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Clamping Secondary med set for atb infusion

We recently have seen an increase in med errors related to nurses forgetting to unclamp the secondary med set (piggybacked into a primary solution).  We have done some education and had a reminder screen added to the pump that reminds the nurse to unclamp the secondary med set before pushing start.  Errors are still occurring.  Now, staff are requesting a secondary med tubing without a clamp.  Does anyone use a secondary med set without a clamp?  I feel it is needed, especially when backpriming with bag change.  Does anyone have any thoughts on this or know of any evidence to support clamping the secondary med set?  Any advice/thoughts is appreciated? 

 If there was no clamp on the

 If there was no clamp on the secondary piggyback set, this could result in the pump driving fluids back into the empty secondary set. I understand that nurses are busy but it looks to me like they are just going to have to pay more careful attention to what they are doing by opening the clamp to allow for infusion and closing it when the med is infused. The only other way is to connect and disconnect the secondary set but that increases set manipulation and the risk of infection and is outside the INS SOP. If they are forgetting to open the clamp, they are also forgetting to assess for flowing fluid, another critical element of safe infusion therapy. I think you have to hold them accountable for safe practice which includes opening the clamp and assessing for fluid flow before leaving the patient. Lynn

Lynn Hadaway, M.Ed., RN, BC, CRNI

Lynn Hadaway Associates, Inc.

126 Main Street, PO Box 10

Milner, GA 30257


Office Phone 770-358-7861

 We've seen an increase in

 We've seen an increase in the same problem, which we've dealt with by taping the roller clamp after the secondary is initially set up as there really is no purpose for it beyond that.  It can be tricky to connect the secondary initially without it being clamped, but after that we consider the secondary tubing to be "one" with the primary tubing leaving no continuing need for a clamp.  The line is primed and flushed between doses through backflushing.  We have seen our error rates drop although it's a small sample so far.

If a secondary was connected to primary set below the pump then the pressure variability that exists below the pump could potentially push fluid back up into secondary tubing, but since it attaches above the pump the only influence is the difference in height of the two bags.  The height of fluid column in the secondary tubing will be the same as in the primary bag.


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