IV Pump and Infusion
Overview of Tubing Types and Uses
Primary tubing: standard tubing used for the main IV infusion (not always made for a pump). It often differs from pump-specific tubing.
Pump tubing: tubing designed to work with IV pumps; includes a blue connector section and a specific setup to fit the pump brain.
Micro drip tubing: a narrower tubing with a small metal needle-like component in the chamber stem; used for dialysis patients and other slower infusions.
Dialysis and special applications use micro drip tubing; generally slower flow than standard pump tubing, but not by a large margin.
Blue tubing and blue connector: identify which tubing works with the pump (blue end goes into the pump’s blue side).
Pump-inserted pieces such as a “drift chamber” or similar section: these parts help regulate flow and prevent air entry; some bags/chambers have lines or marks indicating minimum fluid in the chamber (e.g., a line showing the minimum amount of fluid that should be present).
Air vent: a small vent to let air escape from the bag as fluid enters the line when priming.
Spiking, Priming, and Preparing IV Bags
When spiking a bag, do not hold the bag flat and spike sideways to avoid puncturing the bag’s side. Hold the bag firmly and spike at the correct point to prevent spurt leakage.
Before spiking, ensure the system is closed at one or more points to prevent air from entering the line.
After spiking, compress the bag or the chamber to push air out and allow the solution to fill the chamber, then flip the bag upright to push fluid through the line.
If you over-spill air as you prime, you can turn the bag upside down to push liquid through the line and expel air.
If using a rapid adhesive and wanting to remove air before connecting, you can squeeze the air out of the line to speed priming.
Spiking technique taught by the instructor: hold the part you’re spiking tightly with fingers to compress the chamber, then spike, then release to avoid drawing air into the line.
Before priming, ensure the system is closed at all possible points (one or multiple points can be closed depending on the department).
Prime by letting the end of the tubing run into a waste container to remove air and ensure the line is flushed before connecting to the patient.
Pump Components and Safety Features
Brain: the central controller of the infusion pump (the “brain”); sets dosage, rate, and monitors infusions.
Chamber: the physical fluid path that the pump controls; the pump’s brain can manage multiple chambers/tubings. A single brain can handle up to six chambers; commonly three on each side (i.e., up to six channels total).
Safety mechanisms: pumps are designed to prevent incorrect drug delivery by requiring confirmation of drug, concentration, dose, and rate (drug library checks, double checks). If a pump is not used correctly, hospital policies may not cover the practitioner’s actions.
Unit-specific configuration: pumps ask for the patient’s unit (e.g., ER/ICU vs Med-Surg). The brain’s unit setting affects defaults and permissible rates; ICU units may allow faster infusions due to one-on-one staffing.
Pediatric settings: the pump can adjust dosing when the unit is set to pediatrics; it uses pediatric dosing calculations (e.g., <40 kg vs ≥40 kg) to tailor calculations.
Dashboard indicators: color-coded alerts (red, yellow, green) indicate status; red commonly signals an occlusion or alarm condition, yellow/warn, green meaning normal operation after a fix.
Silence button: used to silence alarms/beeping temporarily; essential to keep families calm and manage alarms efficiently.
Setting Up the Pump on a Med-Surg Unit (Walkthrough Highlights)
Unit selection on startup: choose Medical-Surgical (Med-Surg) or other appropriate unit; then confirm the patient, and select the patient type such as adult, pediatrics, labor and delivery, etc. Page through options to find the appropriate unit and patient type.
Patient status prompts: pump may ask if the patient is new; typically you should answer according to whether the patient has moved floors or rooms.
Pediatric weight considerations: for pediatrics, confirm whether the patient weighs <40 kg or ≥40 kg since this affects dosing calculations.
Channel selection: if there is only one infusion channel, you’ll see channel A. If multiple channels exist (A, B, C, etc.), you can select the appropriate channel for the infusion. The numbering typically follows the order of activation rather than physical position; the first active infusion is A, the next is B, etc.
Drug/fluids vs basic infusion: when selecting the infusion type, avoid selecting “basic infusion” in nursing school scenarios because it could enable improper infusion rates. Choose either Drugs or Fluids (then browse to the specific solution or drug).
Primary vs secondary (piggyback): identify whether you are infusing a primary solution (the base fluid, e.g., normal saline) or a secondary piggyback infusion (e.g., an antibiotic mixed in a smaller volume). The pump will show the current infusion as a primary or secondary infusion.
Normal saline setup example: select Normal Saline as the primary infusion; set an infusion rate (e.g., 15 mL/hr) and VTBI (volume to be infused, e.g., 500 mL bag).
VTBI and rate basics: VTBI is the total volume to be infused from the current bag; rate is the infusion rate (mL/hour). The basic formulas you’ll use are:
Example values: a 500 mL bag at 15 mL/hr results in a total time of roughly
Dose confirmation: ensure the selected drug, concentration, and total dose match the doctor’s order; the pump prompts a confirmation step to re-check drug amount and delivery rate before starting.
Starting the infusion: unclamp, verify line patency, and press Start; if an occlusion is detected, the pump will display a red alert and pause; you can press Restart after addressing the occlusion.
Practical Pump Use and Troubleshooting
Occlusion alarms: red indicates an occlusion; check the patient-side line first (occlusion may be between the pump and the patient). If the line is occluded, fix the issue and restart the infusion.
Delays and pump programming: you can delay the start of a secondary infusion (e.g., vancomycin) if needed; pumps provide a Delay option to queue the start time.
Drug library checks: when selecting a drug (e.g., vancomycin), the pump displays drug amount, volume, and dose; it requires confirmation (double-check) before starting; this protects against wrong-drug or wrong-dose errors.
Piggyback considerations: for a piggyback, the infusate may piggyback onto the line carrying another primary fluid; ensure the connections are correct and do not disrupt the primary infusion when swapping bags.
Infusion sequence visibility: the pump shows which bag is currently infusing and what it contains; if you switch to a different drug (e.g., vancomycin) after starting, the pump will typically switch to the new drug’s line and show the new infusion status.
Stopping and safety: to stop a pump, you may need to press and hold the stop button; avoid abrupt disconnections that can cause line patency issues. Ensure the line is clamped when stopping infusion to prevent backflow.
Completing an infusion: after a bag finishes, the pump can automatically flush or switch to a secondary bag; if you remove a bag, make sure you manage the line to avoid backflow or air introduction.
Administration and Real-World Considerations
LR vs NS: lactated Ringer’s (LR) and normal saline (NS) are common IV fluids; if you switch from NS to LR mid-infusion, the pump will sometimes switch to the new bag’s content and flushes; be mindful of what the line is currently delivering.
KVO (Keep Vein Open) limits: typical nursing practice allows up to 50 mL/hr for KVO; higher rates require formal orders and physician oversight, depending on hospital policy and patient condition (considering fluid restrictions, dialysis, dehydration, etc.).