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Cape Cod Gal
Back Flushing Secondary Med Tubings
What are everyones thoughts on this.  The topic is being greatly discussed at our hospital.  The issue is that one secondary tubing is used for several meds, they may or may not be compatible, but the nurses are told if they run the fluid in the  tubing down to the primary them back prime they can use it for any meds!  I have never used a secondary tubing for more than one med!  Always had a separate tubing.  I feell that if they are incompatible meds....which many are these days, that this alone should warrent each having its own tubing!   Can't wait to see the responses.  I am sure this will vary like flushing and dressing change protocols!  But don't think cost should play a role in this.  Thanks
cathie
we back flush and have for

we back flush and have for years....no complications identified...keeps system closed and 

reduces cost 

lynncrni
Don't kit yourself -- cost

Don't kit yourself -- cost is an important part of everything we do in all aspects of healthcare. Backpriming is an acceptable procedure. Although the INS standards do not specific use this term, the standards for tubing changes do support the use of backpriming. When a secondary set is connected and disconnected multiple times, it should be considered an intermittent set and therefore changed every 24 hours. This is because of the excessive manipulation on both ends. When a secondary and primary set remain connected, they can both be changed no more frequently than every 72 hours. 

Regarding compatibility - you will have 2 issues. Compatibility between the secondary med and anything admixed in the primary fluid. This is the most important issue because this fluid is what will remain in the secondary tubing after you connect the next dose of the secondary med. Compatibility between 2 secondary medications is the other issue but  in my opinion, this is a lesser concern. The secondary tubing will be  filled with fluid from the primary bag instead of the secondary medication after the backpriming procedure has been done.

All nurses responsible for delivery of IV therapy must have easy assess to updated  information about IV medication that does include compatibility information. And they must be taught to assess this information frequently because compatibility information changes as new information is known. Wall charts that remain up for years are not the answer. You need to at least have a yearly book such as Intravenous Medication published by Mosby or online information such as MicroMedix.

 You can read more about backpriming in:

1.    Hadaway L. I.V. Rounds: Delivering multiple medications via backpriming. Nursing2004. 2004;34(3):24, 26.
 

Lynn Hadaway, M.Ed., NPD-BC, CRNI

Lynn Hadaway Associates, Inc.

PO Box 10

Milner, GA 30257

Website http://www.hadawayassociates.com

Office Phone 770-358-7861

lynncrni
Sorry, I meant - don't kid
Sorry, I meant - don't kid yourself in my first message. Lynn

Lynn Hadaway, M.Ed., NPD-BC, CRNI

Lynn Hadaway Associates, Inc.

PO Box 10

Milner, GA 30257

Website http://www.hadawayassociates.com

Office Phone 770-358-7861

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