INFUSION  PUMPS
Basic Infusion System <ul><li>Flow by gravity </li></ul><ul><li>Flow controlled by roller clamp </li></ul><ul><li>Difficul...
Infusion Pumps <ul><li>What are they? </li></ul><ul><li>Usually electrically powered infusion devices </li></ul><ul><li>Wh...
Infusion Pumps <ul><li>Why are they used? </li></ul><ul><li>To provide accurate and controllable flow over a prescribed pe...
Infusion Pumps <ul><li>TWO BASIC TYPES </li></ul><ul><li>Syringe Pumps </li></ul><ul><li>Volumetric Pumps </li></ul>
Syringe Pump
 
Syringe Pumps <ul><li>Generally used for low volume, low flow rate infusions </li></ul><ul><li>Good short term accuracy </...
Volumetric Pumps
 
Latch Cam followers (fingers) Pressure sensor Air in line detector
Volumetric Pumps <ul><li>Preferred for medium and high flow rates and large volumes </li></ul><ul><li>Generally not suitab...
Infusion Pump Incidents <ul><li>700 incidents/year reported to MHRA, including  10 deaths </li></ul><ul><li>20% Device rel...
Reporting Incidents <ul><li>All incidents should be reported on a Clinical Adverse Patient Incident Form </li></ul><ul><li...
What Goes Wrong? <ul><li>Medication Errors </li></ul><ul><li>Prescription </li></ul><ul><li>Preparation of infusion soluti...
 
What Goes Wrong? <ul><li>Medication Errors </li></ul><ul><li>Prescription </li></ul><ul><li>Preparation of infusion soluti...
 
If you accidentally use a  BLUE  1hr pump instead of a  GREEN   24 hour pump, you will deliver the drug at 24 times the in...
What Goes Wrong? <ul><li>Medication Errors </li></ul><ul><li>Prescription </li></ul><ul><li>Preparation of infusion soluti...
What goes wrong? <ul><li>Free flow by gravity/siphoning </li></ul><ul><li>What is it: Uncontrolled fluid flow by gravity f...
Free Flow in Volumetric Pumps <ul><li>If fluid container is a few inches above heart level, free flow by gravity can occur...
Latch closed Clamp open
Latch open Clamp closed
Free Flow in Volumetric Pumps <ul><li>If fluid container is a few inches above heart level, free flow by gravity can occur...
 
Free Flow in Volumetric Pumps <ul><li>If fluid container is a few inches above heart level, free flow by gravity can occur...
Free Flow in Syringe Pumps <ul><li>If pump is a few inches above heart level, free flow by gravity can occur if: </li></ul...
 
Free Flow in Syringe Pumps <ul><li>If pump is a few inches above heart level, free flow by gravity can occur if: </li></ul...
 
Free Flow in Syringe Pumps <ul><li>If pump is a few inches above heart level, free flow by gravity can occur if: </li></ul...
 
To prevent free flow <ul><li>Never remove syringe or set from pump whilst connected to patient, without closing the clamp ...
What Goes Wrong? <ul><li>Occlusion alarm (all pumps) </li></ul><ul><li>Occurs when pump is unable to sustain set flow rate...
Occlusion Alarm <ul><li>Time to alarm </li></ul><ul><li>Dependent on occlusion pressure level (usually variable) and flow ...
Occlusion Alarm <ul><li>Hazards </li></ul><ul><li>Interruption to therapy </li></ul><ul><ul><li>Problem with critical, fas...
Tissuing (Extravasation) Extravasation occurs when fluid that should be delivered intravenously is inadvertently delivered...
Tissuing <ul><li>Cannot be detected by infusion pumps </li></ul><ul><ul><li>Usually little or no increase in pressure </li...
What Goes Wrong? <ul><li>Air-in-line </li></ul><ul><li>Volumetric pumps have a risk of air being delivered due to poor pri...
Air-in-line Alarm <ul><li>Hazards </li></ul><ul><li>Nuisance alarms </li></ul><ul><li>Interruption to therapy </li></ul><u...
What Goes Wrong? <ul><li>Tampering by patients/visitors/carers </li></ul><ul><ul><li>Keylock </li></ul></ul><ul><ul><li>Lo...
 
Ambulatory (portable)
What Goes  Wrong? <ul><li>Equipment Faults </li></ul><ul><li>Often occur as a result of damage due to fluid ingress or bei...
Training <ul><li>This presentation and demonstrations to follow are a general introduction ONLY </li></ul><ul><li>Before u...
Upcoming SlideShare
Loading in...5
×

Pump presentation cds ver2

2,709

Published on

Published in: Education, Business, Technology
0 Comments
1 Like
Statistics
Notes
  • Be the first to comment

No Downloads
Views
Total Views
2,709
On Slideshare
0
From Embeds
0
Number of Embeds
0
Actions
Shares
0
Downloads
167
Comments
0
Likes
1
Embeds 0
No embeds

No notes for slide
  • Show infusion set
  • 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.
  • 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.
  • 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
  • Medicines &amp; Healthcare products Regulatory Agency (England &amp; Wales) Scotland, SHS, no statistics published
  • In NG, std infusion pump prescription and medication sheet used in attempt to reduce medication errors
  • 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
  • … 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.
  • Latch open – demo on 597
  • Infusion set not inserted correctly – demo on 597, show next slide at same time
  • Latch open – demo on 597 Infusion set not inserted correctly – demo on 597
  • 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
  • Luer lock syringe, reduces chance of air leak Always user an anti free flow (or anti-syphon) set DEMO
  • Not instant, dependent on the occlusion pressure level which on most pumps is adjustable, and flow rate.
  • 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.
  • Unable to
  • Pump presentation cds ver2

    1. 1. INFUSION PUMPS
    2. 2. Basic Infusion System <ul><li>Flow by gravity </li></ul><ul><li>Flow controlled by roller clamp </li></ul><ul><li>Difficult to set and control infusion rate </li></ul>Fluid container Drip chamber Roller Clamp
    3. 3. Infusion Pumps <ul><li>What are they? </li></ul><ul><li>Usually electrically powered infusion devices </li></ul><ul><li>What do they do? </li></ul><ul><li>Use pumping action to infuse fluids, medication or nutrients into patient </li></ul><ul><li>Suitable for intravenous, subcutaneous, enteral and epidural infusions </li></ul>
    4. 4. Infusion Pumps <ul><li>Why are they used? </li></ul><ul><li>To provide accurate and controllable flow over a prescribed period or on demand </li></ul><ul><li>What are they used for? </li></ul><ul><li>Wide range of drugs and therapies including </li></ul><ul><li>Chemotherapy </li></ul><ul><li>Pain management </li></ul><ul><li>Total parental nutrition </li></ul><ul><li>Anaesthesia/sedation </li></ul><ul><li>Etc. etc. </li></ul>
    5. 5. Infusion Pumps <ul><li>TWO BASIC TYPES </li></ul><ul><li>Syringe Pumps </li></ul><ul><li>Volumetric Pumps </li></ul>
    6. 6. Syringe Pump
    7. 8. Syringe Pumps <ul><li>Generally used for low volume, low flow rate infusions </li></ul><ul><li>Good short term accuracy </li></ul><ul><li>Long start up time at low flow rates </li></ul><ul><ul><li>Prime and purge line before connecting to patient </li></ul></ul><ul><li>Alarms: End/near end of infusion; drive disengaged, occlusion, battery low </li></ul><ul><li>Specialised syringe pumps for ambulatory use, PCA, sedation, insulin etc </li></ul>
    8. 9. Volumetric Pumps
    9. 11. Latch Cam followers (fingers) Pressure sensor Air in line detector
    10. 12. Volumetric Pumps <ul><li>Preferred for medium and high flow rates and large volumes </li></ul><ul><li>Generally not suitable for rates < 5ml/h </li></ul><ul><li>Variable short term accuracy </li></ul><ul><li>Alarms: Latch/door open, set out, occlusion, battery low, air-in-line </li></ul><ul><li>Specialised volumetric pumps for ambulatory use, epidural infusions etc. </li></ul>
    11. 13. Infusion Pump Incidents <ul><li>700 incidents/year reported to MHRA, including 10 deaths </li></ul><ul><li>20% Device related (e.g. design, failures etc) </li></ul><ul><li>27% User error </li></ul><ul><li>53% Not established (majority user error) </li></ul><ul><li>Many incidents not reported e.g. 6 Trusts, 321 incidents </li></ul>
    12. 14. Reporting Incidents <ul><li>All incidents should be reported on a Clinical Adverse Patient Incident Form </li></ul><ul><li>Aim is to reduce risk in future, not to apportion blame </li></ul><ul><li>Where an infusion pump is involved, the pump and its disposables must be retained, and Clinical Physics informed. </li></ul>
    13. 15. What Goes Wrong? <ul><li>Medication Errors </li></ul><ul><li>Prescription </li></ul><ul><li>Preparation of infusion solution </li></ul><ul><li>Calculation of rate of infusion </li></ul>
    14. 17. What Goes Wrong? <ul><li>Medication Errors </li></ul><ul><li>Prescription </li></ul><ul><li>Preparation of infusion solution </li></ul><ul><li>Calculation of rate of infusion </li></ul><ul><li>Setting up infusion pump/unfamiliarity </li></ul>
    15. 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.
    16. 20. What Goes Wrong? <ul><li>Medication Errors </li></ul><ul><li>Prescription </li></ul><ul><li>Preparation of infusion solution </li></ul><ul><li>Calculation of rate of infusion </li></ul><ul><li>Setting up infusion pump/unfamiliarity </li></ul><ul><ul><li>Do not use a model you have not been trained and are deemed competent to use </li></ul></ul>
    17. 21. What goes wrong? <ul><li>Free flow by gravity/siphoning </li></ul><ul><li>What is it: Uncontrolled fluid flow by gravity from syringe or bag. </li></ul><ul><li>Has resulted in a significant number of fatalities, none yet in North Glasgow. </li></ul>
    18. 22. Free Flow in Volumetric Pumps <ul><li>If fluid container is a few inches above heart level, free flow by gravity can occur if: </li></ul><ul><li>Pump latch/door open. Always close roller clamp before removing set from pump. </li></ul>
    19. 23. Latch closed Clamp open
    20. 24. Latch open Clamp closed
    21. 25. Free Flow in Volumetric Pumps <ul><li>If fluid container is a few inches above heart level, free flow by gravity can occur if: </li></ul><ul><li>Pump latch/door opened. Always close roller clamp before removing set from pump. </li></ul><ul><li>Infusion set not correctly loaded </li></ul>
    22. 27. Free Flow in Volumetric Pumps <ul><li>If fluid container is a few inches above heart level, free flow by gravity can occur if: </li></ul><ul><li>Pump latch/door opened. Always close roller clamp before removing set from pump. </li></ul><ul><li>Infusion set not correctly loaded </li></ul><ul><li>Damage to set resulting in an air leak </li></ul>
    23. 28. Free Flow in Syringe Pumps <ul><li>If pump is a few inches above heart level, free flow by gravity can occur if: </li></ul><ul><li>Syringe not correctly located and secured to pump. Check syringe barrel clamp, barrel flange and plunger located correctly and secured. </li></ul>
    24. 30. Free Flow in Syringe Pumps <ul><li>If pump is a few inches above heart level, free flow by gravity can occur if: </li></ul><ul><li>Syringe not correctly located and secured to pump. Check syringe barrel clamp, barrel flange and plunger located correctly and secured </li></ul><ul><li>Syringe removed from pump. Always close clamp first. </li></ul>
    25. 32. Free Flow in Syringe Pumps <ul><li>If pump is a few inches above heart level, free flow by gravity can occur if: </li></ul><ul><li>Syringe not correctly located and secured to pump. Check syringe barrel clamp, barrel flange and plunger located correctly and secured </li></ul><ul><li>Syringe removed from pump. Always close clamp first. </li></ul><ul><li>Air leak caused by crack in syringe, plunger seal leak, loose luer connection, distortion of barrel/plunger. </li></ul>
    26. 34. To prevent free flow <ul><li>Never remove syringe or set from pump whilst connected to patient, without closing the clamp first (or checking it is closed) </li></ul><ul><li>Always use a set with an anti free flow device (not available for Alaris/IVAC 59 series) </li></ul><ul><li>Check set or syringe is correctly loaded </li></ul><ul><li>Check drip chamber on volumetric pump for unexpected flow after set loading and during infusion </li></ul><ul><li>Keep syringe pump near to or below infusion site </li></ul>
    27. 35. What Goes Wrong? <ul><li>Occlusion alarm (all pumps) </li></ul><ul><li>Occurs when pump is unable to sustain set flow rate and pressure in line increases </li></ul><ul><li>Caused by partial or complete blockage in delivery tubing (kinked tube, clamp or tap closed) or cannula (clotted off, position changed) </li></ul>
    28. 36. Occlusion Alarm <ul><li>Time to alarm </li></ul><ul><li>Dependent on occlusion pressure level (usually variable) and flow rate </li></ul><ul><ul><li>Low pressure, high flow rate 45 seconds </li></ul></ul><ul><ul><li>High pressure, low flow rate 45 minutes </li></ul></ul><ul><li>To reduce time to alarm and bolus size </li></ul><ul><ul><li>Use highest flow rate clinically acceptable </li></ul></ul><ul><ul><li>Use lowest occlusion pressure setting possible without causing nuisance alarms </li></ul></ul><ul><ul><li>User smaller syringes </li></ul></ul>
    29. 37. Occlusion Alarm <ul><li>Hazards </li></ul><ul><li>Interruption to therapy </li></ul><ul><ul><li>Problem with critical, fast acting drugs e.g. inotropes </li></ul></ul><ul><li>Post occlusion bolus </li></ul>
    30. 38. Tissuing (Extravasation) Extravasation occurs when fluid that should be delivered intravenously is inadvertently delivered into a tissue space.
    31. 39. Tissuing <ul><li>Cannot be detected by infusion pumps </li></ul><ul><ul><li>Usually little or no increase in pressure </li></ul></ul><ul><li>Secure and dress the catheter for stability </li></ul><ul><li>Check IV site frequently for tenderness, skin tightening, cooling and blanching </li></ul>
    32. 40. What Goes Wrong? <ul><li>Air-in-line </li></ul><ul><li>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 </li></ul><ul><li>Volumetric pumps have either a mechanism for preventing pumping of air or an air-in-line detector & alarm </li></ul>
    33. 41. Air-in-line Alarm <ul><li>Hazards </li></ul><ul><li>Nuisance alarms </li></ul><ul><li>Interruption to therapy </li></ul><ul><ul><li>Problem with critical, fast acting drugs e.g. inotropes </li></ul></ul><ul><ul><li>Recent fatality in North Glasgow </li></ul></ul>
    34. 42. What Goes Wrong? <ul><li>Tampering by patients/visitors/carers </li></ul><ul><ul><li>Keylock </li></ul></ul><ul><ul><li>Lock box </li></ul></ul>
    35. 44. Ambulatory (portable)
    36. 45. What Goes Wrong? <ul><li>Equipment Faults </li></ul><ul><li>Often occur as a result of damage due to fluid ingress or being dropped/knocked </li></ul><ul><li>Always return damaged pumps to Clinical Physics – never use or attempt to repair </li></ul><ul><li>Infusion devices very reliable, faults rarely result in adverse incidents </li></ul>
    37. 46. Training <ul><li>This presentation and demonstrations to follow are a general introduction ONLY </li></ul><ul><li>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 </li></ul><ul><li>Otherwise DO NOT USE </li></ul>
    1. Gostou de algum slide específico?

      Recortar slides é uma maneira fácil de colecionar informações para acessar mais tarde.

    ×