Smart pumps with Dose Error Reduction Systems (DERS) reduce the risk of medication error, but the requirement for strict isolation of large numbers of patients during the COVID-19 pandemic has made maintaining the Rights of IV medication administration increasingly difficult.
Right Maintenance of continuous critical short half-life infusions (CSHLI), such as Noradrenaline or Glyceryl Trinitrate is also vital as any prolonged interruption of CSHLI delivery could be fatal, and nursing staff must respond promptly to any infusion alarm if serious cardiovascular events are to be avoided. Centralised monitoring of infusions can significantly reduce nurse reaction times to CSHLI alarms.
To reduce nursing time inside SARS CoV- 2 patient rooms we can use long extension lines that allow the patient’s pumps to remain outside of the isolation room. Running the IV line under the door and across the room’s floor, with taping to prevent tripping or dislodgment, is not ideal but provides protection of the line. However, the technique may cause issues of pressure gradient changes affecting occlusion alarms, and accumulation of air in the line due to the low level of the line in relation to the pump and the patient.
Long lines increase siphonage in the case of large bore lines and increase downstream pressure when microbore lines are used. It is important to maintain the recommended height of the infusion bag above a large volume pump (this is usually 50 centimetres) and any unnecessary resistance in the downstream line should be reduced by limiting the number of extension- set additions whilst achieving a safe working distance, and infusing through as large an IV catheter as possible. Priming of long extension lines can be undertaken by gravity, but it is often easier to control the prime by using the pump. Downstream occlusion pressure limits may need to be increased to avoid nuisance alarms, particularly at higher rates with narrow tubing. This can be done by bedside-users, but with wireless-connected smart pumps changes to default pressure alarms configurations can be made centrally and distributed rapidly via the network to all pumps. Studies on the cleaning of long-lines and their materials suggest that wiping a PVC extension set 2-3 times daily with 70% isopropyl alcohol solution has minimal impact on the line’s function and performance (i.e. there will be no weakening leading to excess kinking or excessive compliance in the line). It is therefore expected that PVC IV extension sets would still deliver their critical function with minimal risk to clinician or patient.
For intermittent infusions nurses should consider priming long extension-sets with the medication rather than with normalsaline or dextrose, to facilitate prompt delivery. Post-medication flushes should be given at the same rate as the medication, the pump’s ‘restore’ function can help achieve this.
Appropriate cleaning and decontamination of pumps between patients, and on a regular basis, is a both vital component of pandemic planning, as well as being central to any ‘standard’ infection control plan. Selection of infusion pumps is a factor here. There should be no difficult to access areas that can harbour contaminant and that cannot be exposed to disinfectant material. This includes plunger grips on syringe pumps and line or cartridge loading spaces on large volume pumps. Furthermore, the pump’s body must be not be degraded by cleaning products that can fight SARS-CoV-2. New polymers released in the last few years by some pump manufacturers have considerably broadened the cleaning products that can be used without fear of damage to the device.
Becton Dickinson
Article supplied by Clinical Resource Consultants, Medication Management Solutions, Eastern Europe, Middle East & Africa. Becton Dickinson.
