IV Pump Management

Pharmacology

IV Pump Management

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Outline

Overview

Intravenous (IV) pumps
1. AKA infusion pumps
  1. Administers to patient
    1. Medications
    2. Fluids
    3. Nutrients
    4. Blood and blood products
  2. Possible routes
    1. Intravenous
    2. Arterial
    3. Subcutaneous
    4. Epidural
2. Variety of types and manufacturers
Types of IV pumps
1. Large volume
2. Patient-controlled analgesia (PCA)
3. Elastomeric
4. Syringe
5. Insulin
Benefits
1. Ability to reduce medication errors
  1. Control
  2. Accuracy
  3. Precision

Nursing Points

General

Safety features
1. Varies based on age and make
  1. No single point of failure
    1. No one thing will cause pump failure
  2. Batteries
    1. Continue operation if pump fails
  3. Anti-free flow
  4. Dose error reducation system
    1. If doses are stored into pump
Sensors/alarms
1. Inactivity
  1. Pump is not running
2. Air-in-line
  1. Steps to eliminate
    1. Close roller clamp
    2. Open door to access IV
    3. Unload and remove air
  2. Prevention
    1. Prime line well prior to loading
3. Max air detected
  1. Steps to eliminate
    1. Close roller clamp
    2. Open door to access IV
    3. Unload and remove air
4. Upstream occlusion
  1. Due to
    1. Kink above pump
    2. Empty bag
  2. Steps to eliminate
    1. Change bag
    2. Remove kink
5. Downstream occlusion
  1. Due to
    1. Closed clamp
    2. Kink in tubing
      1. Location of IV
      2. AC worst spot!
    3. Clogged
  2. Steps to eliminate
    1. Open clamp
    2. Remove kink
    3. Change tubing
6. Near empty
  1. Alarm 30 minutes before empty

Therapeutic Management

IV pump issues
1. Create patient safety concerns
  1. Adverse events
    1. Software malfunction
    2. Failed alarms
    3. User error
    4. Over-infusion
    5. Under-infusion
    6. Battery failures
FDA initiative to improve pump safety
1. Infusion pump improvement initiative (2010)
  1. Increase user awareness
  2. Additional requirements for manufacturers
  3. Device improvements

Nursing Concepts

Clinical judgement
Safety
Skills

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Transcript

Hey guys today I am excited to talk to you about a little bit about IV or infusion pumps, why we use them, the errors we may see, and even the issues they can create for our patients. Keep in mind that there are so many different types of IV pumps and depending on the age of the pump they can have different features.

So just as a review we use IV pumps to administer different things to patients like medications, fluids, blood products, and even nutrients. The most common route that we give these substances are intravenously but we can also administer through arterial, subcutaneous, and epidural means.

There are a variety of different types and different manufacturers for IV pumps a few of the different types of pumps are large-volume, patient controlled analgesia or PCA pumps, insulin pumps, Elastomeric and syringe pumps. And in this picture you can see an IV pump that looks a little older but you may definitely see something like this in your clinical setting..

So a benefit of using IV pumps is that we can give medications in a controlled, accurate, and precise way more so than if we were administering without the help of a pump. So with this said many pumps have safety features that support keeping the patient safe when administering medications, blood products, and fluids. Some of these safety features include something called “No single point of failure” which basically means that there’s not going to be just one single thing that causes that pump to fail there will be an alarm before that would happen. Having a battery is also a safety feature so if there is a power outage in your facility that battery will keep the pump going. The “anti free flow” feature basically is to ensure that there isn’t a great amount of backflow through the IV from the patient to the pump. The Dose Error Reduction System is definitely something that’s going to be in newer IV pumps and this is how a facility can enter standardized doses for certain medications into the pump to prevent any medication dose errors.

So let’s talk about a few sensors or alarms that we may see with IV pumps. Some of them are pretty self-explanatory and some of them I’m going to talk a little bit more about in the upcoming slides. So the first one, inactivity is exactly how it sounds you may have an alarm or sensor to notify you that the pump hasn’t been running after a certain amount of time. Maybe this is expected or maybe you forgot to start your pump and this alarm is going to help you with that. The next s alarm is air-in-line or max air detected which along with upstream occlusion and downstream occlusion which I’m going to talk about that in the next slides. The near empty alarm is exactly how it sounds, about 30 minutes before your bag or medication is going to empty the pump will alarm to notify you of that.

Okay so if there is air in your IV line and your pump is alarming here are a few of the steps that we can take. Now remember guys these steps can vary depending on your pump but these are pretty basic and universal. You’re going to want to close the roller clamp to your patient, open the door to access the IV tubing, unload the IV tubing, and remove the air. Max air detected means that there has been a significant amount of air remember it’s going to vary depending on the pump with the established setting but if there is over a certain amount of ml’s of air detected that’s when that alarm will sound with the exact same steps taken to eliminate. One of the best ways to prevent this issue in the first place is to do your best to prime the line very well before loading it into the pump!

Upstream occlusion is another alarm that is pretty common and it can be due to a kink in the tubing usually above the pump or even an empty bag. Steps to eliminate this would be to change that empty bag, remove the Kink, and if the kink can’t be removed might need to replace the tubing to do get rid of this Upstream occlusion alarm.

So guys a downstream occlusion can be due to a closed clamp, or a kink which is commonly due to the placement of an IV….if you don’t already know the AC location is the best at setting off pump alarms. The way that we can eliminate a downstream occlusion is by simply opening the clamp and yes this has definitely happened to me on more than one occasion and it’ll probably happen to you as a nurse so no worries!. Removing the kink…if its super bad that may mean a new IV site or replacing the tubing especially if there is a clot in the tubing can stop this type of alarm.

Okay guys let’s review…IV pumps come in various types with various manufacturers some infuse large volumes, we also have PCA pumps patient controlled analgesia pump, and Insulin pumps. IV pumps are beneficial because they administer meds, fluids, nutrients, and blood products with precision, control, and accuracy that a human just can’t always do. Some safety features include no single point of failure, the battery feature, anti free flow feature, and dose error reduction system. Some of the sensors or alarms that you will see are inactivity, max air alarm, air-in-line alarm, upstream and downstream occlusion sensors and also the near-empty alarm.

A few nursing concepts that we can apply to IV pump management is definitely safety as this is really why we utilize IV pumps the first place. As nurses we have a responsibilty to have an understanding of the equipment that we are utilizing and the clinical judgement and skills to identify possible errors when infusing a variety of medications and fluids.

We love you guys! Go out and be your best self today! And as always, Happy Nursing!