OK, so I'm a new nurse & run into this problem all the time. Please help me to understand the best way to fix the problem. Here's the scenario:
I'm coming on shift & my saline locked patient is receiving an IV antibiotic via the plum pump. The prior nurse setup the tubing with the antibiotic (let's say zosyn) with a primary IV plumset (which requires about 20 ml's to prime). The zosyn is attached to a 50 ml n.s. bag but once she has primed it, there is no longer 50 ml's left in the bag. She then sets the pump to run VTBI of 50, which causes the line to be left dry all the way down to the cartridge. Now the cartridge has air in it. The chamber "frequently referred to as Minnesota" (because it is the shape of the state) has air in it.
Now I'm on shift & need to hang another dose of Zosyn. The cartridge won't run because there is air in the chambers. How do I get the air out of the cartridge chambers & still use the same primary plum set?
I think I understand the concept of backpriming when you have fluids on the primary & the Abx is on the secondary, but this is not the case here.
Any help would be greatly appreciated!!! Thanks so much.
May 8, '14
First of all forgive me because I'm tired and using my phone which I don't usually answer on but... Easiest thing to do is to grab another bag of maintenance fluid ( a 500 cc bag) and squeeze the spike chamber then just back prime the fluid back into the secondary tubing. If you're still getting a proximal occlusion warning the disconnect the secondary (placing a sterile cap etc) an use a 10cc syringe to the secondary port, take the cartridge out of the plum pump, pull the stopper on the back to the open position and then pull on the 10 cc syringe until the air bubble comes out. As always keep everything sterile and try not to be miffed that your coworker was only concerned about their own time management and no one else's. Voila!!! PS...better to not have the tubing connected to the Pt at the time but I haven't ever seen a problem with nurses leaving it connected when doing the syringe trick...but hey
May 13, '14
I would do what the previous poster said - grab another bag of maintenance fluid, squeeze the chamber, and back prime. And I would probably set VTBI to like 30-40 so I have time to grab another bag.
May 17, '14
This is while you always run your piggy backs on secondary tubing as they are designed to be run. I always set thr pump for kvo of maintain ex fluid so I will have a few mins to get in there once the antibiotic is done.
as far as using the old tubing, just completely take it out and reprime pretend your starting from scratc
May 17, '14
I agree with PP about getting air out of the chamber. As far as how to prevent it, I would only program the pump for ~20ml for the saline; just enough to clear the tubing and chamber. Where I worked, we also only used 250ml bags.
If you get air in the chamber because your primary ran dry, you can empty most of a 10ml flush and put it on the B port. Then, spike a new bag on the primary. Backprime. The air in the cartridge will be pushed into the 10ml syringe and you're good to go.
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