Hi, I'm Sarah and today we're going to do IV piggyback. I have my patients chart
here I'm going to verify that I have the patient's name, Morgan Brown, date of
birth 8/4/70, MR number 5 8 9 1 3 5 1 3 2 5, he has no known allergies, and I
see here he has an order for ciprofloxacin 400 milligrams IV
piggyback in 50 MLS every 12 hours to infuse over 60 minutes. Now I'm going to
compare my physician order to my MAR. Again, I have Morgan Brown, date of birth
8/4/70, MR number 5 8 9 1 3 5 1 3 2 5, he has no known allergies and I see here
he has an order for ciprofloxacin 400 milligrams and 50 ml IV piggyback every
12 hours to infuse over 60 minutes. It's ordered today at 9 a.m. Now I need to
check for compatibility because it looks like he has IV fluids running as well.
So I want to make sure that my antibiotics and IV fluids are compatible so I'm
going to look in the drug book here.
I see here it doesn't look like it's incompatible with 0.9 normal saline so
we're good to go. Other things I need to consider is why the patient's getting
the antibiotic. So, it looks like he was admitted with acute appendicitis and a UTI,
he had a surgical procedure. I also want
to assess for any adverse effects such as an allergic reaction like a rash, and
anaphylactic shock, and I want to complete a proper assessment when I go into the room.
So now I'm going to gather my equipment. I need an alcohol swab, a date sticker,
secondary tubing or piggyback tubing,
my medication, which is the ciprofloxacin,
and now I'm going to calculate my rate. Okay so our order was for 50 ml over an hour.
And we need to calculate two drips per minute. Okay, so we know that our
tubing was drip factor of 10 per ml, then we need to do 1 hour over 60 minutes.
I'm going to go ahead I can cancel out my MLs. I can cancel out my hours I'm left
with drops per minute. That gives us 500 drops over 60 minutes 60 minutes then
that will come out to 8 drops per minute or two drops in 15 seconds.
Okay now I'm going to prepare everything to go into the patient's room. So I want
to complete my first check. So, I have Morgan Brown, right patient.
I have ciprofloxacin 50 mLs with 400 milligrams which is the right drug and
the right dose to give today at 9:00 a.m. via IV piggyback. Now I'm going to
do my second check. I see I have Morgan Brown. I have ciprofloxacin 400
milligrams and 50 mLs to give IV piggyback today at 9:00 a.m.
I'm inspecting my drug and it looks good, it's clear, it's not cloudy, there's no
discoloration, it looks like it was prepared today, the expiration date is
good - 1/10/50, so now I can prepare my medication. So you want to make sure you
hold on to this blue plastic hook, we're going to need that when we go in the
patient's room. You want to close the roller clamp, now if you notice this
tubing is a lot shorter than our previous tubing that we use for the
primary line, so you have to be very careful not to race the drug because you
have such a smaller volume here. So again we want to keep this spike sterile.
Pull a stopper, spike, push and twist.
Okay, fill the drip chamber about half way again. Okay now I'm going to
carefully prime this again without getting air in the tubing.
Okay. Looks good, I don't see any air. So now I can go ahead and get ready to go
into my patients room. I'm gonna get my date sticker ready first. And again you
want to put the date sticker on the tubing and not on the drip chamber.
Now I'm ready to do my third check. Morgan Brown, ciprofloxacin, 50 mLs, 400
milligrams, IV piggyback, due today at 9 a.m. Again, my medication looks good and
it's not expired. So now I can get ready to go to the patient's room. I'm gonna
grab my medication, my MAR, the plastic hook and an alcohol swab. Hey Morgan, it's
Sarah your nurse I'm here to give you your IV antibiotics. How you doing? <<Good.
Any pain? Okay, I need you to go ahead and verify your name and date of birth for me.
<<It's Morgan Brown 1/4/70.
Great, that's what I have here. Morgan, do you have any allergies? <<I do not.
No allergies to latex, iodine or adhesive? <<No. Okay, great. So the doctor has ordered some
antibiotics because of your appendicitis that you came in, that inflammation in
your belly and the infection in your urine. So we're going to prepare these
antibiotics so you can get feeling better. Are you having any burning or
anything at the IV site? <<No. Okay and it looks good. I don't see any swelling or
redness. I'm going to go ahead and raise the bed again so it's at a comfortable
position for me.
All right and then I need to make sure that I clamp my primary tubing, take my
plastic hook, put that here, we have to drop down our primary fluid. Take my
cipro here, and again I'm going to scrub the hub. Now I'm going to connect the
secondary to this port here closest to the primary fluids. So scrub again for 15
seconds and I'm going to make sure that my tubing looks okay again, everything's
primed, the primaries primed, secondaries primed, there's no air. And then going to
carefully connect the two together push and screw again. Okay good.
Then I can go ahead and open up the clamp on my secondary tubing and I'm
going to control my drops with the primary roller clamp. Again, I need to be
using my watch to count my drops per minute which if you remember we had two
drops per 15 seconds.
Okay, it looks that we like, we have our drops, per 2 drops per 15 seconds.
All right Morgan, you're all set here. Is there anything I can get you? <<I'm fine.
Are you comfortable? <<Yes. Thank you. Great, I'll be back in
about 15 to 30 minutes to check and make
sure that that medication is infusing properly. Here's your call light. Feel free to
call us if you have any pain or if you need anything and let us know if you
feel any burning at the IV site. <<Okay.
I'm now going back to the nurse's station to complete my documentation.
Now, I'm back at the nurse's station. I'm going to document what I just completed.
I gave Morgan Brown, ciprofloxacin, 400 milligrams and 50 mLs to infuse over
an hour. Today at 9:00 a.m., I will date in time with my initials. I also will
document that he tolerated the procedure while there was no swelling or burning
at the IV site. I will then return to the patient's room in 15 to 30 minutes to
make sure that the medication is still infusing and that the patient has no
complaints. I will assess the patient for adverse effects such as itching, burning
anaphylactic shock or shortness of breath, and to make sure that my IV site
is still intact. This completes our skill of IV piggyback.