Alaris pumps

KatrinaPM · Oct 19, 2006

Another trick I learned to fix the Air in Line issue was to clean the 'eye' part of the alaris pump with alcohol. When it's dirty is also senses air in line. :)

stamp4me · Aug 31, 2007

would like to know what is thought of the Alaris pumps since they upgraded them?

Pediatric Critical Care Columnist · Aug 31, 2007

We don't have the upgraded version. Our pumps are about 8 years old and will only be replaced when enough of them are dead that we can't function without new ones. We're having a ton of trouble with our Alaris Asena syringe pumps these days, with "excessive plunger deviation" the most common and most problematic. We run our pressors on these pumps and the only solution to that particular problem is to turn the pump off, reset the plunger and turn it back on. I haven't timed it but I'd guess the whole reset takes about 2 1/2 minutes, enough time for baby on norepi to arrest...

Floyd Nightingale · Mar 30, 2011

The system I work for recently went to the Alaris pumps after ditching the ones made by Baxter. If you've used the Baxters you know what a problem they were but as bad as they were, I want them back.

The air in line thing is incredibly frustrating. I've wasted of lot of medicine, sometimes very expensive medicines, trying to clear the lines. Tonight I spent the better of an hour trying to get a potassium infusion going, and that's not the first time. I expect it won't be long before we have a sentinal event because of these pumps.

An does it really have to alarm when I shut the door? Hello?, I'm standing right here. That's how it got closed.

Another thing is they told us that pumps were specifically programmed not only for our system but for specific departments. Ours are set up for the ER and ICUs, I work the ER, but I noticed that at the community satellite ER where I pick up overtime the pumps are set up wrong. At the main campus the potassium piggybacks are 20meq in 250ml and the pumps at the satellite are set up the same way but they use a 10meq in 100cc concentration, so it's wrong.

Otherwise they seem to work pretty well if you can get them going, and they're much easier to program than the Baxters were but they're not much use if it takes an hour to get a drip going. I can't wait until I have to give pressors to a dying pt.

Pediatric Critical Care Columnist · Mar 30, 2011

This is a pretty old thread, originally from 2005. In the interim our unit has repalced all the Alaris Signature Gold pumps we had with the Alaris Smart Pump systems that you're describing, Floyd. We have many problems with them too. I'm not sure why they had to program them to require that we scan our IDs before we can do anything, but it creats havoc at certain times, that's for sure. The additional step of having to enter the patient's Universal Lifetime Identifier when first setting it up is a pain in the you-know-what too.

Air-in-line alarms were supposed to be fewer with this pump and they're supposed to have the capability to propel the air through so that it can be caught at the first in-line port, but of course that's not reality. My preferred method for getting rid of air causing alarms is to pull some of the IV fluid out of the bag or buretrol, attaching the syringe on the port below the problem, pulling the impeller tubing out of the pum and gently flushing backward up into the buretrol or bag. Flushing too fast, or pulling fluid down the fluid path creates turbulence and even more air. In a pinch I've just twisted on a prefilled syringe of saline and flushed up with that. We NEVER run pressors or any vasoactive meds on them because this pump too has the pulse-and-pause delivery that causes swings in BP. We don't even run anything into the same lumen as pressors on these pumps, and in smaller babies, not even in the other lumens of the same line. It's just too unpredicable.

hubcaps · Apr 4, 2011

Can anyone explain the pressure limit settings? My hospital switched over to them in December and alaris failed to inform us of this option. I had a kid on a heparin drip and the default pressure setting was not able to detect an occlusion in the line. The kid later on got a clot in his shunt. Fortunately, they were able to stent it open. Later on, our unit found out that you can change the pressure limit for the alarm. Are there guidelines as to what the pressure limit should be?

This was actually the second incident. I was quite mad that management did not inform our unit when it first happened (probably because nothing happened).

I too find the air inline frustrating. We have needed our pharmacy to overfill TPN because we keep wasting it when we pull air from the ports. Our old baxter pumps didn't have as much issues with air.

Pediatric Critical Care Columnist · Apr 4, 2011

The pumps have a default pressure limit on them. They can be increased or decreased by the user. For example, if you're running TPN through a PICC on a tiny infant, there's going to be a lot of resistance, so you'd want to increase the pressure limit so that it's not alarming all the time. I usually increase it by one increment at a time until the alarms stop... and of course assess the line frequently. Another situation we see is when running heparinized saline into an arterial line (at 1.5 mL.hr) and the baby is hypertensive. It would seem that in your instance, the limit should have been lower so that you could assess back pressure more easily.

As for wasting TPN, see my previous post for a tip on how to reduce that. We run ATGAM and rATGAM on ours and we can't afford to waste a drop of that!

hubcaps · Apr 4, 2011

As for wasting TPN, see my previous post for a tip on how to reduce that. We run ATGAM and rATGAM on ours and we can't afford to waste a drop of that!

Unfortunately that won't work with our setup. There is a disc below the chamber that is connected to the spike which prevents back flow.

Pediatric Critical Care Columnist · Apr 4, 2011

There's a way around that too. The secret with that situation is to use a large syringe and to aspirate your fluid very slowly so you don't create turbulence in the drip chamber and make more bubbles. Make sure there's at least 50 mL of fluid in the buretrol. Close the stopcock or clamp off the line near the patient to prevent free flow. Vigorously swab the side port below the air and attach your syringe. Open all the clamps between your syringe and the buretrol. Hold the syringe as near to vertical as you can then slowly aspirate the fluid into your syringe. Once all the air has been aspirated, along with a generous portion of fluid, put the tubing back into the pump and close the latch. Remove the syringe from the port then vigorously swab the med port on your buretrol. Return the fluid in your syringe to the buretrol and open all the clamps. Restart your infusion. It takes about 5 minutes, which isn't ideal and you wouldn't want to do this with any fluid driving a pressor, but usually TPN is run on its own.

Some tips on reducing the amount of air in the system would include ensuring that your fluid bags are never sucked completely dry and that the vent on the buretrol be open, especially if the roller clamp to the bag is closed. You don't want a vacuum because when you release it, BINGO... air. Another thing I've found helpful is to hang your buretrols as high as possible above the pump because air rises. As those microbubbles in the fluid start to coalesce they're going to rise. If you've got a dependent loop in your tubing it's going to rise along the shorter portion of the loop - the one closest to the pump, since it can't flow back through the backckeck valve - and get pulled into the air sensor. If you can't raise the top of the pole high enough, then loop the piece of tubing that's between the bag and the buretrol over the hanging loop/hook. See if those tips help.

MegNeoNurse · Apr 5, 2011

I agree with other posters who have had problems with the pumps and dialysis. In our PICU, the bedside nurse cares for the patient and the machine if they are on SLED (CRRT). I've found the error "channel error" when the arterial pressure gets to be -300 + and the machine won't pump. Otherwise the usual "air in line" error but that's easily fixed. I like the Guardrails feature with the drips and drugs as it's a nice "triple check" for some drugs. Haven't had any problems with the drips, and on drips in syringes it's nice that the module warns you before your syringe is out!

Pediatric Critical Care Columnist · Apr 5, 2011

Where are you connecting your infusion line on your CRRT circuit? That might be your problem. Are you using citrate or heparin anticoagulation?

MegNeoNurse · Apr 7, 2011

The last kiddo I took care of was on Heparin SLED (CRRT). His pre and post fluids were connected in at a stopcock hooked up next to the respected arterial or venous port. I've found that I have had far less difficulty in general with Citrate SLED. Sure, it's a bit more work... but I've found I don't have to emergently return patients as often as if they are on Heparin SLED.