Why IV pumps for Central Lines?

[mysticalwaters1]

Hey everyone! I just wanted to understand how come central lines require iv pumps? Is it due to pressure? And this is required for picc line correct also due to the pressure? I've just seen some hang things such as NS and some abx by gravity with not pump is that correct and if not what can it do? If it deteriorates the line how? If one starts a bolus not on a pump is the problem not enough pressure to infuse it without a pump?

[zacarias, ASN, RN]

I would love to do certain abx by gravity but as mentioned above, it isn't the "standard" where I am and I'd be surely reprimanded.

[Otessa, BSN, RN]

Normally if someone has a central-line they are a bit sicker than the average patient-a fluid bolus of not enough fluid could be trouble-

I would want to know that they are getting a certain amount every hour-we have to have ALL IV's on pumps in our hospital..............

[steelydanfan]

Larry, the situation you spoke of on the floors is truly sad, if indeed a dehydrated pt. did not get fluids because a nurse could not trust her eyes and a watch to figure out drip rates.

I was remiss in not including ED in the exceptions, however in my hospital, ER usualy also starts their infusions on pumps, unless it is a code situation.

[doodlemom]

I had a home patient several years ago that needed IV fluids and she had a PICC line. I tried hanging the fluids by gravity and they would not go in. The infusion company told me that I'd need to have pressure behind anything that is going onto a PICC. I'm sure this is different with other central lines because I have hung platelets that have run right into to ports and groshongs.

[StaffEducator]

Any infusion going through a central line including PICC lines must go through an infusion pump. Gravity set ups should never be used with a central line. The reason is that a central line tip ends in the SVC. Intravascular pressure is greatly increase here versus a peripheral line. Once your gravity infusion is completed, blood can back up into your central line and cause it to occlude.

[PMFB-RN, RN]

Any infusion going through a central line including PICC lines must go through an infusion pump. Gravity set ups should never be used with a central line. The reason is that a central line tip ends in the SVC. Intravascular pressure is greatly increase here versus a peripheral line. Once your gravity infusion is completed, blood can back up into your central line and cause it to occlude.

*** I run IV meds into central lines all the time without pumps. The potential problem you not above would be true if there was no MIVF running as well. If you have a MIVF running at, let's say 50ml, then there is no problem of blood backing up into the line. I run the meds into the MIVF line below the pumps. This is standard in our SICU.

Of course fluid boluses are never given with a pump in our unit. Our pumps will only run fluids at 999ml/hour. Hardly a bolus rate. When my trauma surgeon or CV surgeon say he wants a 1L fluid bolus he means now, like in a few minutes, not over an hour.

[PMFB-RN, RN]

I had a home patient several years ago that needed IV fluids and she had a PICC line. I tried hanging the fluids by gravity and they would not go in. The infusion company told me that I'd need to have pressure behind anything that is going onto a PICC. I'm sure this is different with other central lines because I have hung platelets that have run right into to ports and groshongs.

*** Did the PICC have clamps on the line? If not then the PICC likely had it's own internal valves and those would require some pressure. If the PICC had it's own clamps then there is no internal valve and you should have no problem gravity flowing fluids into it.

[StaffEducator]

The issue is not wheter or not the fluids can infuse via gravity. Yes, they will infuse, usually with no issue. The question is, "Is it best practice?" The answer is NO, it is not. When you are busy, especially in a critical care unit, you may not alway be available to change bags once your MIVF run out. And when the fluid starts to run low, or run out, and the pressure in the SVC is greater that the pressure exerted by gravity it will cause blood to back up into your lines. These are guidelines recommended by both INS and ONS.

[PMFB-RN, RN]

The issue is not wheter or not the fluids can infuse via gravity. Yes, they will infuse, usually with no issue. The question is, "Is it best practice?" The answer is NO, it is not. When you are busy, especially in a critical care unit, you may not alway be available to change bags once your MIVF run out. And when the fluid starts to run low, or run out, and the pressure in the SVC is greater that the pressure exerted by gravity it will cause blood to back up into your lines. These are guidelines recommended by both INS and ONS.

*** Naw, I set the pump to alarm before the MIVF runs out. Then the pump alarms and I change the MIVF bag and add volume to the pump. We use Alaris pumps. As I mentioned we run meds in without pumps all the time and for sure blood products and fluid boluses do not run on a pump. The blood backing up problem you worry about is eliminated by the MIVF running. I mentioned the meds are infused BELOW the pump.