IV Meds-Piggyback


  • Alcohol pads
  • Clean gloves
  • Medication
  • IV pole/pump
  • Secondary IV line
  • Normal saline flush

  1. Check accuracy and completeness of each MAR with provider’s written order including the patient’s name, medication name and dosage, route of administration and time of administration.
  2. Educate patient on medications including action and possible side effects. Allow patient to ask questions.
  3. Close room curtain or door.
  4. Perform hand hygiene.
  5. Utilizing aseptic technique, prepare medications for only one patient at a time and deliver medications to patient at correct time. Check label of medication carefully with MAR.

  1. WIIAPA:
    1. Wash hands
    2. Introduce self
    3. Identify patient (use 2 identifiers)
    4. Allergies – don’t forget food allergies
    5. Plan of care
    6. Assess patient

  1. Perform hand hygiene.
  2. Apply clean gloves.
  3. Check primary fluids:
    1. If continuous primary fluids are running or are in patient room to be used for intermittent IV meds carefully inspect the primary fluids for compatibility.
    2. If no primary fluids are present in patient’s room prepare and initiate primary fluids, then proceed with administering piggyback medication.
    1. Preparing Secondary Infusion tubing:
    2. Open secondary IV set, maintaining sterility.
    3. Close roller clamp.
    4. On medication bag – remove cap from IV port, maintain sterility.
    5. On secondary IV set – remove protective cover from tubing spike – maintain sterility.
    6. Insert spike into bag port using a twisting motion.
    7. Clean the upper Y-port (above IV Pump) of existing primary line with alcohol swab.
    8. Connect the secondary line to primary line at upper Y-port.
    9. Prime secondary line using back-priming method:
    10. Lower medication bag below level of primary fluids open roller clamp slowly → allow secondary drip chamber to fill to 1/3 – 1/2 full → close roller clamp & inspect line.
    11. Hang your IV medication bag (piggyback) on IV pole.
    12. Using plastic hook, lower your primary fluid bag so it hangs below the piggyback medication.
    13. Label your secondary line.
  4. STOP Check and ensure your set up is correct prior to infusing!
  5. Regulate medication flow rate by adjusting regulator clamp or IV pump infusion rate (infusion rates vary – check med book or agency policy).
  6. Once medication has infused:
    1. *Continuous infusion* – check rate of primary infusion on pump and ensure primary has resumed infusing.
    2. *Saline lock* – d/c tubing from IV site clean with alcohol flush saline lock with 2-3mL normal saline flush maintain sterility of IV tubing between infusions.
  7. Leave IV piggyback and tubing In place if planning to use again to later to infuse the same medication.  (per hospital policy).
  8. Dispose of supplies.
  9. Perform hand hygiene.
  10. Monitor patient and evaluate medication effectiveness.
  11. Document – ex: medications administered, response to medication, any adverse reactions, patient teaching, validation of understanding, etc.

Reference: Perry, A. G., Potter, P. A., Ostendorf, W., & Laplante, N. (2022). Clinical Nursing Skills & Techniques (10th ed., pp. 692-697). Elsevier.