The University of the West Indies

Faculty of Medical Sciences

The UWI School of Nursing, Mona

Year II

BScN

Administering Piggyback Intermittent IVI of Medication

With intermittent IVI of medication, the drug is mixed with a small amount of IV solution (50
mL to 100 mL), and administered over a short period of time. The administration may be done
using an infusion pump or by gravity infusion.

Considerations

Infusion pump:- The nurse is required to program the infusion rate into the pump.

Gravity infusion:- The nurse is required to calculate the infusion rate in drops per minute.

The IV piggyback delivery system requires the intermittent or additive solution to be placed
higher than the primary solution container, if using a short secondary infusion tubing.

Equipment

 Medication
 Small-volume bag/bottle (labeled)
 Secondary infusion tubing
 Connector (needle/needleless)
 Alcohol swabs
 IV pole
 Medication Kardex
 Tape
 PPE (as required)

Assessment

Assess the patient for any allergies.

Assess the appropriateness of the drug for the patient.

Assess the compatibility of the ordered drug, diluents, and the infusing IV fluid.

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Assess the IV site, noting any swelling, coolness, leakage of fluid at site, redness, or pain.

Assess the patient’s vital signs before administration of the medication (especially if they may be
affected by the drug).

Verify patient’s name, dose, route, and time of administration.

Check the expiration date (before administering the medication).

Assess the patient’s knowledge of the medication.

Nursing Diagnoses

 Risk for Allergy Response

 Risk for Infection
 Risk for Injury
 Knowledge Deficit

Procedure

Action Rationale
1. Ensure the drug is prescribed To prevent medication error

2. Perform hand hygiene This prevents the spread of microorganisms.

3. Gather equipment. Prepare Preparation promotes efficient time

medication cart/tray with the management and organized approach to the
necessary equipment and supplies. task.

4. Check the Kardex/medication order This helps to identify any errors.

for completeness and accuracy.

Check the patient’s chart for

allergies. To prevent complication(s)Assessment is a
prerequisite to administration of medications.

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 5. Wash hands
Introduce yourself then identify
the patient using at least two
identifiers
o Check the name and identification
number on the patient’s
identification band.
o Ask the patient to state his or her
name.
o If the patient cannot identify him
or herself, verify the patient’s
identification with the staff
member who knows the patient
for the second source.
6. Complete necessary assessments
before administering medications.
Check allergy bracelet or ask patient
about allergies.
Educate patient about medication
7. Perform hand hygiene
8. Select the appropriate medication
from stock.
9. Compare the label with the order on
the Kardex. Check the expiry date and helps to prevent medication error
perform calculations, verify
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Identifying yourself is an essential first step
in establishing the therapeutic nurse-patient
relationship (RNAO, 2015). Patient
identification validates the correct patient
and correct procedure. Pulling the curtains
promotes patient’s privacy.
It ensures the right patient receives the
medications and helps prevent errors.
This is the most reliable method.
This requires a response from the patient, but
illness and strange surrounding often cause
patients to be confused.
This is another way to double check identity.
.
Assessment is a prerequisite to
administration of medication
To inform and alleviate any fears and
increase patient compliance
To prevent the spread of microorganisms
This is a part of the first check of the label
which helps to prevent medication errors
This is the second check of the label which
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 calculations with another nurse.
10. Know the actions, special nursing
considerations, safe dose range and
purpose of administration and adverse
effects of the medications to be
administered.
11. Withdraw the medication from the
ampoule or vial.
12. When all medications are prepared,
recheck the label with the medication
administration record before taking
them to the patient.
13. Perform hand hygiene
14. Take the medication to the patient’s
bedside. Keep medications in sight
at all times.
15. Provide privacy.
16. Re-identify patient. Check for
allergies. Reinforce information about
medication. Check the medication
against the kardex.
Explain procedure, the purpose and
action of each medication to the
patient. (Can be done on first contact
with the patient).
17. Assess the IV site for the presence of
inflammation or infiltration. (Can be
done on first contact with the patient).
18. Close the clamp on the secondary
infusion tubing. Using aseptic
technique, remove the cap on the
tubing spike, and the cap from the
port of the medication container. (Be
careful not to contaminate either end.)
19. Using a firm push and twisting
motion, attach the tubing to the
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To evaluate the therapeutic effect of the
medication and to educate the patient.
Re-checking the helps to prevent medication
errors.
To prevent the spread of the microorganisms.
Close observation prevent accidental or
deliberate disarrangement of medication.
To maintain the patients dignity
Assessment is a prerequisite to
administration of medication. This is the
third check of the medication. This also
prevents medication errors.
Explanation provides rationale, increases
knowledge and reduces anxiety.
IV medication must be given directly into a
vein for safe administration
This prevents fluid entering the system until
the nurse is ready.
Maintaining sterility of tubing and
medication port prevents contamination
To ensure that it is properly in place and
prevent wasting of medication.
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 medication container.

20. Using alcohol swab, cleanse the To prevent the spread of microorganism
access port of the medication
container. Inject medication into
container. Hang piggyback container
on the IV pole.
21. Squeeze drip chamber and release to
fill it about halfway. Open clamp and This removes air from the tubing.
prime tubing. Close clamp.
Attach needless connector or needle
to the end of the tubing (using sterile This preserves sterility of the setup.
technique).

22. Using alcohol swab, clean the access This deters entry of microorganisms when
port on the primary IV infusion piggyback setup is connected to port.
tubing.

23. Close clamp on the primary infusion To prevent mixing of medication with fluid
tubing. and to allow a better flow of medication
24. Connect piggyback setup to the
access port on the primary tubing. Tape stabilizes needle in infusion port and
Use strip of tape to secure secondary prevents it from slipping out.
tubing to primary infusion tubing.
25. Open clamp on the secondary tubing. It is important to verify the safe
Regulate flow at the prescribed rate. administration rate for each drug to prevent
Monitor infusion periodically. effects.
26. Close clamp on piggyback set when
solution is infused.
Dispose of equipment according to
institution’s policy.
27. Open clamp on the primary tubing
and readjust flow rate
28. Wash hands. This prevents the spread of microorganisms.

29. Document procedure. Nursing documentation is a means of inter

and
intra-professional communication which
provides evidence of care and is necessary
for
improved patient care (RNAO, 2007).

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 30. Evaluate patient’s response within an For therapeutic and adverse effects from the
appropriate time frame. medications

Documentation.

 Record the drug name and dosage, date, time, site of administration in the nurses'
progress notes.
 Record each medication given on the Kardex
 Document the patient’s tolerance to the procedure.
 Document the patient’s response to the medication (the therapeutic and side
effects).
 Document the volume of fluid administered on the intake and output chart (as
required).

Reference

Lyn, P. & LeBon, M. (2015) Skills Checklists for Taylor’s Clinical Nursing Skills: A nursing
process approach. (3rd ed.). Philadelphia, PA: Wolters Kluwer Health/Lippincott Williams &
Wilkins.

Registered Nurses’ Association of Ontario (RNAO). (2007). Nursing best practice guideline:
Professionalism in Nursing. Retrieved from
http://rnao.ca/sites/rnaoca/files/Professionalism_in_Nursing.pdfRegistered Nurses’
Association of Ontario (RNAO). (2015). Nursing best practice guideline: Person-and Family-
Centred Care. Retrieved from http://rnao.ca/sites/rnao- ca/files/FINAL_Web_Version_1.pdf

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