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IVPB tubing question

Our institution is discussing the back priming method for flushing IVPB tubing to avoid using multiple IVPB lines for patients receiving multiple IVPB medications.  The cost of having multiple lines, which are disconnected from the patient most of the time as well as the risk of infection are both concerns.  For those institutions that use a tubing for each IVPB drug are you also changing the tubing every 24 hours as this consitutes an intermittent infusion scenario?  By back priming enough solution to flush the tubing/medication into the existing bag and discard before spiking the new bag is this enough to clear the tubing or could medication still be adhered to the tubing?  Therefore, is this only an acceptable practice if the medications are compatible?  I have looked in my available resources and have not found anything about this.  Does anyone have any EBP resources that I could refer to?

Thank you,

I tried to locate some

I tried to locate some actual studies on this issue when I was writing this column:

 1.    Hadaway L. I.V. Rounds: Delivering multiple medications via backpriming. Nursing2004. 2004;34(3):24, 26.
I could not find any studies, however the tubing manufacturers have instructions for doing this backpriming method. What I have found is that the main compatibility concern is when you have drugs added to the primary fluid. Vitamins, heparin, insulin, etc could produce an incompatibility with the piggybacked medication, but I have not found any evidence that drugs adhere to the plastic tubing causing a problem between 2 drugs being piggybacked. I know of many hospitals that use a bag of saline as the "carrier" fluid. A 250 or 500 ml bag of saline is placed on a pump and primed, then all meds are piggybacked into this line. The backpriming is done with saline without the concern for meds in the primary fluid. The other place where it could be a concern is ICU where there are so many meds by continuous infusion. The saline carrier works well in those sitautions. 

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

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

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