IV Secondary Line Infusion
A secondary IV line is a complete IV set, container, tubing, and microdrip or macrodrip system, connected to the lower Y port (secondary port) of a primary line instead of to the IV catheter. It can be used for continuous or intermittent drug infusion. When used continuously, a secondary IV line permits drug infusion and titration while the primary line maintains a constant total infusion rate.
When used intermittently, a secondary IV line is commonly called a piggyback set. In this case, the primary line maintains venous access between drug doses. Typically, a piggyback set includes a small IV container, short tubing, and a macrodrip system. This set connects to the primary line’s upper Y port, also called a piggyback port. Antibiotics are most commonly administered by intermittent (piggyback) infusion. To make this set work, the primary IV container must be positioned below the piggyback container. (The manufacturer provides an extension hook for that purpose.)
IV pumps should be used to maintain constant infusion rates, especially with a drug such as lidocaine. A pump allows more accurate titration of drug dosage and helps maintain venous access.
Equipment
Patient’s medication record ▪ patient’s medication administration record ▪ prescribed IV medication ▪ prescribed IV solution ▪ administration set with secondary injection port ▪ needleless adapter ▪ antiseptic pads (alcohol, tincture of iodine, or chlorhexidine-based) ▪ 1″ adhesive tape ▪ time tape ▪ labels ▪ infusion pump ▪ extension hook and appropriate solution for intermittent piggyback infusion ▪ Optional: normal saline solution for infusion with incompatible solutions.
For intermittent infusion, the primary line typically has a piggyback port with a backcheck valve that stops the flow from the primary line during drug infusion and returns to the primary flow after infusion. A volume-control set can also be used with an intermittent infusion line.
Preparation of Equipment
Verify the order on the patient’s medication record by checking it against the doctor’s order.1 Perform hand hygiene.2,3,4,5 Inspect the IV container for cracks, leaks, and contamination, and check drug compatibility with the primary solution. Verify the expiration date. Check to see whether the primary line has a secondary injection port. If it doesn’t and the medication is to be given regularly, replace the IV set with a new one that has a secondary injection port.
If necessary, add the drug to the secondary IV solution. To do so, remove any seals from the secondary container, and wipe the main port with an alcohol pad. Inject the prescribed medication, and gently agitate the solution to mix the medication thoroughly. Properly label the IV mixture. Insert the administration set spike and attach the needleless system. Open the flow clamp and prime the line. Then close the flow clamp.
Some medications are available in vials that are suitable for hanging directly on an IV pole. Instead of preparing medication and injecting it into a container, you can inject diluent directly into the medication vial. Then you can spike the vial, prime the tubing, and hang the set, as directed.
Implementation
Confirm the patient’s identity by checking at least two patient identifiers according to your facility’s policy.6,7
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