I have asked a simular question before with some good feedback. I would love some detailed feedback from other institutions (and Lynn, of course!) on how they handle the issue of the intermittent infusion. Our facility has no standardized practice since we did away with Buretrols several years ago. There are multiple factors involved. Including whether a patient is on MIVF or not, compatibility, cost, line manipulation/infection prevention, regulatory requirements, etc. Attached is a PDF file containing the various options available and pros/cons with each. Please read it and give any and all feedback, opinions, other options, etc. Thank you so much in advance.
Kristi Selck, RN/BSN
Clinical and Evidence Based Practice Council Chair
| Attachment | Size |
|---|---|
 intermittent infusions.pdf | 187.94 KB |
First and foremost - getting rid of the metered chambers is the best thing your facility is doing!!
The issue of shortages of saline bags is causing some increased concern for using bags of saline as a carrier fluid for piggyback meds. There is no such thing as a rate of flow that will keep a vein open - this is a myth. Also an order without a patient specific rate is not a legal order.
Using pumps to infuse every single dose of everything is overkill in my opinion. Antibiotics do not need the exact rate control of an infusion pump.
The issue of primary fluids not infusing while a piggyback med is running has been the case since primary sets with a backcheck valve were introduved in the middle 1970's and I do not see this as an issue for most patients. It coculd be a problem in critical care if the primary line contained meds that were not infusing, but this is typically not the case for most med-surg patients. I don't think fluid volume deficits would be the problem because the med is diluted in fluids, sometimes a larger fluid volume is infused for the meds than what is prescribed for th primary fluid. Are you certain that your pump will only allow infusion from either the primary or secondary and not both at the same time?
Why can you not use a syringe with option 1? I dont understand that.
Option 2 increases complexity and cost by using a bag of saline when it is only needed to flush the med out of the larger pump set. A second pump adds costs.
Option 3 would never be considered on my list because it is so limiting to patient progression toward discharge - trouble with ambulation, etc.
If there is no need for a continuous infusion of fluids and intermittent meds is all that is required, I would use a standard IV set, connect directly to the catheter hub without an infusion pump, regulate with a roller clamp (yes, this means counting drops). It also means that the nurse must return very close to the time the med is finished to prevent backflow of blood with lumen occlusion. This is the tried and true method that was used extensively from the middle 1970's through the early 2000's when we became so dependent upon pumps for everything. The only real reason for using pumps for ABX is nursing convenience and nothing to do with the patient, in my opinion.
Lynn
Lynn Hadaway, M.Ed., RN, BC, CRNI
Lynn Hadaway Associates, Inc.
126 Main Street, PO Box 10
Milner, GA 30257
Website http://www.hadawayassociates.com
Office Phone 770-358-7861
Lynn,
Thank you so much for your very prompt feedback on a Saturday! I wasn't expecting that! Our institution's culture is to always use IV pumps for nearly everything, we almost never run anything to gravity and I don't think I'm going to change that very ingrained culture any time soon. In option one, the primary tubing is on the pump and the secondary tubing is attached to the tubing above the pump, there is no way for it to be on a syringe pump. When hanging an antibiotic (or other med) on primary tubing and infusing either by gravity or on a pump, how would you propose flushing the remainder of the med through the tubing and into the patient?
Thank you so much,
Kristi
We are developing a midline policy. Do any other institutions restrict midline placement to a patient that's been afebrile for 48 hours?
Thank you,
Kristi
I am in the office today working on INS standards. How much does the set actually hold? If you are using a short secondary set, that volume is minimal. What percent of the total volume is actually wasted? How much is too much? What amount should cause concern? I don't know that we have a lot of evidence to answer those questions so it would come down to the professional opinions of the key opinion leaders in your facility - pharmacists, infection prevention, and infusion nurse specialists. Lynn
Lynn Hadaway, M.Ed., RN, BC, CRNI
Lynn Hadaway Associates, Inc.
126 Main Street, PO Box 10
Milner, GA 30257
Website http://www.hadawayassociates.com
Office Phone 770-358-7861
In the case of our primary tubing, the priming volume is 27 mL. If we're talking a 250 mL bag of Vancomycin it's a small percentage, if it's a 50mL bag of magnesium or one of several antibiotics that come in 50 mL bags, it's about half the dose left behind in the tubing. One of our university instructors brought this as a referral to my institution's Clinical and Evidence Based Practice Council a few months ago and we've been trying to work it out ever since. There isn't an obvious solution to all of the various options that I can find. We are assembling a sort of task force with pharmacy, IC and nursing. Any insight you or other experts in the field have is very much appreciated.
Kristi
We are developing a midline policy. Do any other institutions restrict midline placement to a patient that's been afebrile for 48 hours?
Thank you,
Kristi
Our
small infusion dept didnt do a study or debate, we decided what was best for the pt. since the tubing holds at least 20 To 30 mls depending on what is in the drip chamber we flush each med with 30mls Ns by hanging a 50 ml bag of Ns
Our small infusion dept didnt do a study or debate, we decided what was best for the pt. since the tubing holds at least 20 To 30 mls depending on what is in the drip chamber we flush each med with 30mls Ns by hanging a 50 ml bag of NS