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Pump presentation cds ver2

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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>

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