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INFUSION PUMPS

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INFUSION PUMPS Basic Infusion System Flow by gravity Flow controlled by roller clamp Difficult to set and control infusion rate Infusion Pumps What are they? – PowerPoint PPT presentation

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Title: INFUSION PUMPS


1
INFUSION PUMPS
2
Basic Infusion System
Fluid container
  • Flow by gravity
  • Flow controlled by roller clamp
  • Difficult to set and control infusion rate

Drip chamber
Roller Clamp
3
Infusion Pumps
  • What are they?
  • 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?
  • 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
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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

9
Volumetric Pumps
10
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11
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 lt 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

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

18
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19
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.

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

26
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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

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
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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
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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
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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?
  • 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)

36
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
  • To reduce time to alarm and bolus size
  • Use highest flow rate clinically acceptable
  • Use lowest occlusion pressure setting possible
    without causing nuisance alarms
  • User smaller syringes

37
Occlusion Alarm
  • Hazards
  • Interruption to therapy
  • Problem with critical, fast acting drugs e.g.
    inotropes
  • Post occlusion bolus

38
Tissuing (Extravasation)
Extravasation occurs when fluid that should be
delivered intravenously is inadvertently
delivered into a tissue space.
39
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

40
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

41
Air-in-line Alarm
  • Hazards
  • Nuisance alarms
  • Interruption to therapy
  • Problem with critical, fast acting drugs e.g.
    inotropes
  • Recent fatality in North Glasgow

42
What Goes Wrong?
  • Tampering by patients/visitors/carers
  • Keylock
  • Lock box

43
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44
Ambulatory (portable)
45
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

46
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
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