Smart pumps = Stupid pumps?

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    We have the smart pumps with the medication library in it, so it tells you the time/dose range for KG. We are required to use the med library rather then ML/HR on my unit. So My vent is this... nurses are putting up let's say a med that requires a hour to infuse on a infant <1500gm. your med amount is 1ML after being diluted. You enter it into your smart pump which says infuse over a hour, so you do. It takes 1ml in tubing before anything reaches your baby. So you are infusing the med into the tubing for an hour, then afterwards nurses are flushing it with 1 ML over 10 minutes. So all the med that was supposed to be infusing over an hour goes in the baby in 10 minutes in reality. Does anyone else have smart pumps like these or seen people doing this?
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    With our system, we have two ways of doing it with our tubing:

    1) The medication is <0.5ml and given over 15-30 minutes

    The medline is approx .5ml (0.4ml + tubing to the IV is 0.1ml). So we push the med through and apply a 0.5ml flush onto the med-line. The 0.5ml flush is then placed on the smart pump over 15-30 minutes. We just do volume over time since 'normal saline flush' is not an option, so it is entered in as .5ml over 30 minutes.

    2) The medication is >0.5ml and given 15-30 minutes

    The medline is approx .5ml (0.4ml + tubing to the IV is 0.1ml). Since the medication is > the distance of med-line and tubing, we have to use another microbore. We attach medication + 2nd microbore and push it through till med hits the tip. Then we attach med + 2nd microbore filled with med to the medline and push the med (usually will be about .2ml left in syringe) so that the medline + 2nd microbore are filled with med and flush. And then attach a 1ml flush to 2nd microbore and put the flush on the syringe pump over 15-30 minutes.

    3) Medication such as Vanco (in a 5cc syringe) drawn up at for example 2.2ml. We put that med on the pump (attached to the med-line) and run 2.2ml over 1 hr, and then attach a flush (0.5ml) in the same syringe size (5ml syringe size) on the pump and run it at the same rate (2.2ml in 1 hr) so the flush runs in at the same rate as the med. It is important that when you do it this way you use the same syringe size as the medication drawn up, since the smart pumps read the syringe sizes.

    This was so confusing to our nurses when we started this in March, but we have guidelines next to every bed-spot reminding us of the proper way to do this. What a headache at first but it made sense after a few times of doing it.

    Hope this gives you an idea what my unit does
  5. 0
    Quote from IvoryLena
    We have the smart pumps with the medication library in it, so it tells you the time/dose range for KG. We are required to use the med library rather then ML/HR on my unit. So My vent is this... nurses are putting up let's say a med that requires a hour to infuse on a infant <1500gm. your med amount is 1ML after being diluted. You enter it into your smart pump which says infuse over a hour, so you do. It takes 1ml in tubing before anything reaches your baby. So you are infusing the med into the tubing for an hour, then afterwards nurses are flushing it with 1 ML over 10 minutes. So all the med that was supposed to be infusing over an hour goes in the baby in 10 minutes in reality. Does anyone else have smart pumps like these or seen people doing this?
    We've recently started using these smart pumps in our unit. After I dilute the med., I push 1 ml. into the medfuson tubing. That displaces the Saline, and the med. is at the entry point of the IV line to the baby. Then I place my Saline flush on the pump, and set the pump at the same rate as the medication was given, ( 1 ml/hr.) with a total volume to be infused of 1 ml. That way, your medication and flush are infused at the same rate.
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    We flush our meds into the line, up to the total priming volume of the tubing. We then set the flush as the medication on the smart pumps. You've got to trick them.
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    We are just starting to research "smart" syringe pumps for our SCN and Peds units. Can you share what pumps you are using please? And how they are working out for you?
    Thanks!
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    sorry, but any pump is as smart as the person programming it. The RN should know that if the micro tubing is 1ml then the pump should be programmed so that the medication is not bolused in in 10 minutes. This is why it's so important to infuse in ml/hr rather than volume over time. If it means using new microtubing so be it. We use smart pumps and love them. Our med library has been completely customized to our needs including the whole medication/flush timing.
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    Our pumps are great in that once the med is finished, it asks you if you want to put a flush on at the same infusion rate as the med was when it was infusing. Takes some of the math out of the equation...
  10. 0
    If the med is the volume of our tubing we push it thru the med tubing and then hang a flush for the time the med should go over.

    There is liablilty if you don't use the library and a med error is made...ours has all kinds of guardrails on it and if we just hang something and it goes in too fast or the wrong amt goes in and they find out we didn't use the library we get written up since that is a safety issue. They can download the pump by the wireless system to see what it was used.

    We have the new Baxter ones and we do find them cumbersome with all the input
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    We are about to get the Baxter smart pumps house-wide but I didn't think they had smart syringe pumps. We are looking for a syringe pump for SCN and Peds because that's how our pharmacy prepares the meds.
    Can you clarify please exactly what pump you are using?
    And, BTW, I believe you are 100% correct about liability if one bypasses the guardrail system.
  12. 0
    The Baxter ones do have a syringe module that you can use with them. It snaps onto the side of it like the pump for regular fluids. They also havee PCA pumps. You can put 4 modules to one brain.


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