Intravenous intermittent infusion is an infusion of a volume of fluid/medication over a set period of time at prescribed intervals and then stopped until the next dose is required. An intermittent IV medication may be called a piggyback medication, a secondary medication, or a mini bag medication. Intravenous medications may be given in small volumes of sterile IV solution (25 to 250 ml) and infused over a desired amount of time (given for 30 minutes every 4 hours) or as a single dose. Many medications must be given slowly to prevent harm to the patient, and this method of administration reduces the risk of rapid infusion. A piggyback medication is given through an established IV line that is kept patent by a continuous IV solution or by flushing a short venous access device (saline lock). Always check the Parenteral Drug Therapy Manual PDTM to ensure the correct guidelines are followed for each specific medication given in IV solution. The PDTM provides guidelines on how to mix the IV medication, the amount and type of solution, and the rate of infusion (Perry et al., 2014).
An intermittent medication may be administered by gravity or on an electronic infusion device (EID), also known as an infusion (IV) pump. Many piggyback IV medications must be on an IV pump, which requires programming and specialized training to prevent medication errors. The IV infusion pumps provide hard- and soft-dose limits and safety practice guidelines to aid in safe medication administration (Lynn, 2011). IV medications may also be given by gravity infusion, in which case the health care provider must calculate the infusion rate for drops per minute. The best practice for piggyback infusions is to use an IV infusion pump.
- Filled with normal saline solution to prevent clotting
- Also known as saline lock, maintains venous access in patients receiving I.V. drugs regularly or intermittently but not continuously.
- This system keeps the access device sterile and prevents blood from leaking from the open end.
- Much like the administration set injection port; the intermittent injection cap is self sealing after the needle less injector is removed.
- The device minimizes the risk of fluid overload and electrolyte imbalance better than a slow infusion with I.V. to keep the vein open.
Equipment
- Intermittent infusion device
- Needless system device
- Normal saline solution
- Venipuncture equipment
- Transparent semi-permeable dressing
- Tape
- Prefilled saline cartridges
- 1 ml of dilute heparin solution in a 3-ml syringe
Procedure Overview
- Wash your hands
- Confirm the patient’s name and identification number
- Reinforce the explanation of the procedure
- Remove the set from its packaging, wipe the port with an alcohol pad, and inject normal saline solution to fill or prime the tubing and needleless system. This removes air, preventing an air embolus
- Select an venipuncture site
- Put on gloves and necessary personal protective equipment
- Apply tourniquet 2” proximal to the chosen area
- Clean the venipuncture site with antimicrobial solution
- Perform the venipuncture, and ensure correct needle placement in the vein
- Release the tourniquet
- Tape the set in place
- Loop the tubing, if applicable, so the injection port is accessible
- Flush the catheter with normal saline solution
- Apply transparent semi-permeable dressing
- Write the time and date and your initials on the dressing label, and place it in the dressing
- Remove and discard gloves
- Inject normal saline solution every 8 to 24 hours.
- Inject normal saline solution slowly to prevent stinging.
Nursing Interventions
- When assessing an intermittent infusion device, stabilize it to prevent dislodging from the vein.
- If the patient feels burning during the injection of normal saline solution, stop the injection, check cannula placement, and monitor the site for infiltration or infection.
- If the cannula is in the vein, inject the normal saline solution slower to minimize irritation.
- Change the intermittent infusion device every 48 to 72 hours, according to hospital policy, using a new venipuncture site.
- A transparent semi-permebale dressing allows a greater patients freedom and better observation of the injection site.
- If the physician orders an I.V. infusion stopped and an intermittent infusion device inserted, convert the existing the line by disconnecting the I.V. tubing and inserting a male adapter plug into the device.
- Most health care facilities require the use of luer-lock systems on all infusion cannula and lines.