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JMerritt
Draining your IV bag dry

It has come to my recklection that there are times when nurses program their infusion pump to drain their IV bag dry. Can anyone tell me why do we feel the need to over program the pump, and if so how often are we doing this. This practice raises alot of red flags for me as it is not standard practices and can be a safety issue (air in line delievery to the patient).

lynncrni
I can never recall

I can never recall overprogramming an infusion pump or purposefully allowing any infusion container to run dry. Air in the line, and blood reflux into the catheter leading to occlusion are the 2 critical outcomes with this practice. I have also never heard or seen this practice either. The only reason I can think of is the concern some nurses have about ensuring that the entire dose of medication is infused. The rationale goes something like -- there is overfill in the container but the med dose was diluted in the total amount, therefore the total amount must be infused. For small volume medications (50 to 100 mL) I would usually try to ensure that the bag was empty but there was still fluid left in the drip chamber, then stop and disconnect or clamp the set. Busy nurses though can not always be present at the immediate time when the bag empties before air gets into the tubing. Lynn

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

Lynn Hadaway Associates, Inc.

126 Main Street, PO Box 10

Milner, GA 30257

Website http://www.hadawayassociates.com

Office Phone 770-358-7861

JMerritt
Draining the bag dry

I definitely agree that this can not be good practice nor standard practice. Thanks for your response Lynn. I may be calling you back to Hospira Lynn for another meeting of the minds. What does your calendar look like for the next couple of months?

James C. Merritt RN, BSN, MBA
Hospira
275 Fields Drive
Lake Forest, Ill 60031
224 212-6123

janicer
letting IV bag run dry

I always set my primary bag at less than the total amount (such as 960 for 1 liter, 460 for 500 ml).  I have fount over the years that bags are usually short rather than over.  For medication running as a secdondary I will put in the total or 5-10 ml over (because of overfill).  The only time I want every possible drop in is when I am infusing chemotherapy and biotherapy.  It is also why I am in the camp that chemo should always run as a secondary.  That way if it runs dry and you are not in the room, it isn't going to infuse any further (and chemo bags are always overfilled.

What concerns me is the number of newer nurses who run a secondary (say antibiotic) with nothing on the primary to a) keep the line from going dry and b) push the medication in the distal line in.  I have heard beeping and gone into a room and that has been the case.  The same goes it turning a pump off when the medication has finished infusing but the nurse doesn't want to take the time to flush so she leaves it connected to the patient but not running (I have disconnected and flushed several of those recently when a CNA has come to me. 

lynncrni
I think you are correct to be

I think you are correct to be concerned about these practices, however an intermittent med can safely be infused with a direct connection to the catheter and no primary fluids infusing. It does take paying attention to return at the right time to disconnect and flush and this can be a problem for busy nurses. So a "carrier" fluid is what many hospitals do use to prevent reflux. Please keep teaching all nurses that when the infusion pressure is gone (fluid left only in the set) there will be blood reflux into the catheter and this leads to partial or complete occlusion over time. Lynn

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

Lynn Hadaway Associates, Inc.

126 Main Street, PO Box 10

Milner, GA 30257

Website http://www.hadawayassociates.com

Office Phone 770-358-7861

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