IV Pump use
Various types of pumps electronically regulate the flow of IV solutions or drugs with great accuracy. (See Infusion pumps.)
Volumetric pumps, used for high-pressure infusion of drugs or for highly accurate delivery of fluids or drugs, have mechanisms to propel the solution at the desired rate under pressure. (Pressure is brought to bear only when gravity flow rates are insufficient to maintain preset infusion rates.) The peristaltic pump applies pressure to the IV tubing to force the solution through it. (Not all peristaltic pumps are volumetric; some count drops.) The piston-cylinder pump pushes the solution through special disposable cassettes. Most of these pumps operate at high pressures (up to 45 psi), delivering from 1 to 999 mL/hour with about 98% accuracy; some pumps operate at 10 to 25 psi. The portable syringe pump delivers very small amounts of fluid over a long period of time. It’s used for administering fluids to infants and for delivering intra-arterial drugs.
Other specialized devices include smart pumps (such as bar code automated programming devices), the controlled-release infusion system, the secondary syringe converter, and patient-controlled analgesia. (See Understanding smart pumps.)
Pumps have various detectors and alarms that automatically signal or respond to the completion of an infusion, air in the line,
low battery power, and occlusion or inability to deliver at the set rate. Depending on the problem, these devices may sound or flash an alarm, shut off, or switch to a keep-vein-open rate.
low battery power, and occlusion or inability to deliver at the set rate. Depending on the problem, these devices may sound or flash an alarm, shut off, or switch to a keep-vein-open rate.
Understanding Smart Pumps
Conventional, general-purpose infusion pumps allow nurses to program an hourly infusion rate and volume. A smart pump has software that allows the pump to be programmed with a facility’s guidelines for specific drugs and patients, making it a customized drug library. These pumps can help you intercept and correct potentially serious infusion mistakes before they happen.
Before smart pumps are used at the bedside, a facility programs the pumps with its own specific information. These profiles specify the infusion requirements for different types of patients, such as adults and children, and care areas, such as pediatric, maternal, oncology, intensive care, and postanesthesia care units. Each profile includes a drug library that contains facility-defined drug infusion parameters, such as acceptable concentrations, infusion rates, dosing units, and maximum and minimum loading and maintenance dose bolus limits. The maximum rate and pressure at which the infusion will run can also be programmed into the software. A team that typically consist of pharmacists, doctors, and nurses within each facility sets up and manages these profiles based on the facility’s own best-practice guidelines.
Smart pumps vary by manufacturer, with some pumps even incorporating bar code technology on each IV medication bag. The bar code automatically programs the pump according to a current drug order.
Programming the Pump
When you turn on a typical smart pump, it asks you to designate the specific patient care area you’re going to use it in. Then it automatically configures itself to provide you with the infusion parameters for that area. Because a pump may be used in different types of patient care units and departments throughout the facility, this feature adds an extra layer of safety.
You then program the pump by choosing the intended drug and concentration from the smart pump’s list and entering the ordered dose and infusion rate. The pump checks this information against the drug library. If the parameters you’ve programmed match those in the pump’s drug library for that patient care area, the pump allows the infusion to begin. However, if what you’ve programmed is outside of the specified limits, the pump alerts you with a visual and audible alarm and lets you know which parameter lies outside of the recommended range.
Depending on the pump’s settings, it will sound a soft or hard alarm. If your facility’s policy permits it, you can override a soft alarm to allow the infusion to begin at the current settings. However, a hard alarm requires you to reprogram the pump with settings that lie within your facility’s specified limits before allowing the infusion to run.
A smart pump also logs and tracks all alerts, recording the time, date, drug, concentration, and infusion rate, as well as your action—including whether you overrode the alert or reprogrammed the pump with different settings. This provides your facility with data it can use to shape current practice guidelines and identify process improvements.
Guidelines for Safe Administration
Health care facilities provide safer, more effective care when they follow these guidelines from the Institute for Healthcare Improvement before deploying smart pumps:
Standardize concentrations within the health care facility; asking a health care worker to choose from several concentrations increases the risk of selection error.
Standardize dosing units for a given drug; for instance, always use either mcg/minute or mcg/kg/minute for nitroglycerin, but not both.
Standardize drug nomenclature; for example, agree to use the abbreviation KCl for potassium chloride consistently rather than allowing a variety of terms, such as K, pot chloride, or potassium chloride (spelled out).
Make sure that all concentrations, dose units, and nomenclature used in the smart pump are consistent with those used in the medication administration record, pharmacy computer system, and electronic medical record.
Meet with all relevant clinicians to agree on the proper upper and lower hard and soft dose limits.
Monitor the frequency and type of alert overrides to determine if alert settings have been properly configured or if they need adjustment.
Make sure the pump’s smart feature is used in all parts of the facility; for instance, if the operating room sets up the pump volumetrically without the smart feature, but the intensive care unit uses the smart feature, an error may occur if the pump isn’t reprogrammed properly.
Make sure to establish upper and lower dose limits for bolus doses, when applicable.
Have a biomedical technician identify previously unidentified risks for failure when the pumps are deployed.
Establish procedures that allow staff members, when necessary, to administer drugs in nonstandard concentrations as well as to administer drugs that aren’t in the drug library.
Deploy one type of smart pump throughout the health care facility; doing so helps prevent errors that may occur when different types of pumps are used on different units.
Equipment
Infusion pump ▪ IV pole ▪ IV solution ▪ sterile administration set ▪ sterile tubing or cassette, if needed (tubing and cassettes vary among manufacturers) ▪ alcohol pads ▪ gloves ▪ adhesive tape.
Preparation of Equipment
Verify the doctor’s order and gather the appropriate equipment. Inspect the IV solution to make sure that it’s labeled properly, its integrity is intact, it contains the right solution in the right concentration, and it hasn’t expired.1 Perform hand hygiene.2,3,4,5,6 Attach the pump to the IV pole (as shown below).
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