Administering IV Medications by Piggyback Skills

Which instruction reflects the nurse's correct understanding of the role of nursing assistive personnel (NAP) in caring for a patient receiving an intravenous (IV) antibiotic medication by piggyback? A. "Assess the IV site frequently for signs of infiltration." B. "Let me know immediately if the patient complains of pain at the IV site." C. "Notify the physician that the patient is allergic to the medication prescribed." D. "Remember to hang the piggyback medication higher than the primary solution."

B. "Let me know immediately if the patient complains of pain at the IV site." Rationale: NAP can let the nurse know when an IV pump alarm sounds or the patient complains of discomfort. Assessment may not be delegated to NAP. Physician notification may not be delegated to NAP. No aspect of preparing or administering IV piggyback medication may be delegated to NAP.

What is the best way to protect a patient from an IV site injury when giving an antibiotic medication by piggyback? A. Use a site into which a primary solution is already infusing. B. Assess the IV site before initiating the IV piggyback medication. C. Select a relatively small vein to infuse the IV medication. D. Instruct NAP to notify you immediately if the insertion site appears swollen.

B. Assess the IV site before initiating the IV piggyback medication. Rationale: Assessing IV site placement and patency before initiating an IV medication is important in preventing IV infiltration. Primary IV solution infusions may not be flowing while IV piggyback medication is hanging, and this would not prevent an infiltration or extravasation. A larger vein is preferable for infusing an IV medication. IV site assessment may not be delegated to NAP.

When administering an IV piggyback medication to infuse by gravity, how can the nurse ensure that the medication will flow properly? A. Use an infusion pump to regulate the flow rate of the piggyback medication. B. Hang the piggyback medication higher than the primary fluid. C. Attach the piggyback medication to the most proximal insertion port on the primary tubing. D. Use a secondary infusion set for the piggyback tubing.

B. Hang the piggyback medication higher than the primary fluid. Rationale: By hanging the piggyback medication higher, gravity allows the piggyback solution to run first. A pump is not used when infusing medication by gravity. Selecting a proximal insertion point will not ensure proper fluid flow from the piggyback. Use of a secondary piggyback infusion set is unrelated to proper fluid flow.

What is the best way to prevent infection and conserve resources when terminating an IV piggyback medication infusion in a patient who also has a primary fluid infusion? A. Remove the tubing from the primary line Y-site port, and cap the end. B. Leave both the piggyback tubing and the bag attached to the primary line Y-site port until the next scheduled dose. C. Place an unopened secondary setup at the bedside, and discard the used one. D. Change both the primary and secondary tubing upon terminating the piggyback infusion.

B. Leave both the piggyback tubing and the bag attached to the primary line Y-site port until the next scheduled dose. Rationale: Leaving the piggyback tubing and bag attached will help maintain tube sterility while conserving supplies and nursing time. Although the tubing can be removed from the port and capped, it is better to leave the tubing and bag in place until the next scheduled dose. Secondary tubing can be reused for up to 72 hours. Changing the tubing with each piggyback infusion is expensive. It is unnecessary to change the primary and secondary tubing when terminating an infusion of IV piggyback medication.

Which nursing intervention is most important in ensuring safe infusion of a medication delivered by IV piggyback through a saline lock? A. Use the most proximal insertion port on the primary tubing. B. Hang the piggyback solution higher than the primary infusion solution. C. Use a pump to regulate the infusion rate of the piggyback medication. D. Flush the saline lock with sodium chloride solution before initiating the infusion.

D. Flush the saline lock with sodium chloride solution before initiating the infusion. Rationale: Flushing the saline lock with 0.9% sodium chloride solution to assess for placement and patency before initiating a piggyback infusion reduces the likelihood of infiltration and extravasation. The piggyback is connected directly to the saline lock, not to primary tubing. There is no primary infusion solution when infusing piggyback medication directing through a saline lock. Although using an infusion pump to regulate the infusion rate of a piggyback medication may be appropriate, it is not the most important intervention for ensuring safe infusion.