1. Stop the Beeping:
Decreasing Clinically Insignificant IV Pump Air-in-Line Alarms with an Anti-Siphon Valve
Karen Meade, MS, APRN-CNS, AGCNS-BC, CPAN®, OCN®, Kimberly Catania, MSN, APRN-CNS, AOCN
Ben Lopez, PharmD, MS, MHA, BCPS & Ryan Connell, CPhT
Introduction- Clinically Insignificant Alarms
Anti-Siphon Valve Implementation
Outcome and Evaluation
Per the Oncology Nursing Society community discussion boards, some organizations have instituted an anti-siphon valve to pressurize the infusion, decreasing air bubbles in the line and ultimately AIL alarms.
At this organization, nursing collaborated with pharmacy to trial use of the anti-siphon valve to decrease AIL alarms in EPOCH infusions.
Trialed on an inpatient hematology oncology unit
Drug delivered to unit primed with valve
Focused pharmacy tech education
Adequate supply prior to rollout
Minimal nursing education needed
Positive responses from nursing staff.
Data revealed a 91.7% decrease in AILs when comparing 4 weeks of infusion data pre and post anti-siphon valve implementation.
The Joint Commission recommends strategies to reduce nuisance alarms to include identifying opportunities for improvement through reviewing trends and patterns of alarms. 1
A recent survey of over 1200 health care team members reported that alarms occurred frequently (81%) and disrupted patient care (77%), causing caregivers to distrust and disable them (78%). 2
Some infusions are known to trigger frequent and clinically insignificant or nuisance air-in-line (AIL) alarms.
It is unknown why some infusions are more gaseous than others, causing small air bubbles throughout the infusion.
Literature shows no consensus of the “amount of air” a patient may safely receive via an infusion.
No articles addressed strategies to decrease AIL alarms.
(Used with permission, K. Meade)
Practice Considerations
EPOCH Infusions
Takeaways
The anti-siphon valve inadvertently prevented the nurse from being able to check blood return via the normal means of withdrawing through the primary tubing during the infusion.
This problem was addressed with the addition of a dual-lumen extension device.
Chemotherapy infusions are one of the pillars of oncology treatment.
The etoposide-prednisone-vincristine-cyclophosphamide-doxorubicin chemotherapy regimen, also known as EPOCH, is notorious in the nursing community for creating nuisance AIL alarms.
Nuisance AIL alarms may prolong infusion times, disrupt patients’ sleep, and increase nursing workflow.
Previous work had been done to ensure proper infusion per manufacturer guidelines/recommendations to decrease AIL, without success.
GOAL: Decrease clinically insignificant EPOCH AIL alarms.
Clinician reports and analysis of infusion pump data may be beneficial to identify specific medications or fluids that cause frequent and insignificant air-in-line alarms.
Healthcare institutions should consider use of an anti-siphon valve to decrease clinically insignificant air-in-line alarms, especially with continuous infusions.
Although the use of an anti-siphon valve requires minimal education, it is important for users to know that it cannot be primed by gravity and may disable the ability to check blood return.
(Used with permission, K. Meade)
References:
1. The Joint Commission. (2013). Medical device alarm safety in
hospitals. Sentinel Event Alert, 50, 1–3.
2. Korniewicz, D.M., Clark, T., & David, Y. (2008). A national online survey on the effectiveness
of clinical alarms. American Journal of Critical Care, 17(1),