Chapter 7
Using an infusion device
Learning outcomes
At the end of this chapter, the practitioner will be able to:
Select an appropriate infusion device
Reduce risk for the patient during intravenous therapy
Deliver safe intravenous therapy using infusion devices.
Introduction
There are several different types of infusion pump available, such as volumetric infusion pumps (used to deliver fluid from a bag or other container) and syringe drivers (used to deliver fluid from a syringe). An infusion pump is always recommended to maintain a high degree of accuracy in the administration of intravenous (IV) fluids or medicines.
The healthcare practitioner’s responsibilities regarding infusion pumps
The healthcare practitioner responsible for administration needs to ensure that an appropriate infusion pump is used, that it is in good working order, and that they know how to operate it correctly. Your local healthcare provider may insist that you undertake additional training and be competent in the use of the specific devices used within your clinical area. Education and training should ensure that the user understands the basic principles associated with operating infusion pumps, as well as providing practical training in the use of specific devices (Amoore & Adamson 2003).
If you have not been trained, or are not confident in setting up a particular type of infusion pump, always ask! All qualified healthcare practitioners are accountable and responsible for their own practice. This means that you are answerable to your professional body and your employer for all your actions and omissions, regardless of the advice or directions given by another professional. Many reported adverse incidents have been due to human error and/or a lack of understanding of infusion device operation (Amoore & Ingram 2002) so it is essential to adhere to safe practice.
Different types of infusion pump
The main types of infusion are:
Drip rate controllers
Volumetric pumps
Syringe pumps
Patient controlled analgesia (PCA) pumps.
Drip rate controllers
These are very simple systems that are generally used to administer IV fluid. The infusion rate is selected in drops per minute. The flow is gravity fed, rather than by a forced pump action.
Volumetric pumps
These are the preferred type of infusion pump for administering medium- or large-volume infusions. The infusion rate is selected in millilitres per hour (usually from 1mL to 999mL per hour). For any infusion that needs to be delivered with a rate of less than 5 millilitres per hour, a syringe pump should be used.
Syringe pumps
Syringe pumps are designed to infuse low flow rates. They deliver fluid in millilitres per hour (usually 1mL to 999mL per hour). Syringe pumps will accept different sizes and different brands of syringe; some of the newer models automatically detect the syringe size and type. Syringe pumps should not be used for rates less than 0.5mL per hour for adult patients, as an increase in the occlusion response time occurs.
Patient controlled analgesia (PCA) pumps
Patient controlled analgesia (PCA) pumps are similar to syringe pumps. However, the pump has the facility to enable patients to self-administer a bolus dose of the medication themselves. The PCA pump has different programming options, which need to be set by the relevant healthcare professional.
Choosing the right infusion pump
Before a decision is made on which pump to use, consider:
Is the patient a neonate, child or adult?
What sort of infusion is required?
Does the patient have special needs?
Is there a critical volume that needs to be delivered?
If the infusion stopped for any reason, would this be dangerous?
Using infusion pumps
When safely used, infusion devices can deliver fluid or medication in a controlled manner, and are relatively straightforward to use. The basic operation of an infusion pump involves setting up the pump to deliver the fluid at the prescribed rate over a specified period of time.
All infusion pumps feature the following characteristics:
A method to generate pressure to infuse fluid
A method of controlling the infusion rate
A fluid container (syringe or bag)
Tubing that allows the fluid container to be attached to the patient. Infusion lines will generally be manufactured specifically for a certain pump and you must always ensure that the set designed for that particular pump is used. (NB: Standard infusion giving sets should not be used.)
Activity 7.1
Look at the different types of infusion pumps that are available to use in your own clinical area. Familiarise yourself with how each type of pump works, and the functions and features that are on that particular device.
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