Conditions: You have a physician's orders requiring the administration of a medication by the IV piggyback route. You must prepare the piggyback unit. A patient care handwash has been performed. Necessary materials and equipment: medication, diluent, needle, syringe, alcohol (or other antiseptic) prep pads, label, container of IV solution, IV administration tubing, tape, and the patient's clinical record.

Standards: Prepared the IV piggyback unit without contamination and administered it to the patient without complications.

Performance Steps

1. Identify the patient, explain the procedure, and ask about allergies.

2. Check the medication sheet (DA Form 4678) against the physician's orders.

a. Name of the medication.

b. Amount (dose) of medication.

c. Route of administration.

d. Time to be administered.

3. Select the medication.

a. Check the medication label three times to ensure that the correct medication is being prepared for administration.

b. Check the expiration date of the medication.

c. Handle only one medication at a time.

NOTE: If unfamiliar with a medication, look it up to determine contraindications, precautions, and side effects.

4. Prepare the medication.

a. Calculate the amount of medication required to equal the prescribed dose.

NOTE: If the medication is in powdered form, prepare it for use by adding the diluent specified on the drug information instructions.

b. Draw the prescribed amount of the prepared medication into a syringe.

c. Check the medication and calculations again to ensure that the correct medication and correct dose have been prepared.

5. Prepare the piggyback unit.

NOTE: Refer to the drug manufacturer's instructions to determine the type and amount of solution to be used as the piggyback unit.

a. Use an alcohol prep pad to swab the injection port on the container of IV solution to be used as the piggyback unit.

b. Inject the prepared medication into the container of IV solution.

c. Mix the solution and medication into the container of IV solution.

d. Label the piggyback unit with the name of the medication, the amount added, the time added, the date added, and the initials of the person who prepared the piggyback unit.

e. Dispose of the needle and syringe IAW local SOP.

6. Prime the piggyback infusion tubing.

a. Close the clamp on the piggyback tubing.

b. Aseptically insert the spike on the piggyback tubing into the solution port on the piggyback unit.

c. Squeeze the drip chamber to fill it half full.

d. Open the clamp on the piggyback tubing, allowing the solution to prime the tubing.

e. Close the clamp on the piggyback tubing when the solution reaches the end of the tubing.

NOTE: Attach a sterile needle to the end of the piggyback tubing if one is not provided by the manufacturer.

CAUTION: Take care not to waste any medicated IV solution while priming the tubing.

7. Connect the piggyback unit to the primary tubing.

a. Swab the injection port on the primary tubing with an alcohol prep pad.

b. Insert the needle into the injection port of the primary tubing.

c. Secure the connection with tape.

NOTE: Attach the piggyback tubing to the primary tubing below the level of the roller clamp. This will allow the piggyback unit to flow at its set rate without adjusting the flow rate of the primary solution.

8. Hang the piggyback unit on the IV pole, ensuring that the piggyback unit is at least 6 inches higher than the primary container.

9. Ensure patency of the primary IV.

10. Begin the secondary (piggyback) infusion.

a. Calculate the flow rate in accordance with the physician's orders.

NOTE: If the physician does not specify a flow rate, set the flow rate IAW the drug manufacturer's instructions.

b. Adjust the roller clamp on the piggyback tubing to regulate the flow rate of the piggyback solution.

CAUTION: Do not adjust the flow rate of the primary container.

NOTE: When fluid from the secondary line enters the primary tubing, the primary infusion is automatically interrupted. When all the solution in the piggyback unit has been delivered, the primary infusion will resume flow at the set rate.

11. Label the piggyback infusion tubing with the time and date the medication was initiated.

12. Observe the patient for signs of infusion complications or reaction to the medicine. (See task 081-833-0034.)

13. Document the procedure and significant nursing observations on the appropriate forms IAW local SOP.

Evaluation Guidance: Score each soldier according to the performance measures in the evaluation guide. Unless otherwise stated in the task summary, the soldier must pass all performance measures to be scored GO. If the soldier fails any step, show what was done wrong and how to do it correctly.

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