Introduction to Volumetric Infusion Pumps
Volumetric infusion pumps are medical devices that deliver precise amounts of fluid, such as medication, blood, or nutrition, to a patient intravenously over a specific period. They offer greater accuracy and can deliver fluids against resistance compared to gravity-fed systems, making them vital in modern healthcare. Accurate programming is crucial for proper function and patient safety.
Pre-Setup: The Crucial Preparation Phase
Before using the pump, thorough preparation is necessary to minimize errors and ensure the correct medication is delivered to the right patient at the right time.
Verifying the Prescription and Patient
Adhering to the 'five rights' of medication administration is essential for safe care. This involves confirming the right patient using two identifiers, the right drug and concentration, the right dose, the right intravenous route, and the right time of administration.
Gathering and Inspecting Equipment
Gather all required supplies, including the IV fluid or medication bag, a compatible IV administration set, alcohol wipes, and gloves. Inspect the equipment before use:
- Check the infusion pump for any damage or malfunctions.
- Verify the expiration date and integrity of the IV fluid bag, ensuring the fluid is clear.
- Inspect the IV set for compatibility with the pump and any damage.
Step-by-Step Guide: How to Set a Volumetric Pump
After preparation, you can proceed with the physical setup and programming of the pump.
Setting Up the IV Administration Set
Properly setting up the IV administration set is vital for preventing air embolism.
- Spike the Bag: After hand hygiene, insert the IV set spike into the medication bag's port.
- Fill the Drip Chamber: Gently squeeze the drip chamber to fill it about halfway, aiding in monitoring the drip rate.
- Prime the Tubing: Open the roller clamp to let fluid flow and remove all air bubbles. Close the clamp once air is expelled.
Loading the Tubing into the Pump
The process for loading tubing varies slightly by pump model.
- Open the Pump Door: Open the designated door or chamber for tubing placement.
- Thread the Tubing: Follow the manufacturer's directions to thread the tubing into the pump, ensuring it's correctly seated.
- Close the Door: Securely close the door to allow the pump to apply proper pressure on the tubing.
Programming the Infusion
Programming involves entering specific parameters for the fluid or medication.
- Turn On the Pump: Power on the device.
- Select a Channel: Choose the correct channel if using a multi-channel pump.
- Input Parameters: Enter the infusion rate in mL/hr and the total volume to be infused (VTBI) using the pump interface.
- Confirm Settings: Double-check the entered rate and VTBI against the order. For high-risk medications, an independent double-check by another clinician is standard.
Initiating and Monitoring the Infusion
Once settings are confirmed, start the infusion.
- Attach to Patient: Connect the tubing to the patient's IV access.
- Open Clamps: Ensure all clamps are open.
- Press Start: Begin the infusion by pressing the 'Start' button.
- Monitor Regularly: Periodically check the pump display and the patient's IV site for correct infusion progress and signs of complications.
Volumetric Pump vs. Syringe Pump: A Comparison
Volumetric and syringe pumps serve different purposes based on flow rate and volume requirements.
| Feature | Volumetric Pump | Syringe Pump |
|---|---|---|
| Mechanism | Uses peristaltic action. | Pushes a syringe plunger. |
| Flow Rate Range | Higher volumes (e.g., 7–50 mL/hr or more). | Lower volumes (e.g., 0.1–10 mL/hr). |
| Typical Use | Standard IV fluids, antibiotics. | Potent, concentrated drugs. |
| Volume | Large volume infusions (e.g., 100-1000 mL). | Small, precise volumes (e.g., 5-50 mL syringe). |
Handling Volumetric Pump Alarms
Infusion pumps have safety alarms to alert clinicians to potential issues.
- Air in Line: Indicates air bubbles. Stop the infusion, locate the air, and remove it following protocol.
- Occlusion: Indicates a blockage. Check for kinks, closed clamps, or an infiltrated IV site.
- Low Battery: The pump needs to be connected to power or have batteries replaced.
- Infusion Complete: The programmed volume is delivered. The pump may stop or enter KVO mode.
Safety Best Practices for Medication Infusion
Adhering to safety practices is crucial for minimizing risks.
- Independent Double-Check: Have another clinician verify settings for high-risk medications.
- Label Everything: Clearly label pumps and tubing to prevent errors.
- Trace the Line: Before connecting to the patient and at the start of each shift, trace the line from the source to the patient.
- Manage Post-Occlusion Bolus: Be aware of the risk of a medication surge after clearing an occlusion and follow protocols to manage this safely.
- Use Drug Libraries: Utilize smart pump drug libraries to help prevent dosage errors.
Conclusion
Properly setting a volumetric pump is a fundamental skill for safe patient care. Following a systematic process from preparation and inspection to accurate programming and monitoring ensures precise medication delivery. Regular training, adherence to safety protocols, and understanding pump functionality and alarm management are all essential. Always consult the manufacturer's user manual for specific pump models, such as the BD Alaris Recommended Priming Tip Sheet.
