Pump presentation cds ver2

1. INFUSION PUMPS

2. Fluid container
Drip chamber
Roller Clamp
Basic Infusion System
•Flow by gravity
•Flow controlled by roller
clamp
•Difficult to set and control
infusion rate

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

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

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 < 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 ErrorsMedication Errors
•Prescription
•Preparation of infusion solution
•Calculation of rate of infusion

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

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 ErrorsMedication 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/siphoningFree 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

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:
3.Syringe not correctly located and secured to pump.
Check syringe barrel clamp, barrel flange and
plunger located correctly and secured.

30. Free Flow in Syringe Pumps
If pump is a few inches above heart level, free
flow by gravity can occur if:
3.Syringe not correctly located and secured to pump.
Check syringe barrel clamp, barrel flange and
plunger located correctly and secured
4.Syringe removed from pump. Always close clamp
first.

32. Free Flow in Syringe Pumps
If pump is a few inches above heart level, free
flow by gravity can occur if:
3.Syringe not correctly located and secured to pump.
Check syringe barrel clamp, barrel flange and
plunger located correctly and secured
4.Syringe removed from pump. Always close clamp
first.
5.Air leak caused by crack in syringe, plunger seal
leak, loose luer connection, distortion of
barrel/plunger.

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)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-lineAir-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/carersTampering by patients/visitors/carers
1.Keylock
2.Lock box

44. Ambulatory (portable)

45. What Goes Wrong?
Equipment FaultsEquipment 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