the secondary tubing is connected to the cleansed port, and the primary fluid bag is lowered using an extension hanger. Because the secondary bag is hung higher, gravity allows it to exert greater hydrostatic pressure, ensuring the secondary medication infuses first while temporarily halting the primary infusion until the secondary bag is empty.

Step-by-Step Solution

1
Verify compatibility.
Ensures the secondary medication will not form a precipitate when it mixes with the primary IV fluid.
Patient safety is the highest priority; incompatible medications can cause life-threatening complications.
2
Close the roller clamp.
The secondary tubing is closed off to fluid flow.
Prevents the medication from immediately spilling out when the fluid bag is spiked.
3
Spike the bag and prime the tubing.
Air is completely removed from the secondary tubing.
Expelling air from the intravenous line prevents an air embolism from reaching the client's vascular system.
4
Cleanse the upper Y-port.
The connection site above the infusion pump is disinfected.
Vigorously scrubbing the needleless port maintains asepsis and prevents the introduction of pathogens into the bloodstream.
5
Connect the tubing and lower the primary bag.
The secondary medication is ready to infuse first.
Gravity causes the fluid in the higher bag (secondary) to exert greater hydrostatic pressure, allowing it to infuse while temporarily halting the flow of the lowered primary bag.

Key Concept

Safe administration of intravenous piggyback (IVPB) medications
Estimated Time:1m 30s
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Topics

Pharmacological and Parenteral Therapies

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