Before anyone jumps on my case, let me preface this story by saying I immediately questioned my preceptor and corrected my to-be questioned issue. Now:
I had an alcoholic come into one of my MICU beds. Among other problems, he had fairly low K and Mag values. I went into lexicomp, looked at the IV compatibility, and saw that there was no apparent problem with running K and Mag concurrently through the same line. I piggybacked the K+ to run with the NS at 50 that was already on the Plum pump, and hooked the mag up distally to the pump in the port close to the patient. My understanding of both pumps and high school physics (which was a long time ago, granted) taught me that if the pump isn't running, nothing is coming out of the tip of the line. If the pump IS running (at say, 50?), then anything that's open and infusing into that port (if the bag is even with the line) is also running at 50 ml/hr, as the flow is restricted by what the pump is pushing into the patient (hence why the pump goes "DISTAL OCCLUSION! ALERT! ALERT!" when you try to push anything into that port while it's running...because you're increasing the pressure so much that it's restricting flow and sensed by the pump cartridge/pump/whatever it is that senses that). Since I knew the mag and K could both run at 50 an hour, I hooked it up to that distal port that's PAST the pump, and immediately went to question my preceptor if this was ok. After a quick "No!" and slight freak-out on both our parts, we returned to the room, and the mag was disconnected and reinfused through its primary pump that I went and found (within about 45 seconds. My preceptor said running the mag into that line was running it free-flow (which, considering it's mag, is incredibly dangerous). I explained my thought process, yet still received a scathing write-up on that week's orientee review. I thought that was a bit harsh, considering I immediately left the room and asked, but I was more concerned about whether my line of thinking was correct.
When forming you're answer, please don't lecture me about the dangers of this. I know how dangerous this potentially was, which is why I asked so quickly when i left the room. Should I have asked her first about this? Yes, but I was in the room already, and I truly thought I was right. I've already been lectured about this, I promise. I'm just curious as to whether something in the free flow port, if it's hanging open, is running at the same rate as whatever the pump is infusing in. Thank you all for your answers in advance!
Apr 15, '12
Central line or peripheral?
Apr 16, '12
we give mag IVP during codes and emergencies.
I don't understand though, was the Mag not programmed into the pump at all?
Apr 16, '12
The IV pump is only going to control the rate of fluid that is actually going through the pump. If you connect another IV fluid to the IV after the pump, the pump does not control the rate of that fluid.
Pumps will only control the rate when the IV tubing is in the pump and programmed.
Apr 16, '12
This is a really, really good question. I always learned that you have your primary bag going through the pump, and that any secondary line needs to be conected to the cartridge port, therefore needs to be programmed in as a secondary, or can be programmed in as a concurrent fluid. I do not do IV pushes, but I have observed that the pump is usually turned off and the the push in done in the port on the line as you describe, then fluids are turned back on. I would conclude that the pump controls only from the cartridge down, therefore, anything you hang to gravity in a port below the cartridge is a free flow but has around 3 or so inches of the primary bag's fluid diluting it as well. I can also see how one could assume that you could add a line to the port on the line below the cartridge. When I prepare my IV fluids and tubing, I always add a connector to the top opening in the cartridge, as then if I do need to add some sort of secondary it is easier to do so--and will remind you that this is where it goes. Most of what I have seen in ETOH cases, a banana bag is hung, which contains all of the vitamins that normally are diminished in ETOH patients. Then you are not having to continue secondaries that are each individual vitamin supplement. With that all being said, if you counted drips and calculated correct flow of the mag, although not ideal in procedure, really would not be that much different than if you put it on a secondary or concurrent--although the write up may have more to do with the procedure in your school, and if you opened the bag wide, or drip counted it. Thanks for sharing this, as it really is an interesting concept, and a learning moment.
Apr 16, '12
The two rates are unrelated to each other.
The rate of the pump is governed by the pump.
The rate of the bag connected distally is controlled by
- Height of the bag
- Drip chamber
- Tube size
- Length of the PB tube
- Length of distal tube
The rate of the pump is not at all controlling the rate of the PB line.
Anytime you have a question, get it answered BEFORE you start running the med.
The write-up is valid, IMO.
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