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Patti Atteberry
retrograde flushing and tubing changes

I recieved this question from our local hospital:

I have a question about retrograde flushing of IV antibiotic bags with a NS main line.  In order not to have to change administration sets after each antibiotic infusion, I understand that there is a practice that allows retrograde flushing of the iv tubing from the main NS bag, then another antibiotic is placed on the tubing and then infused, then repeated whenever a new antibiotic is needed.    This allows for fewer administration sets to be used, and less entering of the system at the port site.  Lines are disposed of at 72 hours.  I cannot find any information stating pro or con on this, other than the CDC recommends that lines are changed no less than every 72 – 96 hours.  So I would assume from this that it is okay to do this process.  What do you think?  I never heard of this, I was always used to changing every  24 hours for an intermittent infusion and 72 hours for continuous.  Can you help me?  Thanks

This process is known as

This process is known as backpriming, not retrograde flushing. Actually retrograde flushing is an old practice used in peds long ago. The medication was injected into the tubing so that it flowed upstream or retrograde, then the flow was established into the patient.

Backpriming is an acceptable practice and it allows you to be in compliance with the INS standards of practice on primary and secondary continuous IV administration sets. These sets should remain connected together. When they do remain connected, they can be changed together at 72-96 hours.

Backpriming is not supported by a lot of clinical research but it is something that the set manufacturers have suggested since we began using piggyback tubing many many years ago. At issue is the additives that might be in the primary fluid and the compatibility with the secondary piggybacked med. If there is no incompatibility, there is no problem. Some hospitals will use a bag of normal saline and piggyback all secondary meds into the saline so the backpriming would never present a risk of incompatibility.

I would suggest you take a look at the common solutions prescribed in your hospital. What has been added such as KCl, vitamins, insulin, heparin, etc? What about meds in ICU? Backpriming is a good method for reducing the costs associated with having numerous piggyback sets as long as there is no problem with incompatibility between what is added to the primary fluid and what is being piggybacked. See the following for more details on the process

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

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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