CNA’s restarting IV pump

londonflo · Jun 24, 2021

What I really dislike is when a CNA or RN take the tubing apart to help the patient with removing or putting on a gown. Of course IV gowns are the answer but if the IV was put in after a regular gown was put on, some caregivers think it is perfectly okay to take the IV tubing apart....causing an opportunity for contamination.

DavidFR, BSN, MSN, RN · Jun 24, 2021

No no no! Don't do it.

I get annoyed with care assistants who think they've done me a favour fixing a pump issue. I've signed for the infusion, I'll carry the can. I like care assistants who respect the limitatons of their rôle and just come and tell you when something's up. You sound like a good one, I wouldn't mind working with you. Stand your ground and don't give in. You're in the right here.

Career Columnist / Author · Jun 24, 2021

2 hours ago, MunoRN said:

We allow our CNA's and techs to be delegated the ability to address pump alarms for which they have been trained (this has survived many years of various accreditation, regulatory, and internal review).

This is primarily for 'upstream' alarms and downstream alarms where the pump alarms due to a bent arm with an IV in the AC, the CNAs and techs can remind a patient to straighten their arm and restart the pump if the automatic restart has timed out, if the pump still arms with the arm straight then they must notify an RN.

Agree with this.

It's not really about CNA scope of practice bc CNAs do not have a practice. CNAs can be trained to do a lot of tasks. I've always said I could easily teach a smart child to do most any task an RN does- except think.

It's about proper delegation on the part of the RN and facility policy. The RN must determine that the person has the right training, and then supervise as needed.

**CalicoKitty, BSN, MSN, RN** · Jun 24, 2021

Kinda OT, but the hospital I am working at now has these IV pumps that beep, but when the patient straightens out their arm, the IV restarts and stops beeping. Wish Alaris would do that!

HopefulRN4ever, RN · Nov 25, 2021

good for you! stick to protecting your patients and your license!

SarHat17, ASN, RN · Nov 25, 2021

On 6/23/2021 at 8:00 PM, londonflo said:

What I really dislike is when a CNA or RN take the tubing apart to help the patient with removing or putting on a gown. Of course IV gowns are the answer but if the IV was put in after a regular gown was put on, some caregivers think it is perfectly okay to take the IV tubing apart....causing an opportunity for contamination.

How else can you remove a gown that doesn't have sleeves that snap together? The ED gowns at our hospital are just regular sleeves, so there is no other way to remove the gown without pausing the infusion, safely securing the line (we have green Curos caps for lines) when you unhook it, and wiping the IV port before reattaching the line to restart the infusion.

100% agree CNAs should not be doing this though (it is considered outside their scope at our hospital), it should be a RN.

londonflo · Nov 25, 2021

On 6/23/2021 at 8:00 PM, londonflo said:

What I really dislike is when a CNA or RN take the tubing apart to help the patient with removing or putting on a gown. Of course IV gowns are the answer but if the IV was put in after a regular gown was put on, some caregivers think it is perfectly okay to take the IV tubing apart....causing an opportunity for contamination.

Having been a patient, this really irritates me the MOST. No matter if it is done by CNA or RN. I have said, "look I will help you with this." The IV tubing 'follows the path of the arm'. Oh no, They say this is what we do!. Only takes 30 seconds more to prevent contamination!

My other biggest irritant was when I was in with an NG for an incarcinated hernia. (when I was admitted I had vomited at home a lot totally unexpectedly) and when the NG was put in the ER 2 hours later there was over 1000 ml out. I get to the floor...2 shifts no NG output. . but I am very nauseous, I was going to vomit. The nurse fiddled with the wall suction. About 500 ml came out and nothing more over the next hours. About 3 hours later I was nauseous again. More fiddling with the suction (no output) and Zofran. Then the next shift RN came in and connected the NG suction to another outlet and more than 1 liter out ....ahh peace .The MD came in the morning and said I heard you didn't get any sleep with the NG problems..

I wonder if the first nurse ever reported the ineffective suction to the responsible engineers. I was there 10 more days and no one ever investigated. ..

Kooky Korky, BSN, RN · Nov 25, 2021

On 6/23/2021 at 11:35 AM, Tofumilk said:

I’m a CNA at a hospital. Lately, I’ve had nurses tell me to just press restart on my patients alaris pump when it’s beeping (occluded). Is this okay? The most I’ll do is silence it then go to the nurse to fix the issue. I don’t want to potentially harm the patient by pressing restart.. and the nurse hasn’t seen what’s wrong with the pump and what not. Am I being unreasonable? The other cnas on my unit do it but I don’t really feel comfortable because I don’t know much about IV medications and the pump itself.

Absolutely do not take on this responsibility and liability.

Inform the nurse so he/she can come do his/her job. The devil with them getting upset if you don't expose yourself to liability.

Yes, tell the pt to straighten his arm and keep it as still as possible.

MunoRN, RN · Nov 25, 2021

1 minute ago, Kooky Korky said:

Absolutely do not take on this responsibility and liability.

Inform the nurse so he/she can come do his/her job. The devil with them getting upset if you don't expose yourself to liability.

Yes, tell the pt to straighten his arm and keep it as still as possible.

The liability lies with the nurse delegating the task, not the person the task is delegated to.

And sure, ideally the nurse is always immediately available to respond to every beeping IV pump. But when in reality they aren't, there's the balance between the risks of a potentially long lapse in a critical infusion and pressing 'start' rather than a full, but potentially not indicated assessment of the IV site itself.

There have been arguments that it's always better for the patient to have a lapse in an infusion, even in a potentially time sensitive infusion, rather than to delegate the restarting of the pump with appropriate limitations on the CNA. That's view is straight-up bad nursing practice.

londonflo · Nov 25, 2021

3 hours ago, SarHat17 said:

How else can you remove a gown that doesn't have sleeves that snap together? The ED gowns at our hospital are just regular sleeves, so there is no other way to remove the gown without pausing the infusion, safely securing the line (we have green Curos caps for lines) when you unhook it,

We have had IVs in patient's arms long before we had 'gowns with snaps.' and we did not open up the tubing when changing the gown. When removing or changing the gown, the IV bag and tubing follow the path of the arm. So if the patient removes their arm from the sleeve, the IV bag and tubing goes into and up the gown arm the same way. Easy

3 hours ago, SarHat17 said:

we have green Curos caps for lines) when you unhook it, and wiping the IV port before reattaching the line to restart the infusion

Wiping an IV tubing before reconnecting it just increases the chance for contamination. Curos caps are for sites where a a syringe may go in and must be sitting on the needle site for a long time to be effective.

iluvivt, BSN, RN · Nov 26, 2021

Absolutely unacceptable to restart the pump without assessing the alarm type and troubleshooting the problem.That is the responsibility of the person with the nursing license! Not every alarm is a downstream occlusion either. There are many alarm types.Keep doing what you do now, it's perfect!