IV Infusion Pumps and Administration Notes

Plump Pump

  • Used at Ascension and ProHealth.
  • Regulates each line separately.
  • Dependent on gravity; the higher line dictates the flow.

Plum Series or Mixed Infusion System

  • Regulates each line separately through the machine.

Administration Set Management

  • Intermittent: Secondary infusions.
  • Continuous: Primary infusions.
  • Luer locks: Connections to secure attachments.
  • Label all solution sets.

Primary vs. Secondary Continuous Infusions

  • Continuous infusion sets (excluding lipids, parenteral nutrition, blood) can be used for up to seven days if not disconnected from the patient (only changing the bag).
  • If intermittent infusions (secondary bags) are not disconnected, the tubing can also remain for seven days.
  • If two different antibiotics are used with separate tubing and disconnections occur, the tubing must be changed every 24 hours.

Phlebitis

  • Know the difference between mechanical, infectious, and post-infusion phlebitis (refer to the worksheet and Open RN).
  • Understand the appropriate interventions for each type.

Infiltration and Extravasation Interventions

  • Study the provided worksheet for interventions related to infiltration and extravasation.

Common Errors in Programming Secondary Infusions

  • Ensure the primary bag is lower to prevent air bubbles.

Alarms

  • Air leak detector: Call for assistance to resolve.
  • Occlusion: Trace the line to identify and resolve the pinch.
Tracing the Line
  • Essential to ensure the correct IV is connected to the right solution.
  • Trace from the IV site to the solution or vice versa.
Addressing Occlusion Alarms
  • Silence the alarm.
  • Trace the line to find the occlusion.
  • Reset the pump after resolving the occlusion.
Importance of Roller Clamp Position
  • Verify the secondary clamp is open to run the secondary infusion at the correct rate.
  • Failure to open the clamp causes primary infusion to run at a higher rate, potentially missing doses of the secondary infusion.
  • Always visually confirm drops are dripping when hanging bags as a double-check.

Secondary IV Bag Examples

  • Clindamycin, vancomycin, and potassium chloride are provided as examples.
  • Vancomycin and clindamycin often come in 250 mL bags; cefazolin in 100 mL bags.

Dilution

  • Larger bags are used for secondary antibiotics to ensure adequate dilution.
  • Vancomycin may be administered via a central line due to its potential to irritate the vein.

Types of Phlebitis

  • Phlebitis types: Chemical (drug-related), mechanical, and infectious.
  • Cause of Chemical Phlebitis: The drug is causing the problem, like with potassium chloride.
Potassium Chloride
  • Always diluted due to its potential to be deadly as a bolus; prepared by pharmacy.
  • Lethal injection component.
  • If the patient reports burning at the IV site, slow down the infusion rate or dilute it further with normal saline.
  • Consider a central line if available, but prioritize dilution and slowing the rate.
  • Lidocaine: Some hospitals may add lidocaine to the bag for numbing effect (requires a medication order).
Potassium Administration
  • The rate of potassium administration depends on the reason for needing it.
Hypokalemia
  • Associated with Arrhythmias, which can be fatal.
  • Calcium: More related to muscle weakness.
  • Magnesium: Low levels can also cause arrhythmias.
Calculation Practice
  • Example: Infusing potassium over 15 minutes vs. vancomycin over 90 minutes.
  • Use Q=mcΔTQ = mc \Delta T to calculate milliliters per hour.
  • Use Ratio proportion method 25015=X\frac{250}{15} = X is shown.

Vancomycin Peak and Trough Levels

  • Vancomycin: Drug frequently requiring peak and trough levels to be monitored.

Definitions

  • Peak: Highest drug level in the body.
  • Trough: Lowest drug level in the body before the next dose, while remaining therapeutic.
Purpose
  • Ensure drug levels are therapeutic, not toxic, and effective against bacteria.
Metabolization
  • Vancomycin: Metabolized by the Kidneys.
Lab Values to Monitor
  • Creatinine to assess renal function.
  • Pharmacists: Adjust dosages and frequency based on renal function.
Timing
  • Trough levels: Drawn right before the next dose.
  • Nurses: Coordinate with lab to draw blood at the correct time, accounting for trough levels.
Factors Influencing Dosage
  • High peak levels or low trough levels: Adjust dosage or intervals.
  • Nurses' Role: Administer drugs at the correct time according to orders.

Secondary Tubing Connection

  • Connect the secondary tubing to the designated port on the primary line.

Back Priming Technique

  • Used to avoid disconnecting the secondary tubing when changing bags.

Steps

  1. Clamp the primary line before the empty secondary bag.
  2. Switch to the new primary bag.
  3. Maintain sterility of connections.
  4. Lower the secondary bag below the level of the primary bag.
  5. Open the clamp to allow fluid from the primary bag to fill the secondary tubing, pushing air bubbles back into the secondary bag.