Intravenous Medication Administration
Administering IV Medication by Piggyback
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Safety
- Ensure that the Six Rights of Medication Administration are followed: right medication, right dose, right patient, right route, right time, and right documentation.
- Use aseptic technique during all phases of parenteral medication administration.
- Use the mnemonic CATS PRRR to help remember safety checks for administering IV medications: C = compatibilities, A = allergies, T = tubing correct, S = site checked, P = pump safety checked, R = right rate, R = release clamps, R = return and reassess the patient.
- Monitor the patient closely for hypersensitivity, anaphylaxis, and other adverse effects. If such a reaction occurs, stop delivering the medication immediately, notify the health care provider, and be prepared to administer emergency medications, such as an antihistamine or epinephrine.
- Discontinue the infusion immediately if you notice signs of infiltration or phlebitis. Be prepared to provide IV extravasation care specific to the medication that has infiltrated.
- Never administer an IV medication through tubing that is infusing blood or blood product, a parenteral nutrition solution, or insulin.
- Use a syringe with a 5- or 10 mL barrel when flushing a peripheral IV catheter, and 10 mL or larger when flushing a central IV catheter. A syringe with a 3-mL barrel exerts higher pressure and may fracture or damage the catheter.
Equipment
(Roll cursor over items to see labels)
Antiseptic swabs
Medication (50- to 250-mL labeled infusion bag or a 5- to 60-mL syringe)
Prefilled syringes of normal saline solution
Piggyback secondary infusion tubing set
Saline lock
PrintableDelegation
The skill of administering intravenous medications by piggyback may not be delegated to nursing assistive personnel (NAP). Be sure to inform NAP of the following:
- Explain the possible side effects of the medications, and instruct NAP to report their occurrence to you.
- Request that NAP report any change in the patient’s condition or vital signs.
- Stress the need to notify you if the patient reports moisture or discomfort at the IV site.
Preparation
- Check the accuracy and completeness of the MAR or computer printout against the prescriber’s written medication order. Clarify incomplete or unclear orders with the health care provider. Confirm the patient’s name and the medication name and dosage, route of administration, and time of administration.
- Note if the patient has allergies.
- Observe the Six Rights of Medication Administration: right medication, right dose, right patient, right route, right time, and right documentation. (For details, see the Video Skill “Ensuring the Six Rights of Medication Administration.”)
- Check the label on the IV piggyback against the MAR two times. Note the expiration date.
- Calculate the infusion rate based on volume and duration of hang time.
- Label newly opened IV infusion tubing with the date and time.
- Check for Y-site and tubing compatibility of the medication with running IV fluids and additives.
- Assess the IV site for redness, warmth, swelling, leakage, tenderness, and patency.
Follow-up
- Observe the patient closely for adverse reactions during administration and for several minutes thereafter. Dyspnea, wheezing, and circulatory collapse are signs of a severe anaphylactic reaction. Report any adverse effects to the health care provider.
- Monitor therapeutic levels of drugs such as vancomycin, aminophylline, and phenytoin.
- Assess the IV site for redness, swelling, warmth, or coolness at the insertion site after the infusion. Document preinfusion and postinfusion IV site assessment.
- Include the volume of IV piggyback medication in the patient’s intake.
- Document and report to the health care provider if the patient has any side effects.
Documentation
- Immediately after administration, document in the medication administration record (MAR) the name and concentration of the medication delivered by IV piggyback, the volume infused, the start and stop time of administration, and the venous access device type and location.
- Document the volume of the IV piggyback as intake on the I&O form.
- Document IV placement verification, presence of blood return, and appearance of the IV site before and after the infusion.
Review Questions
1. Which instruction reflects the nurse’s correct understanding of the role of nursing assistive personnel (NAP) in caring for a patient receiving an intravenous (IV) antibiotic medication by piggyback?
“Assess the IV site frequently for signs of infiltration.”
“Let me know immediately if the patient complains of pain at the IV site.”- “Notify the physician that the patient is allergic to the medication prescribed.”
- “Remember to hang the piggyback medication higher than the primary solution.”
INCORRECT. Assessment may not be delegated to NAP.
CORRECT. NAP can let the nurse know when an IV pump alarm sounds or the patient complains of discomfort.
INCORRECT. Physician notification may not be delegated to NAP.
INCORRECT. No aspect of preparing or administering IV piggyback medication may be delegated to NAP.
2. When administering an IV piggyback medication to infuse by gravity, how can the nurse ensure that the medication will flow properly?
- Use an infusion pump to regulate the flow rate of the piggyback medication.
- Hang the piggyback medication higher than the primary fluid.
- Attach the piggyback medication to the most proximal insertion port on the primary tubing.
- Use a secondary infusion set for the piggyback tubing.
INCORRECT. A pump is not used when infusing medication by gravity.
CORRECT. By hanging the piggyback medication higher, gravity allows the piggyback solution to run first.
INCORRECT. Selecting a proximal insertion point will not ensure proper fluid flow from the piggyback.
INCORRECT. Use of a secondary piggyback infusion set is unrelated to proper fluid flow.
3. What is the best way to protect a patient from an IV site injury when giving an antibiotic medication by piggyback?
- Use a site into which a primary solution is already infusing.
- Assess the IV site before initiating the IV piggyback medication.
- Select a relatively small vein to infuse the IV medication.
- Instruct NAP to notify you immediately if the insertion site appears swollen.
INCORRECT. Primary IV solution infusions may not be flowing while IV piggyback medication is hanging, and this would not prevent an infiltration or extravasation.
CORRECT. Assessing IV site placement and patency before initiating an IV medication is important in preventing IV infiltration.
INCORRECT. A larger vein is preferable for infusing an IV medication.
INCORRECT. IV site assessment may not be delegated to NAP.
4. What is the best way to prevent infection and conserve resources when terminating an IV piggyback medication infusion in a patient who also has a primary fluid infusion?
- Remove the tubing from the primary line Y-site port, and cap the end.
- Leave both the piggyback tubing and the bag attached to the primary line Y-site port until the next scheduled dose.
- Place an unopened secondary setup at the bedside, and discard the used one.
- Change both the primary and secondary tubing upon terminating the piggyback infusion.
INCORRECT. Although the tubing can be removed from the port and capped, it is better to leave the tubing and bag in place until the next scheduled dose.
CORRECT. Leaving the piggyback tubing and bag attached will help maintain tube sterility while conserving supplies and nursing time.
INCORRECT. Secondary tubing can be reused for up to 72 hours. Changing the tubing with each piggyback infusion is expensive.
INCORRECT. It is unnecessary to change the primary and secondary tubing when terminating an infusion of IV piggyback medication.
5. Which nursing intervention is most important in ensuring safe infusion of a medication delivered by IV piggyback through a saline lock?
- Use the most proximal insertion port on the primary tubing.
- Hang the piggyback solution higher than the primary infusion solution.
- Use a pump to regulate the infusion rate of the piggyback medication.
- Flush the saline lock with sodium chloride solution before initiating the infusion.
INCORRECT. The piggyback is connected directly to the saline lock, not to primary tubing.
INCORRECT. There is no primary infusion solution when infusing piggyback medication directing through a saline lock.
INCORRECT. Although using an infusion pump to regulate the infusion rate of a piggyback medication may be appropriate, it is not the most important intervention for ensuring safe infusion.
CORRECT. Flushing the saline lock with 0.9% sodium chloride solution to assess for placement and patency before initiating a piggyback infusion reduces the likelihood of infiltration and extravasation.
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