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Kaiser Ann Pajulas, USRN

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Hanging an IV Piggyback

Hanging an IV Piggyback

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10 Hanging an IV Piggyback NCLEX Questions

Question 1 of 10

The nurse is preparing to hang a bag of IV cefepime for a client with a maintenance fluid of NS running. The nurse gathers all of the following supplies except which?

Bag of cefepime hydrochloride

Primary IV tubing

Gloves

Alcohol swabs

Question 2 of 10

The nursing student is preparing to prime a secondary IV infusion in order to administer the infusion to a client. The student’s preceptor notes that the student correctly sets up the infusion when the student performs which of the following ordered steps?

Close secondary roller clamp, spike secondary infusion bag, squeeze the drip chamber, prime secondary tubing by slowly opening roller clamp

Open secondary roller clamp, connect secondary tubing to primary tubing, backprime primary infusion into secondary tubing, spike secondary infusion bag

Close secondary roller clamp, spike secondary infusion bag, connect secondary tubing to primary tubing, backprime primary infusion into secondary tubing after opening roller clamp

Open secondary roller clamp, spike secondary infusion bag, connect secondary tubing to primary tubing, backprime primary infusion into secondary tubing

Question 3 of 10

The nurse is caring for a client with an order to administer IV insulin and heparin. Which of the following actions is the best way to prevent a medication error with these high-alert medications?

Set up both infusions at the same time, and label only the primary line

Set one infusion up completely, then set the next infusion up completely, labeling the lines for each.

Contact the provider to clarify which medication could be delayed until later in the shift

Prime the IV tubing outside of the client’s room and bring them in for scanning once they are primed and hung

Question 4 of 10

The student nurse correctly demonstrates understanding of IV infusions when stating which of the following about a programmable IV pump?

When the secondary line is hung above the primary line, the primary line runs in first

A maintenance infusion rate is calculated based on the individual client’s weight

The pump senses which IV line is the secondary line on a single channel, and if the secondary line is connected, it will infuse first

When a secondary medication is running on a single channel, the primary medication is temporarily stopped

Question 5 of 10

When administering a secondary IV medication, which of the following positions is correct placement of the bag?

Above the primary bag because this indicates to the staff which bag is actively infusing

Above the primary bag because the gravitational pressure is greater

Below the primary bag because the IV pump detects the closest fluid to infuse first

Below the primary bag because this temporarily halts the primary infusion

Question 6 of 10

The nurse enters a client’s room at the beginning of the shift and finds two secondary IV tubing sets hanging, each with a different, empty IV medication bag attached. Neither tubing set is labeled with a date. Which of the following actions is most appropriate for the nurse to take?

Immediately disconnect the IV tubing sets from the secondary medication bags and replace with new sets, labeled with the date and time.

Check the provider order to find out when the IV medications were started, and discard the sets if the medications were started more than 48 hours prior.

Leave the IV tubing sets in place to prove they were left unlabeled and write an incident report

Promptly discard the unlabeled tubing, and replace with new labeled sets when it is time to administer the next antibiotic infusions

Question 7 of 10

The nurse has verified the order, gathered supplies, and primed the tubing for IV cefepime due at 1000. After following the 6 rights of medication administration, the nurse attaches the tubing and scans it into the computer to start the infusion. The nurse returns at 1030 to discover that the secondary bag is still full of medication, and the pump was never started. What action should the nurse take next?

Follow the 6 rights of medication administration, start the pump at 1030, and edit the administration in the charting

Discard the spiked bag of cefepime and replace it with the next dose from the client’s medication bin

Notify the provider

Call the pharmacy to notify them that the nurse will be returning the spiked bag of cefepime

Question 8 of 10

A student nurse is watching the nurse preceptor set up a secondary infusion. The student notes that after pushing the “start” button on the pump, the nurse takes a moment to look at the drip chamber. Which of the following is the reason for this?

The nurse is allowing the student to verify that the piggyback is set up appropriately

The nurse is verifying that the “right drug” is being infused

The nurse is ensuring that the drip chamber is at least 1/3 full of medication

The nurse is verifying that the secondary infusion is running

Question 9 of 10

The nurse is caring for a client with acute hypotension. The nurse receives an order to initiate IV norepinephrine titrated to keep systolic blood pressure >90. The client has maintenance fluid running and an initial blood pressure of 78/55. The nurse sets up the secondary infusion of IV norepinephrine by following the 6 rights of medication administration. The nurse spikes the bag, primes the tubing, programs the pump at an initial dose of norepinephrine 8 mcg/min, scans the client and the pump, and starts the infusion. 15 minutes later the client’s blood pressure drops to 65/38. Which of the following is a potential reason for this?

The nurse hung the secondary bag above the primary bag, so it did not run in

The nurse re-checked the client’s blood pressure too soon because norepinephrine takes 30 minutes to affect blood pressure

The nurse did not connect the secondary tubing so the client is not receiving the norepinephrine

IV norepinephrine is given for hypertension, not hypotension

Question 10 of 10

A nurse is starting a day shift in the intensive care unit. The client has a maintenance infusion, as well as 5 IV piggyback medications. How should the nurse verify that the correct medications are infusing appropriately with this client?

Check the previous nurse’s medication scan times in the electronic chart

Verify with the outgoing nurse that the appropriate medications are currently infusing

Perform a neurological assessment on the client

Trace the line of each piggyback medication from the pole to the pump

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Study Tools For Hanging an IV Piggyback

IV bags and tubing (Image)

140 Must Know Meds (Book)

Medication Administration Pro-Tips (Cheatsheet)

Spiking & Priming IV Bags (Cheatsheet)

Starting an IV (Cheatsheet)

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Outline

Overview

Purpose
1. Some IV infusions are hung as secondary, or piggyback, infusions with primary infusions of IV fluids
2. This method ensures all of the medication is infused
3. It also ensures the primary infusion is restarted immediately once the secondary is complete

Nursing Points

General

Supplies needed to hang an IV piggyback
1. Primary infusion – already spiked, primed, and infusing to patient
  1. Ensure fluids are compatible
2. Secondary tubing
3. Bag of med for piggyback infusion

Nursing Concepts

Steps and Nursing Considerations
1. Verify provider order
2. ALWAYS follow 5 rights BEFORE preparing medication
  1. Right Patient
  2. Right Drug
  3. Right Dose
  4. Right Route
  5. Right Time
  6. Right Documentation
3. ALWAYS prepare medications at the patient’s bedside
4. Gather supplies
5. Perform hand hygiene
6. Don clean gloves
7. Let the patient know what meds they will be receiving
8. Remove IV med bag from package if applicable
9. Open Secondary IV tubing package
10. Clamp tubing with roller clamp
11. Spike and prime the tubing appropriately
12. Clamp tubing once fully primed
13. Attach the secondary IV tubing to the port on the primary IV tubing that is above the pump
  1. Scrub the hub for 30 seconds with alcohol scrub
  2. Twist the leur-lock in place
14. Set the pump for a secondary infusion per manufacturer instructions and according to the ordered rate
15. Unclamp the secondary tubing , THEN Start Infusion
16. AFTER administration
  1. Document administration
  2. If using barcode medication administration
    1. Scan all meds before preparing
    2. Confirm administration AFTER giving to patient
17. Discard all used supplies
18. Remove gloves
19. Perform hand hygiene

Patient Education

Indication and possible side effect(s) of medication(s)
Signs to report to nurse or provider

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Transcript

In this video we’re going to look at how to hang an IV piggyback, otherwise known as a secondary IV infusion. To do this, you have to have a primary infusion running, so make sure you go back and watch how to spike and prime an IV infusion first!

So once you’ve verified your orders, you’re going to get your IV med bag out of the package if it’s in one.
Then you’ll open the secondary IV tubing package – this is usually much shorter than primary tubing and doesn’t go inside the pump. Then you’ll clamp that tubing once you have it open.

Then you need to spike and prime your secondary med bag – use a trashcan or the sink if you need to, then clamp it once it’s primed.

Now you’re going to attach the secondary IV tubing to the primary tubing – usually there’s a port above the pump, that’s where you want to attach it. Make sure you scrub the hub.

Now you can set the pump for a secondary infusion. If you aren’t sure how, check the manufacturer instructions or check with a charge nurse. Ad of course, make sure you’re setting it according to the ordered rate.

And, of course, make sure you unclamp the secondary tubing before you hit Start!

If you’re ever unsure how long to infuse these meds over, check with your pharmacist. Then, document the administration and monitor the patient for effects of the meds.

That’s it! Now, go out and be your best selves today. And, as always, happy nursing!

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