I have a quick question when an order for a primary solution lets say NS that is ordered to be infused at 100ml/hr and the volume is 500 ml. When your setting up the infusion pump do you set it up exactly as prescribed or can you set the volume to be infused at 450ml and rate @ 100ml/hr. That would leave you enough time to get a new one right, but wouldn't the pump eventually shut off or doesn't it. I know some nurses during clinical would add a few ml to the rate, they said that the medication had to be infused, does the amount in the tubing allow us to change the rate? I'm confused on this topic.
Jan 9, '13
Yes you are correct about the primary infusion. You want to give yourself time to get another bag once it gets low. It can be time consuming if you let the bag run dry and have to reprime the IV tubing. For instance, if my order is for NS @100 ml/hr and I have 1 liter bags available, I usually set my volume to 900 ml. With the secondary, some nurses will add extra volume. The reason is so the pr gets all of the antibiotic or med. Pharmacy usually puts more in the bag than the actual volume stated for the purpose of priming the tubing. For instance, if I have an order for zosyn that comes in a 50 ml piggy back, pharmacy probably actually put 65 ml in the bag. The extra is to prime the tube unless the line is already primed from a previous secondary. I never add extra volume. If it says 50 ml , that's what I enter in the IV pump. Sorry so long but I hope I explained everything in a way that can be understood.
Jan 9, '13
Yes you can set the volume to be infused just a bit under to give you some time to get your next bag. Most large volume parenterals have an overfill already so most of the nurses I know just set it at about 10-20 ml less that the total volume to be infused (VTBI). If you are using a new or newer volumetric pump it will default to a KVO rate once the VTBI that you set is achieved or infused. The one we use is set at 3 ml per hour unless of course the original rate is lower. It also alerts at the KVO rate constantly until attended to. You need to read the pump IFUs for the product that you have to see if it will default to a KVO rate on a primary infusion
I always had my next bag ready to go hanging on the IV pole. I also did this if the bag was getting low near shift change and reported that off to the oncoming nurse. Your coworkers will appreciate it.
You should never ever up a prescribed rate that is a medication order legally prescribed by a licensed practitioner . So if the rate is to be 100 cc per hour DO NOT up it to 110 cc per hour or EVER try to play catch up if the IV had to be stopped for any reason. This is the same for any overfill in a piggyback so if you are running it at 250 cc per hour and it still has some medication that has not infused just add some more volume and keep the rate the same. You could also add some volume so for example if the mini bag has 100 ml but usually has 10ml overfill..yes you can add that to the VTBI for the secondary. In many cases you do have a say in the rate of infusion for example unless specifically ordered you can adjust the rate of a blood transfusion as long as you do not exceed the 4 hr limit. There are also many IV medications that may have a range for the rate of administration and some that will have a taper up or ramp up as in IVIG administration.
Last edit by iluvivt on Jan 9, '13
Jan 9, '13
Most pumps don't shut themselves off... they just beep incessantly once the VTBI has completed or if there's air in the line. If the ordered rate is 100 mL/hr, you infuse the fluids at 100 mL/hr. In my experience, bags of IV fluid always contained some overflow... so I set the volume at the volume of the bag or a little more. I would let the bag run completely dry but change it out when there was still fluid in the drip chamber. If that ran dry, our pumps had a back-priming option and it took only a few seconds longer to hang a new bag even with air in the line. IV fluid bags in my hospital didn't come in bags smaller than 500 mL (unless the order was straight Normal Saline) and it was pediatrics, so maintenance IVF for a newborn might be infusing at 15 mL/hr... the extra 25-50 mL that's in the bag gives you an extra 2-3 hrs and our hospital was big on pinching pennies so we tried not to waste too much... especially when we knew that most babies would be hep-locked in less than 24 hrs once they started eating.
Jan 9, '13
I recommend you ask your facility Educator to assist you on learning about how the pump works. The advice above is good, but you need to understand the equipment so you can make critical decisions. Happy learning!
Jan 9, '13
For medications I was taught to add in a flush volume because the medication in the tubing needs to get administered too. But I second asking your educator for clarification. Not all pumps have a back prime option and facilities will have different policies in place.
Jan 9, '13
That is why I said she needs to get the instructions for use (IFUs) for the type of volumetric and /or smart pump that is in use. They can also be found on line as well. I know they are long but they often have little cheat sheets and shortened versions that you can carry in your pocket. I like to read the whole thing though the Curlin pump one that I just copied was nearly 200 pages..that one I think I will just skim.
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