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INFUSION PUMPS.

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Presentation on theme: "INFUSION PUMPS."— Presentation transcript:

1 INFUSION PUMPS

2 Basic Infusion System Fluid container Drip chamber Roller Clamp
Flow by gravity Flow controlled by roller clamp Difficult to set and control infusion rate Drip chamber Show infusion set Roller Clamp

3 Infusion Pumps What are they? What do they do?
Usually electrically powered infusion devices What do they do? Use pumping action to infuse fluids, medication or nutrients into patient Suitable for intravenous, subcutaneous, enteral and epidural infusions

4 Infusion Pumps Why are they used? What are they used for?
To provide accurate and controllable flow over a prescribed period or on demand What are they used for? Wide range of drugs and therapies including Chemotherapy Pain management Total parental nutrition Anaesthesia/sedation Etc. etc.

5 Infusion Pumps TWO BASIC TYPES Syringe Pumps Volumetric Pumps

6 Syringe Pump

7 Syringe Pump: Most widely used syringe pump in NGD, Alaris Asena
Top - control buttons and display showing flow rate and volume delivered by pump. Chance to look at setting up a pump later. Syringe plunger connected to syringe pump carriage and held in place by the syringe plunger clamp. As motor turns, carriage moves, plunger depressed, fluid infused Syringe clamp – two purposes. Holds syringe in place Detects size and manufacturer from diameter. If incorrect, will get error in rate calculation. Important to confirm size AND manufacturer before starting infusion. Important that any label attached to syringe kept well clear of the syringe clamp or should not obscure the scale, as this need to be read while infusion being given.

8 Syringe Pumps Generally used for low volume, low flow rate infusions
Good short term accuracy Long start up time at low flow rates Prime and purge line before connecting to patient Alarms: End/near end of infusion; drive disengaged, occlusion, battery low Specialised syringe pumps for ambulatory use, PCA, sedation, insulin etc Long start up time i.e. delay between starting infusion and patient receiving medication. Caused by mechanical backlash/slack in pump drive. To reduce start up Prime line before installing syringe in pump Before connecting line to patient, use pump’s purge facility to take up the mechanical slack.

9 Volumetric Pumps

10 Most widely used volumetric pump in NG is Alaris Signature
LHS control and displays, large display showing flow rate in ml/h, smaller displaying giving additional information again not discussing in detail RHS is the dedicated infusion set – show, built-in flow clamp

11 Cam followers (fingers)
Latch Cam followers (fingers) Pressure sensor Air in line detector

12 Volumetric Pumps Preferred for medium and high flow rates and large volumes Generally not suitable for rates < 5ml/h Variable short term accuracy Alarms: Latch/door open, set out, occlusion, battery low, air-in-line Specialised volumetric pumps for ambulatory use, epidural infusions etc.

13 Infusion Pump Incidents
700 incidents/year reported to MHRA, including 10 deaths 20% Device related (e.g. design, failures etc) 27% User error 53% Not established (majority user error) Many incidents not reported e.g. 6 Trusts, 321 incidents Medicines & Healthcare products Regulatory Agency (England & Wales) Scotland, SHS, no statistics published

14 Reporting Incidents All incidents should be reported on a Clinical Adverse Patient Incident Form Aim is to reduce risk in future, not to apportion blame Where an infusion pump is involved, the pump and its disposables must be retained, and Clinical Physics informed.

15 What Goes Wrong? Medication Errors Prescription
Preparation of infusion solution Calculation of rate of infusion

16 In NG, std infusion pump prescription and medication sheet used in attempt to reduce medication errors

17 What Goes Wrong? Medication Errors Prescription
Preparation of infusion solution Calculation of rate of infusion Setting up infusion pump/unfamiliarity

18 2 version of this ambulatory battery operated pump.
Simple pump, no syringe size detection, so as it cannot know the volume of fluid contained in the syringe, it is calibrated in mm of syringe movement. If that doesn’t make dose calculations difficult enough, we have two version of same pump: mm/hr and mm/day (24hr). Only obvious difference is colour. Confusion between these two models of pump have led to a number of fatalities in UK In GGH a senior experience ward manager, unable to find a pump from her own unit, borrowed one from another unit

19 … and it wasn’t realised it was blue (mm/hr) instead of the normal green (mm/24Hr) pump.
Result – pt got 24 times prescribe dose rate. No fatality this time, close run incident. If you accidentally use a BLUE 1hr pump instead of a GREEN 24 hour pump, you will deliver the drug at 24 times the intended rate.

20 What Goes Wrong? Medication Errors Prescription
Preparation of infusion solution Calculation of rate of infusion Setting up infusion pump/unfamiliarity Do not use a model you have not been trained and are deemed competent to use

21 What goes wrong? Free flow by gravity/siphoning
What is it: Uncontrolled fluid flow by gravity from syringe or bag. Has resulted in a significant number of fatalities, none yet in North Glasgow.

22 Free Flow in Volumetric Pumps
If fluid container is a few inches above heart level, free flow by gravity can occur if: Pump latch/door open. Always close roller clamp before removing set from pump. Latch open – demo on 597

23 Latch closed Clamp open

24 Latch open Clamp closed

25 Free Flow in Volumetric Pumps
If fluid container is a few inches above heart level, free flow by gravity can occur if: Pump latch/door opened. Always close roller clamp before removing set from pump. Infusion set not correctly loaded Infusion set not inserted correctly – demo on 597, show next slide at same time

26

27 Free Flow in Volumetric Pumps
If fluid container is a few inches above heart level, free flow by gravity can occur if: Pump latch/door opened. Always close roller clamp before removing set from pump. Infusion set not correctly loaded Damage to set resulting in an air leak Latch open – demo on 597 Infusion set not inserted correctly – demo on 597

28 Free Flow in Syringe Pumps
If pump is a few inches above heart level, free flow by gravity can occur if: Syringe not correctly located and secured to pump. Check syringe barrel clamp, barrel flange and plunger located correctly and secured.

29 What happens if syringe is not correctly secured, plunger is allowed to move – DEMO free flow
Also mention particular hazard of MS16A/26. No alarms, syringe only held in by rubber band, easily dislodged

30 Free Flow in Syringe Pumps
If pump is a few inches above heart level, free flow by gravity can occur if: Syringe not correctly located and secured to pump. Check syringe barrel clamp, barrel flange and plunger located correctly and secured Syringe removed from pump. Always close clamp first.

31

32 Free Flow in Syringe Pumps
If pump is a few inches above heart level, free flow by gravity can occur if: Syringe not correctly located and secured to pump. Check syringe barrel clamp, barrel flange and plunger located correctly and secured Syringe removed from pump. Always close clamp first. Air leak caused by crack in syringe, plunger seal leak, loose luer connection, distortion of barrel/plunger.

33 Luer lock syringe, reduces chance of air leak
Always user an anti free flow (or anti-syphon) set DEMO

34 To prevent free flow Never remove syringe or set from pump whilst connected to patient, without closing the clamp first (or checking it is closed) Always use a set with an anti free flow device (not available for Alaris/IVAC 59 series) Check set or syringe is correctly loaded Check drip chamber on volumetric pump for unexpected flow after set loading and during infusion Keep syringe pump near to or below infusion site

35 What Goes Wrong? INTERRUPTION TO THERAPY
Occlusion Alarms/Post occlusion bolus Air in line Alarms

36 What Goes Wrong? Occlusion alarm (all pumps)
Occurs when pump is unable to sustain set flow rate and pressure in line increases Caused by partial or complete blockage in delivery tubing (kinked tube, clamp or tap closed) or cannula (clotted off, position changed)

37 Occlusion Alarm Time to alarm
Dependent on occlusion pressure level (usually variable) and flow rate Low pressure, high flow rate 45 seconds High pressure, low flow rate 45 minutes Not instant, dependent on the occlusion pressure level which on most pumps is adjustable, and flow rate.

38 Occlusion Alarm Hazards Interruption to therapy Post occlusion bolus
Problem with critical, fast acting drugs e.g. inotropes Post occlusion bolus Interruption to therapy – can be hazardous – e.g. later Post occlusion bolus. Occlusion, pump continues to attempt to deliver fluid until preset pressure is reached and pump stops and alarms. Because of the compliance (give) of the set (tubing), tubing expands under the increasing pressure. When occlusion released (kink removed) extra fluid under pressure is released and delivered to patient as a bolus. In some fast acting drugs, that can prevent a hazard. Some modern pumps have a “backoff” facility, when occlusion occurs pump briefly runs backwards to reduce the pressure and potential bolus.

39 Tissuing (Extravasation)
Extravasation occurs when fluid that should be delivered intravenously is inadvertently delivered into a tissue space.

40 Tissuing Cannot be detected by infusion pumps
Usually little or no increase in pressure Secure and dress the catheter for stability Check IV site frequently for tenderness, skin tightening, cooling and blanching

41 What Goes Wrong? Air-in-line
Volumetric pumps have a risk of air being delivered due to poor priming of set, upstream leak or pumping action drawing air out of solution Volumetric pumps have either a mechanism for preventing pumping of air or an air-in-line detector & alarm

42 Air-in-line Alarm Hazards Nuisance alarms Interruption to therapy
Problem with critical, fast acting drugs e.g. inotropes Recent fatality in North Glasgow

43 What Goes Wrong? Tampering by patients/visitors/carers Keylock
Lock box

44

45 Ambulatory (portable)

46 What Goes Wrong? Equipment Faults
Often occur as a result of damage due to fluid ingress or being dropped/knocked Always return damaged pumps to Clinical Physics – never use or attempt to repair Infusion devices very reliable, faults rarely result in adverse incidents

47 Training This presentation and demonstrations to follow are a general introduction ONLY Before using any infusion device you MUST have received specific training for that model and be signed off as competent – over 50 models in North Glasgow Otherwise DO NOT USE Unable to


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