How to hang a secondary IV infusion
Other platforms explain it with text and video. In VMS you practice it on the patient.
A secondary infusion (piggyback) lets you give an intermittent drug like an antibiotic through a running IV line. Most mistakes come from bag height, clamps and pump settings.
What you need
- Secondary bag with medication
- Secondary tubing
- Extension hook
- Alcohol swab
- IV pump
Step by step
Check order and compatibility
Confirm the drug, dose, volume and time. Make sure it is compatible with the primary fluid in the line. [1]
Identify the patient
Use two identifiers and check allergies before you connect anything. [2]
Prime the tubing
Spike the secondary bag, fill the drip chamber halfway and prime the tubing. Label the tubing with the date as policy requires. [3]
Hang it higher
Hang the secondary bag above the primary bag, using the hook to lower the primary. Gravity lets the secondary run first. [3]
Connect above the pump
Scrub the upper port on the primary line and connect the secondary tubing there. [3]
Program the pump
Choose the secondary setting and enter the secondary rate and volume. Use the drug library if your pump has one. [1]
Open the clamp and watch
Open the secondary clamp and confirm the drops fall in the secondary chamber, not the primary. Check the patient during the first minutes. [3]
Common errors
- Forgetting to open the secondary clamp.
- Hanging the secondary bag at the same height as the primary.
- Entering the rate under the primary setting instead of the secondary.
Practice it in VMS
In VMS you do this on the patient, not on paper: every step goes on the checklist with a score, and in Teach mode Blocky tells you what comes next.
VMS cases that train this skill
Sources
- Open RN, Nursing Pharmacology 2e (CC BY 4.0)
- The Joint Commission, National Patient Safety Goals
- Open RN, Nursing Skills 2e (Chippewa Valley Technical College) (CC BY 4.0)
Steps adapted from Open RN, Nursing Pharmacology 2e and Open RN, Nursing Skills 2e (Chippewa Valley Technical College), licensed under CC BY 4.0. VMS is not affiliated with these organizations. Updated: 2026-10-11.