Drip line change policies??

Pediatric Critical Care Columnist · Aug 30, 2011

I've seen all of the variations you've listed except swapping out the whole pole. The safest method is to double pump, one infusion at a time with enough time beween swaps to allow the patient to restabilize. Second safest is to start the new pump and then switch out the tubing quickly. Perhaps the most dangerous is to simply change the syringe. If it's done too slowly the kid's BP is going to plummet. If it's done too aggressively - shoving the plunger driver up against the plunger too vigorously, even with the stopcock or clamp closed - there'll be a huge spike and then a plunge. These all apply to vasoactives and anything driving vasoactives.

Our unit recently purchased a large number of new "smart" syringe pumps and we're in the process of retiring the old (simple-to-use, set-the-rate-and-go) ones. With these pumps we have little choice but to double-pump because there are too many steps to restarting them after a syringe change to allow it to be done smoothly. There's also no early warning that the syringe is nearing empty. If I had any influence over practice on our unit, I'd make it mandatory to double pump, with a clearly-written procedure for doing it correctly. I'd make it standard practice to set a volume to be infused of 5 mL less than the volume in the syringe with every syringe change to provide that advance warning and avoid the holy-****-my-epi-'s-empty emergent syringe changes. And I would re-educate the staff about mixing up ALL their drips right at the beginning of the shift when setting up for an admission they know won't be arriving until many hours later. They could save that part of the setup for a couple of hours later, and stagger them like I do so that the person who will have the patient 3 days later (99% of the time it's NOT them!) isn't going to be trying to change 15 lines right at the start of their shift. I like to work smart, not hard!

umcRN, BSN, RN · Sep 2, 2011

In my peds cardiac icu if a line with pressors needs to be changed the whole line is swapped out at once by running the complete setup on another pole for up to a few hours and then switching over quickly

picurn1972, RN · Sep 13, 2011

This is PT based. An entire pole change out is required to let drips run thru tubing so it will mimic the same infusion on the other pole. We do this with 2 rn's scrubbing and reconnecting almost simultaneously. This prevents really sick babies, under 1 that are on crrt from coding. Other kids aren't as sensitive to these gtts, older kids, and you can change out to the same pumps by building the knew line and switching over. This is safe practice but once again clinical judgement. These kids have primary nurses on our unit and they know their patient. They know how they respond. Having worked with adults prior we never set up an extra pole just switched. You should have a standard guideline to building the line, we build on sterile drape attaching all gtts carrier and or med line. This is on a surface wiped with chlorahexadine wipes prior to the draping. No laundry cart, pt bed etc. Only bedside table or nurse server. This reduces cvc associated infections and has been found to be the best practice. Our facility has research and articles that support these steps. then you place new sterile drape at cvc site. Hope this helps. The pole/individual/pump issue should all be determined by the RN because the new pole set up is very time consuming and if it is not necessary the RN could be doing tasks that are more beneficial for the patient.