Common practice for any ER??

[BAMARN09]

Have a question to those of you who work in the ER.. do you hang blood on a patient without it being on a pump even when the patient isnt THAT critical ...What about antibiotics?? Just wanted to ask in school we always learned to put things like that on a pump but I have yet to see that where I work I always try to put my antibiotics on a pump but I have yet to hang blood. another question can you have multiple antibiotics hanging on a patient at one time I generally let one completely finish before hanging the other and if you have normal saline infusing into a patient with an antibiotic do you hang the ns or antibiotic as the primary? I have also seen nurses put the antibiotic on a pump and the piggy back the normal saline without it being on the pump because on our pumps if you need your saline to run in Bolus then it will not do it on concurrent

[BULLYDAWGRN, RN]

regarding hanging blood, we will hang blood infussion via iv pumps. we are aware of literature showing cell damage but our staff hemotologist claimed he was in a study in residency that showed the damage is done when the rate of infusion is cranked up high, so we cant run blood no higher than 85cc/hr. it basically the same damage to the cell as trying to pressure infuse a unit through a 22g.

[imanedrn]

It's against our hospital policy to infuse blood products via pump. We always hang it by gravity, and monitor frequently, adjusting the rate as needed. You need to check what your hosp. policy is, so you learn to do it correctly

I'm curious about a hospital policy that forbids administering blood products BY pump? This seems counterintuitive. Can you please provide more information - just because I'm curious?

>> edit: I see a lot of you have said something similar. I've never heard this before, and I'm incredibly curious now - esp literature that supports not using a pump d/t hemolysis.

TYIA.

[Footballnut]

Hemolysis of blood cells varies by the type of pump used, age of blood cells, rate of administration, temperature of blood cells and smoothness of tubings and walls of pumps used. You need to check with your hospital and pump manufacturer to determine whether your pumps and tubings work well in keeping hemolysis at check. Even then, your hospital policy is your guide.

In a trauma center I used to give units of O neg RBCs as fast as I could on occasion. We're talking 5-10 minutes or less with tubing systems and IVs the size of a garden hose. A pump would only hinder me. Other times a pump is quite useful. I admit, I rarely use a pump. I do the initial checking for reactions but some of my patients are too critical to wait long for the blood. Faster pump rates create more problems for the cells. There are pumps created specifically for blood. These pumps warm just as the blood is in the last part of its journey and gently move it along.

I always treat the little cells like fragile babies whether I am giving them or drawing blood. Strong suction when drawing blood automatically calls for a redraw. If I can't coax them out to me I'm done.

[murphyle, BSN, RN]

Hospital policy here calls for "tiered" priority with pump vs. gravity infusions. Any concentrated electrolyte solutions, any vaso- or cardio-active drug, any chemotherapeutic agent, any sedative or anesthetic agent (propofol, Ativan, etc), heparin and other anticoagulants, vanco, gent, etc. all must be run on pump, and any infusion on a pediatric patient must be run on pump. After that, antibiotics and slow-running maintenance solutions can be run on a pump at the nurse's discretion per equipment availability. I've only ever seen blood gravity-hung in trauma resus, and in those cases it's usually a "tideover" pack while someone is swearing their head off trying to configure the rapid infuser! For medical transfusions, we always run it over pump at 75 mL/hr. I'll have to check our blood policy tonight and get back to you.

As for my own practice, I usually put maintenance fluids on a gravity set unless it's ordered for a slow rate and/or the patient has fluid management issues (i.e. LOL with CHF with fluids ordered at 50 mL/hr - that's going on pump). I pump my antibiotics wherever possible. Frankly, our gravity sets stink for fine-grained drip control, and nine times out of ten the patient already has a pump for something else, so I'll just snap on another arm, program and go. I don't like running multiple antibiotics through a Y-site for the same reasons others have mentioned - even if they are IV-compatible, you don't know which drug caused any possible reaction, and a lot of the same patients who require multiple antibiotics also have poor veins, either from age or from IV drug use. If I'm dumping .9, Cipro and Flagyl all down the line at 125, 200 and 100 mL/hr respectively, I stand a great chance of blowing that poor little 22 we barely managed to sneak into the patient's big toe...

[Footballnut]

I feel the need to clarify.

I definitely use pumps when it counts - for titrating many, many meds, almost all antibiotics, infusions on patients with tricky fluid balance issues, when I want to be told by the machine when it is done, when I know the patient will need a pump on admission, etc. I just don't much for blood. Our pumps are considered acceptable for use for blood but still have a statistically significant rate of hemolysis.

Most of the time it is easier to use a pump. Sometimes it is not. If I need infuse a couple of bags of fluid on a normally healthy patient who needs a little fluid replacement I generally don't use a pump.

[ZippyGBR, BSN, RN]

two main reasons to put a drip through a pump

1. drug / pharmacological/ pharmodynamic reasons

2. volume sensitive patients

and a third relative reason

3. volume sensitive vascular access e.g. poor site, small for required volumes ....