IV pumps for art lines

  1. 0 Just curious if anyone is routinely using IV pumps in place of pressure bags on arterial lines? We have a new chief flight nurse who is insisting that we put all art lines on an IV pump to run at 3ml/hr, instead of using the pressure bags. Is this common or is she just a little to OCD? Thanks in advance.
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  3. Visit  shadowflightnurse profile page

    About shadowflightnurse

    41 Years Old; Joined Mar '05; Posts: 95; Likes: 20.

    13 Comments so far...

  4. Visit  ZASHAGALKA profile page
    0
    Without some serious literature to support this practice, the phrase you will hear in Court when some artery gets seriously damaged is this:

    "Would a prudent nurse have done this?"

    Find some literature to support this, a facility policy to support this, or refuse to do it. Your obligation is to your patient, not your supervisor. Your practice is guided by evidence based practices and policy, not by your supervisor's whims.

    Demand that your supervisor provide supporting literature or that she ensures that policy support this practice before you yield to 'imprudent' care.

    This is a patient advocacy issue. You have a legal duty to protect your patients from harm. This prohibits you from engaging in activities that are not supported by literature or policy.

    I will say this: I don't engage in flight nursing: maybe there is literature that supports pressure changes in flight that mess w/ pressure transducers.

    Boyle's law (relationship between volume and pressure of a gas at a constant) shouldn't apply to the NS/Heparin in the system, so long as there isn't free air IN THE SYSTEM (and there shouldn't be). But now, the air in the pressure bag that is supposed to be maintaining a set pressure: that MIGHT be affected by altitude driven pressure changes. However, I would point out that as long as there is ENOUGH pressure (by routinely adding/checking volume of air during flight?) on the pressure bag, that pressure is mediated by the transducer (not the pressure bag itself) and so, should be fine.

    There COULD be a valid reason for this practice. But however valid, that reason needs to be supported by literature (research) and policy.

    I have a question though: How do you put pressure tubing on an IV pump w/out adding extention tubing that ISN'T pressure tubing? How does THAT tubing affect the overall pressure on the system?

    ~faith,
    Timothy.
    Last edit by ZASHAGALKA on Jun 5, '06
  5. Visit  ZASHAGALKA profile page
    0
    From: http://www.flightweb.com/forum/viewt...ht=art%20lines

    " * the transducer should be secured during transport at the level of the tip of the monitoring catheter (phelebostatic axis for PA lines, wrist for art lines, etc.)
    * Zeroing only needs to be done when the monitor cable is first connected or if it's been disconnected.
    * Forward flow of fluid needs to be maintained to reduce the chance of clotting the monitoring catheter. This can be done by a pressure bag set well above the highest systolic pressure (typically 300mmhg) or via an IV pump at an appropriate rate.
    * Altitude changes only affect the air in the pressure bag, not the fluid in the system. Therefore, the pressure bag should be monitored and adjusted to make sure it doesn't expand or deflate too much."


    Personally, an art line has more purpose than just for a flight. Changing the system to accomdate an IV pump is more time-consuming and system altering (causing needless opening and closing of the system to change the configuration of tubing back and forth) than just keeping an eye on the pressure bag during flight. This seems like an unneccessary deviation from a standard pressure transducer system.

    Maybe your flight nurse had a bad experience (pressure bag burst in flight?) and is over-reacting to that experience. Shoot, just bring an extra bag with you and be done w/ it.

    ~faith,
    Timothy.
    Last edit by ZASHAGALKA on Jun 5, '06
  6. Visit  ZASHAGALKA profile page
    0
    More thoughts on the topic:

    1. IV pumps can malfunction and/or be mis-calc'd and deliver more or less than you think. How many times have you run in '1000' ml from a bag on the VTBI, only to find 3-400 ml still in that liter bag? I would think that smaller amounts, like 3ml, would cause for even GREATER relative rate errors. So, what happens when this pump - set at 3ml/hr - either delivers none (clotting off the cath), or too much (damaging the artery)?

    2. Is the IV pump above (between NS/Heparin and transducer) the tranducer, or below (between transducer and pt) it??? I would guess below it, because the 'pressure tranducer' would create a feedback setting off the alarm on the IV pump constantly if it were 'above' the tranducer. And if set 'below', you are driving the 'forward flow of fluid' by BYPASSING the design in the system that controls the flow: the tranducer itself. By BYPASSING the design of the system, haven't you created a legal liability?

    If I were a lawyer and could prove that damage happened to my client and that damage is a reasonable result of you nullifying the safety built into the design of a system, do you think I'll win that case?

    3. Which is more time consuming on a busy flight? Checking the air in a pressure bag from time to time (theorectically, only on take-off and landing, as a constant altitude shouldn't continue to affect the system)? Or dealing w/ a squaling IV pump the whole flight, as any given pump is likely to be 'difficult' from time to time?

    ~faith,
    Timothy.
    Last edit by ZASHAGALKA on Jun 5, '06
  7. Visit  hrtprncss profile page
    0
    I agree with what zashagalka said, besides wouldn't the patient get charged the IV pump every day, unneeded cost when the alternative ''could'' be cheaper. But I won't claim to know how much a pressure tubing cost in comparison to IV tubing with a pump per day. I'm trying to think also how they hook up the IV pump tubing going at 3 cc/h. Where is it connected? I mean where does the transducer hooks up? Is there specialized pressure tubing with a transducer AND a cartridge for the IV pump to regulate? How would you regulate the fast flush mechanism when you're flushing the A line after drawing blood, would it have to be flushed manually? Would you set the pump at 999? I'd be interested in the whole set up, if the OP can explain, for my curiosity's sake.
  8. Visit  NotReady4PrimeTime profile page
    0
    In my previous facility we ran ALL our pressure lines on a pump at 2 mL/hr. It was policy. In my current facility we run pressure lines on pressure bags at 300 mmHg for patients over ten kg and on a pump at either 1 mL/hr (CVP/LA/RA) or 1.5 L/hr (art). No rationale.
  9. Visit  hrtprncss profile page
    0
    Quote from janfrn
    In my previous facility we ran ALL our pressure lines on a pump at 2 mL/hr. It was policy. In my current facility we run pressure lines on pressure bags at 300 mmHg for patients over ten kg and on a pump at either 1 mL/hr (CVP/LA/RA) or 1.5 L/hr (art). No rationale.
    Hi I was wondering if you could explain the setup? I'm quite curious as to what kind of tubing it is, you know the whole component of it. Just in case I run into it. I mean when it's connected to a pump, does that mean it comes with a transducer as well for monitoring? Thanks in advance.
  10. Visit  NotReady4PrimeTime profile page
    0
    Quote from hrtprncss
    Hi I was wondering if you could explain the setup? I'm quite curious as to what kind of tubing it is, you know the whole component of it. Just in case I run into it. I mean when it's connected to a pump, does that mean it comes with a transducer as well for monitoring? Thanks in advance.
    We use the appropriate tubing for whatever pump we're using. In Winnipeg we used IVAC syringe pumps and microbore tubing, here we use Alaris SE Gold volumetric pumps and their dedicated tubing. (IMO these pumps are junk and not worth the powder to blow them to Heck. ) The transducer set is separate. We used to use Cobe sets but had a lot of trouble with several lots of them having the vents on the back of the transducer obstructed and therefore inaccurate measurements. Now we're using Edwards transducers, which are not without problems of their own... air in the system anywhere from start to finish, no proper education on using them (:angryfire not the product's fault)... Anyway, we set up the pump and tubing as if we were running any other infusion, except that we attach the pump tubing to the transducer set at the connection where the tubing from the pressure bag would attach, and prime the whole set before putting the cassette into the pump. It isn't a good idea to get too far ahead in this process, as in priming the tubing, putting it into the pump and setting the rate and volume, because the stupid things develop millions of microbubbles in the cassette while it sits idle waiting; these microbubbles cannot be gotten rid of and the pump will NOT run with them there:smackingf . So it's always easiest to just have it ready to prime when you get your call from the OR that the kid's on their way; gives you something constructive to do while you wait. It's a bit of a hassle to do this; when the infants come back from the OR they all have pressure bags, so we have to change it all out. We couldn't possibly reuse any of the items the OR set up... that would only make too much sense. Does it seem to worry anyone that we're changing out these systems at a time when the patient could logically be expected to be UNSTABLE??? Nah. Does it bother anyone that we're wasting hundreds of dollars in supplies (transducer sets, bags of IV fluid, heparin, tubing) every day? Nah. :trout: Sorry... mini-rant over. Hope this helps...
  11. Visit  hrtprncss profile page
    0
    Thanks again for the explanation, very interesting.

    EDIT: One more thing, you said there was a weight limit and then you switch to the regular 300mmhg pressure bag. This might sound ignorant, but I was wondering if it's because of vessel size that's why you use it and there's a weight limit.
    Last edit by hrtprncss on Jun 6, '06
  12. Visit  NotReady4PrimeTime profile page
    0
    Quote from hrtprncss
    One more thing, you said there was a weight limit and then you switch to the regular 300mmhg pressure bag. This might sound ignorant, but I was wondering if it's because of vessel size that's why you use it and there's a weight limit.
    I don't think that's why. I think it's because NICU uses pumps, and when we transfer our post-op cardiac babies back to them they don't want to have to change it over. If vessel size was the consideration, we could simply use the pressure bag at 150 mmHg, and have the same volume of fluid delivered.
  13. Visit  shadowflightnurse profile page
    0
    Thanks for the replies. I have not been able to find any documentation to support putting pressure lines on a pump. Like was already said, as long as the pressure n the bag is maintained at the appropriate level the transducer will only allow 3ml/hr (adult tubing) to flow. The pressure bags we use have a pop-off just above 300mmHg (about 350, I think). If you had a significant change in altitude and the air in the pressure bag expanded (Boyle's Law) then the pop-off would vent any excess pressure. We fly helicopter EMS/critical care and rarely get more than 1000ft off the ground. I think she is just wanting to have things her way and not listen to anyone else's opinion. She can give no justification for the new policy, but just says that's how we will do it. I don't plan on setting up a pump for every art line, I think I'll just deal with the repercussions later

    Thanks again
  14. Visit  ZASHAGALKA profile page
    0
    Quote from shadowflightnurse
    Thanks for the replies. I have not been able to find any documentation to support putting pressure lines on a pump. Like was already said, as long as the pressure n the bag is maintained at the appropriate level the transducer will only allow 3ml/hr (adult tubing) to flow. The pressure bags we use have a pop-off just above 300mmHg (about 350, I think). If you had a significant change in altitude and the air in the pressure bag expanded (Boyle's Law) then the pop-off would vent any excess pressure. We fly helicopter EMS/critical care and rarely get more than 1000ft off the ground. I think she is just wanting to have things her way and not listen to anyone else's opinion. She can give no justification for the new policy, but just says that's how we will do it. I don't plan on setting up a pump for every art line, I think I'll just deal with the repercussions later

    Thanks again
    Demand that it is a written policy and not an 'unofficial' policy.

    With a written policy, YOU have protection in Court: it was your facility's decsion to use the pump; not yours.

    I also think, since there is no reason to use a pump when the transducer is DESIGNED to provide the same functioning, that charging for a pump is fraud. If it's a medicare pt, it's MEDICARE FRAUD.

    I would not follow this as an 'unwritten' policy. If questioned, I would say that I have no official policy to back me up, and I felt that it would be fraud to charge for unnecessary equipment.

    ~faith,
    Timothy.
  15. Visit  NotReady4PrimeTime profile page
    0
    As is said, we have no real rationale for doing things the way we do them, and trying to elicit any kind of reasoning is like pulling teeth. Our unit says it's part of the 100,000 Lives campaign, but we're only taking selected bits out of each of the bundles and disregarding a lot of the rest. Frustrating. I agree with Zashgalka... make sure it's an official, written and approved policy to protect yourself.


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