I work in pediatrics and I am hearing from many of our families doing home IV antibiotics on their kids that the pharmacies are setting them up with gtravity drip and maybe a dial-a-flow. I have alot of concerns around this and have spoken to the pharmacy that is involved, and they state it is routine and alot of pharmacies practice as such. I understand that the these pharmacies may be in survival mode, but I am wondering about serveral questions:
Are you seeing this trend in home care?
What is the standard?
Is there any standard that regulates this type of practice?
If this is seen as a routine practice, what is the youngest age cut off for it?
Lastly, is this method equally "safe" through a port as well as a PICC?
When I practiced at the bedside, many years back, we did do gravity and the only pts that had infusion pumps were those with central lines. We use infusion pumps noe for all of our meds in the hospital, why should we expect patients/parents to do gravity at home? I have called numerous parenteral pharmacies in the area (greater LA area) and have received different answers, ranging from "they may have a parent or patient push the med to avoid gravity or a pump if the med is ok to do so" to "they would not send out gravity on a young child but on an older child, > 10 years".
Any additional feedback or references is welcomed.
Thank You for your feedback, it is most appreciated.
Linda Tirabassi
Long Beach CA
See Infusion Nursing Standards of Practice #29, Practice Criteria F regarding the choice of flow control devices. There are no hard and fast mandatory rules or regulations about this. As you have seen it varies between companies. A standard roller clamp has the same accuracy rating as a mechanical flow regulator such as a Dial-a-flo. So no greater accuracy with their use. You will need to assess the potential outcomes if a medication infuses too fast. Vancomycin might produce red man syndrome. Most cephalosporins can be manually pushed over a few minutes, so why have the added expense of any type of electronic infusion pump? I think we have gone way too far with using these electronic infusion pumps on all hospitalized patients especially when a medication can easily be regulated with a simple roller clamp. Accuracy rating of roller clamps is up to +/- 25%, but will that truly make any difference for a cephalosporin? It might for vancomycin, aminoglycosides, or amphotericin. There are numerous types of simpler mechanical pumps, spring-loaded or elastomeric balloon pumps used in home care. Their use depends upon the amount of reimbursement and the patient/family needs such as manual dextrity and vision, or the total volume of dilution for the medication based on the child's age. 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