- Hello and welcome to Santa Fe Nursing Labs.
My name is Professor Sandra Milner.
And today I will be demonstrating
how to administer a med via a secondary line.
A secondary line is used to administer medications
to patients.
However, it has to be attached to a primary fluid line.
Secondary lines should only be attached
to maintenance IV fluids or normal saline bags
that are specifically used for flushing the IV line.
The advantage to administering medications
via secondary line is that majority of the medication
is administered to the patient.
A disadvantage to administering meds
via secondary line is that your primary medication
or your primary fluid is gonna temporarily be stopped
while the secondary med is administering.
Remember to always include your IV administration of fluid
in your patient's daily intake.
Hi, Miss Duncan.
How are you doing?
You're okay?
Good, well, I'm getting ready to go get
your vancomycin, your medication.
I'm just gonna check your IV lines
and make sure I can hang it with your fluid
that you have here.
So before gathering my supplies
to give my medication, I need to check
what type of line Miss Duncan has.
I can see here that she has some normal saline.
And I know that she has some maintenance IV fluid hanging.
So just double checking, this is my normal saline.
My bag's not expired.
I'm double checking my date on my tubing.
My tubing has not expired.
I can continue to use it.
Let me just check your IV site.
I'm just gonna check her IV site
and make sure there's no infiltration.
And your IV looks good.
Is it bothering you at all?
No?
Okay, wonderful.
Okay, everything looks great, Miss Duncan.
Okay, so I'll be back in a little bit with your medication.
When administering medication to patients,
you always wanna make sure you follow
the eight rights of medication administration.
The first right is the right patient,
right drug, right dose, right time,
right route, right reason, right documentation,
and right response.
So next I am gonna check my MAR
to double check the dose of my medication.
And I can see that Miss Duncan needs 500 milligrams
of vancomycin every six hours.
And it is due in the next 10 minutes.
I'm just gonna double check my drug guide,
make sure my dose is accurate.
Yep, and then the other information
that I need to know is how quickly
I'm gonna be administering the medication.
I do know that vancomycin, and I checked my drug guide,
that it is compatible with the solution that's running,
the normal saline.
So we are good with compatibility.
Okay, next I am gonna pull my medication
out of my drug cart.
So I have my vancomycin 500 milligrams.
Just double checking that I have the correct medication.
And then I need a secondary set.
Perfect.
I'm gonna label my tubing, and then I am all ready.
I'm gonna label my secondary set
with the date that the tubing was hung,
the date that the tubing expires, and my initials.
I am also gonna label my medication bag,
make sure it has the patient's name,
date of birth, their medical record number.
I wanna initial it, what date
and time the medication was hung,
and make sure that it has an expiration date.
Remember to always follow your hospital policy
and infection control guidelines
with the expiration dates for both your fluids
and your IV lines.
Hi, Miss Duncan.
I have your medication for you.
Okay.
Can you confirm your name and date of birth for me?
Great, and do you have any allergies?
(beep)
No allergies?
Okay, remember to always educate your patient
on the type of medication and the side effects
that they might experience.
So this medication that I have for you,
this is your vancomycin that you get
every six hours.
And this is to treat that infection of your foot.
Do you have any questions for me?
No?
Okay, and just let me know if you notice
any sort of rash or flushing of your skin, okay?
Gonna go ahead and put on some gloves.
I'll now go ahead and prepare my tubing.
Your secondary tubing comes with the hanger
that you use to hang your primary fluid.
Your primary fluid needs to be lower
than your secondary bag.
Next I'm gonna make sure I have the roller clamp
on my secondary set closed.
Okay.
I'll go ahead and attach my label
that has my expiration date and time on it.
There's two ways to prime your tubing.
You can either prime your tubing with your medication,
or you can go ahead and attach your tubing
to your primary bag and use the normal saline
from this primary bag to prime your secondary tubing.
This is the preferred method,
because it makes sure that you don't waste any medication.
There's the potential that you might waste
your medication when you prime your secondary line
with your actual medication.
I need my alcohol swab so I can make sure
that I scrub the ports.
When administering medication via secondary route,
you are gonna attach your secondary tubing
to the port that is above the pump.
You want this pump, this channel
to control both your medication and your fluid.
Remember, when you hang a secondary medication,
your primary is gonna temporarily be stopped.
Make sure, again, that my tubing is clamped.
Go ahead and scrub my port, 15 seconds.
Once I have cleaned and scrubbed that port,
I do not wanna touch it.
Gonna remove the cap on my secondary tubing
and go ahead and attach it to my primary tubing.
So let's untangle this tubing a little bit.
Okay.
Next what I'm gonna do is go ahead
and retrograde prime my secondary line
with the normal saline.
So I'm gonna hold this drip chamber lower
than my primary line.
And I'm just gonna temporarily pause my infusion.
So this drip chamber is lower than the normal saline,
and by gravity, it's just gonna flow
into this tubing.
So I'm gonna open, slowly, my roller clamp
to allow the fluid to flow into my secondary set.
If you had a bag attached to this,
either an old bag or a new bag,
your new medication bag, the air would go into the bag,
the air that is displaced out of the tubing.
So I'm gonna allow the normal saline to go in
to about, and fill up halfway
from my drip chamber.
I'll fill it halfway up.
Okay, if I raise it higher,
the fluid is gonna stop dripping.
If I lower it, the fluid is gonna continue to drip in.
Can go ahead and raise this secondary drip chamber up
and clamp my tubing.
I am now gonna attach my new medication bag.
And I confirmed it again, that it is the vancomycin.
Make sure I scan my med and administer it.
Go ahead and scan my medication,
confirm that it is the right med.
Yep.
Okay, and then I'm gonna attach my secondary bag.
Gonna maintain sterility of this spike.
It's easiest to spike your pumps,
I mean, spike your bags when they're upside down.
So now I have my secondary bag hanging,
or attached to my line.
I can go ahead and hang my secondary bag
above my primary.
I will now need to set my pump.
You're gonna first set your primary,
and then you're gonna set your secondary.
So your primary needs to go at the same rate
as your secondary, 'cause once your secondary medication
goes in, you're gonna have a whole lot of medication
sitting in your primary tubing
that you need to flush in at the same rate
as the medication.
What I'm gonna go ahead and do is click channel select.
I have 100 mLs in here that has my vancomycin.
And I know it's gonna go over one hour.
So my rate is gonna be 100 mLs per hour.
So I wanna set my primary
to 100 mLs per hour.
And I wanna set my volume to be infused at only 30 mLs.
Your primary tubing has about a 26 mL priming volume,
so I need at least 30 mLs of normal saline
to go ahead and flush the remaining vancomycin
out of the tubing.
I can then go ahead and select my secondary.
And I'm gonna find the vancomycin.
It is 500 milligrams
in 100 mLs.
And I know I'm gonna give it over one hour, or 60 minutes.
I know it's 60 minutes, because my drug guide
tells me it is.
I then go ahead and hit start.
I wanna make sure that I unclamp my secondary tubing
and watch to make sure that the medication drips
in the chamber.
If your primary is dripping down here,
your secondary clamp is closed.
So you wait until you make sure
that the secondary is dripping.
Once the medication has fully infused,
it's gonna kick over to the normal saline.
The normal saline is gonna run in
at the same rate, 100 mLs per hour,
for 30 mLs to flush the rest of the medication through.
Once that flush is complete, I need to make sure
that I come back and reset my normal saline
for the maintenance IV fluid rate.
So many nurses choose not to reset their primary infusion
when hanging a secondary infusion,
especially if the medication rate is similar
or faster than the maintenance IV fluid.
If your maintenance IV fluid is a little slower,
that is okay.
You want to avoid pushing the rest
of the medication through too quickly.
So right now I'll go ahead and show you
how to set that on your pump.
I can see over here that my normal saline is running
at 70 mLs per hour.
Gonna channel select.
Right here at the bottom, I know my medication rate
is gonna be 100 milliliters per hour.
So my rate at the moment is going
for my primary at 75.
So my medication is quicker, and my primary's slower.
I can select my secondary button right here.
I can then find my medication, my vancomycin.
It was 500 milligrams in 100 mLs.
Click next.
The duration is gonna be 60 minutes.
I can then hit start.
Make sure I unclamp my medication.
At the end of this 100 mLs of vancomycin going in,
it is then gonna kick back to my normal saline
at a slightly slower rate of 75 mLs per hour,
which is the maintenance IV fluid.
Remember to periodically check on your IV solutions
to make sure that they are running
and infusing correctly, at the correct rate.
Also make sure that you periodically take a look
at your patient's IV site to make sure
that the IV has not infiltrated.
Sometimes when going to hang a secondary medication,
you already have a secondary line
with an old medication bag.
There are two things that might happen.
You might have the same medication hanging,
or you might have an incompatible medication hanging.
First I'll show you what to do
if you have the same medication hanging.
So over here I have vancomycin.
I'm gonna double check this bag,
make sure this one is clamped,
and I'm gonna lower my bag
and double check, yep, it is vancomycin
at the same dose.
So all I am gonna do is go ahead
and switch my two bags.
Remember to maintain sterility of this spike.
I'm gonna take off my cap here.
And I'm just gonna spike my new bag.
Okay.
I'll discard my old medication bag.
Double check my line, that it does not have any bubbles,
so I do not need to re-prime.
And I can go ahead and hang my bag
and set my pump.
If your medication is incompatible
with the one that you need to hang,
you will need to go ahead and back-prime
and back-flush your incompatible medication
into the old bag.
Gonna go ahead and lower this.
Currently it is clamped, so I'm gonna hold it lower
than my normal saline bag.
And I am gonna go ahead and fill up the drip chamber
with normal saline and the old medication.
And you can see that if I keep it lowered,
it's gonna fill up not just the chamber
but into the old bag, as well.
I'm gonna clamp.
And I'm gonna flip my bag upside down.
And I'm gonna go ahead and squeeze this fluid
out of the chamber.
I can then do the process again
to ensure that all of the incompatible medication
is flushed out of the drip chamber and tubing.
And let it continue to fill up my empty bag.
Gonna go ahead and clamp.
Once again, just to be on the safe side,
empty the normal saline out of that drip chamber.
Okay, and I'll just fill it up halfway.
Okay.
I have now cleared my secondary tubing
of incompatible medication.
And I can go ahead and switch to my medication
that I need to administer.
And then discard the old medication.
This concludes that demonstration.
Thank you for joining us.
Remember to always follow your hospital policy
and the latest infection control practices
in regards to flushing and fluid
and IV line expiration dates.
Don't forget to check out some of our other
Santa Fe Nursing videos.
Thank you.