What Are the Medical Advantages of an IV Piggyback?

Susan Abe

An IV piggyback is a very small bag of IV fluids that is piggybacked or attached into an existing IV line. In most cases, the piggyback medication is an antibiotic, although steroids or minerals may also be administered this way. These small IV bags containing 50 to 150 cc (or ml) of fluid are attached to a length of clear, plastic intravenous tubing known as secondary tubing to differentiate it from the primary tubing of the established IV line. The terminal end of the secondary tubing is then attached to the primary IV tubing at a port in close proximity to the IV cannula insertion site. Medical advantages of using an IV piggyback include nursing care and maintenance of only one IV site as opposed to two or more and decreased risk of infection or complication with a single, as opposed to multiple, intravenous sites.

An IV cannula and tubing. An IV piggyback can be attached to the yellow-capped port next to the three-way stopcock.
An IV cannula and tubing. An IV piggyback can be attached to the yellow-capped port next to the three-way stopcock.

IV insertion sites, where the IV catheter pierces the skin to enter a vein, require frequent nursing assessments and evaluations for patency, leakage into the tissues and infection. These evaluations are conducted prior to the administration of any new medication or IV bag, as part of a patient's physical evaluation each nursing shift, and whenever an IV pump alarm sounds. Depending upon the facility, IV catheter sites are only allowed to remain for a maximum number of days before a new site is established in order to decrease the chance of infection. Thus, the use of an piggybacked IV may decrease the nursing workload by reducing the number of IV sites to be evaluated multiple times a day or to be restarted when the cannula site times out.

Intravenous antibiotics are often piggybacked.
Intravenous antibiotics are often piggybacked.

Another medical advantage to using IV piggyback medication administration is the decreased chance of infection or complications. Every interruption in skin integrity allowed by an IV catheter is a potential route for pathogens and subsequent infection. Hooking an IV piggyback into an existing primary IV line allows for only one IV site at a time, as opposed to two separate IV catheters doubling the chance of untoward reactions.

IV piggybacks may increase comfort in those undergoing chemotherapy.
IV piggybacks may increase comfort in those undergoing chemotherapy.

Using an IV piggyback can also increase patient comfort, or at least decrease the number of times an IV catheter needs to be inserted. This can be particularly important in individuals with poorly accessible veins who often require multiple attempts to establish a patent IV line. This is often the case in the elderly, the obese, those undergoing chemotherapy, and individuals with a history of IV drug abuse.

A piggyback IV bag can easily be attached to an existing IV line.
A piggyback IV bag can easily be attached to an existing IV line.

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Discussion Comments


The EMS world sometimes uses a piggyback too. There are drugs that have to be given especially on a long transfer, that are too powerful to just squirt directly into a vein. They have to be diluted and given over time.

One way to do that is to simply squirt it into the main IV bag and mix it up, but then if you need to give something else and it interacts with whatever is in the bag, you have to change everything and it takes time.

By using a piggyback, it can be stopped and started as needed, and other medications can be given too. This can be a lifesaver, literally, when time is of the essence. And in the EMS world, time is usually of the essence.


Even in a more long-term care environment, the piggyback can be very convenient. In the ICU we frequently have patients on multiple medicines at a time, titrated through a very precise pump. They sometimes have multiple IV sticks and maybe even a central line put in place by a doctor as a semi-permanent way to give IV medicine.

Even in that environment, we will hang a piggyback when we need one. The patient is still usually going to have a saline IV running somewhere, so medicine can just be hooked into there.


I work in an emergency room, and we use piggybacks quite a bit. A lot of times, the medicine we have to give is not something that the patient is going to be on for a long time, so we can just hang it on the main bag as a piggyback and when it's done, we take it off. No reason to stick the person again or to use a complicated multi-drip pump.

Generally, everyone in the ER is going to have an IV anyway if they are there for something medical, so it's no work at all to hang the piggyback. It really takes more time to get it from the pharmacy, check all the records and orders for consistency, and bring it to the patient's room than it does to hang it.

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