[corks]

Hi Guys,
Yet another question from me!!!! Can anyone tell me what the current reccomended pressure limits are for infusion pumps? we use Graesby's and we have low (77-105mmHg), med (200-240 mmHg approx), high (400 mmHg approx). Do you use different settings when administrating TPN?
We recently had an extravasation injury with Dex 10% and the pump was at a medium pressure settingIs there any research on pressure settings??
What type of volumetric or syringe pumps are suitable for neonatal use????? Sorry to bombard you loads of questions but the staff who were involved in the incident were very upset and I have been asked to review the circumstances and make reccomendations. So I would be mega thankful for any help. Ta

[dawngloves]

Slippery slope. If you set the alarm for low pressure it is going to beep everytime the kid lifts a pinky. Too high and the kid will have a liter of fluid in him before you know it. But how many of you have had an infiltrate and the pressures weren't even near to going off, no matter how low?
I never trust the pressure readings. I trust my eyes and my fingers.

[texas2007]

Originally Posted by dawngloves

I never trust the pressure readings. I trust my eyes and my fingers.

Ditto. The only time I pay attention is when the thing is beeping, but it's usually beeping bc of a positional problem. 9 times out of 10, the PIV is already out before any type of pressure limit is reached on the pump.

[NicuGal]

That is a tough one. We use Alaris and they are set anywhere from 25-75 unless it is a one french picc then it is over 100, esp with IL infusing in it

Oh, I had a bad infiltrate last week....I haven't had a kid with one like this in ages . 1.2 kg kid, no picc of course even though the kid was sick and not eating, IV running at 9.5ml/hr into a precarious foot vein. Though, hmmm maybe I'll retape it, didn't do it because I didn't want to risk pulling it since he was an awful stick, was 1/2 hour late reading it and his leg looked a bit puffy between the tape, took the tape off and his leg started to swell....insert swear word here. Detachol the tape and opsite and the skin come off the top of the foot and low and behold it is infiltrated. I just couldn't believe when I took that tape off how his little leg swelled from the fluid! So, in one and half hours there was at least 14 mls of fluid in there! And guess what, the pump never ever went off, read the same thing pretty much all day, limit set at 25. I wanted to cry when I saw this! Sometimes I think that maybe they were alarming for another person before me, they just kept resetting it and then when it was going into the tissue the pressures went down because the fluid was dispersing out. I really hate when people tape IV's so that you can't really see the site and then put so much tape on that you really can't see what the extremity looks like

For meds and drips we use SmartPumps....they are awesome!

[corks]

Don't beat yourself up about it. Have just been reading some articles about it and this is a quote from one of them 'it is a common misconception that occlusion alarms on infusion pumps will signal infiltration. In fact, pumps will alarm
only when downstream pressure reaches a specified value, and elevated pressures resulting from infiltration are typically far lower than occlusion alarm triggering levels. In infants, monitoring of inline intravenous pressure is not useful for predicting or detecting infiltration of peripheral catheter sites. Resistance measurements may be useful in detecting infiltration injuries, but
are not widely available and at present there are no commercially available infusion pumps that can reliably detect infiltration'

[SteveRN21]

Originally Posted by corks

at present there are no commercially available infusion pumps that can reliably detect infiltration'

Exactly. That is why every NICU nurse needs to actually walk over to the isolette or RW and physically lay eyes and a finger on that IV site every hour.

We use Sigma smart pumps. I used the Alaris pumps at my last unit, and liked them WAY better. The Sigmas can't run slower than 0.5cc/hr. So our IL has to run on our old Baxter pumps. So we usually have 3 types of pumps at each bedside.

The nice thing about the Sigma pumps is that they are tiny and weigh around a pound, compared with the hefty alaris pumps.

[elizabells]

I just visited the PCICU the other night and EVERYTHING is on Alaris pumps... they're so pretty! Oh, and I'm sure they work well too, but... pretty!

[SteveRN21]

AND you can snap up to 4 syringe pump modules right on the alaris pump....

[corks]

You guys should become sales reps for Alaris - you've sold me. Will access there web site and see what they have to offer here in the UK Hey might even get a free lunch out of it!!!!!!!!

[NICUnrs]

We recently switched to the Alaris pumps...love them!!!