Why IV pumps for Central Lines?

SouthernLPN2RN, MSN, RN, APRN, NP · Jul 16, 2006

I'm pretty sure that central lines require a pump due to the incredible potential for injury if a free-flow situation were to occur and also most pumps raise cain if an air bubble appears. Definitely don't want air going in there.

ZASHAGALKA, RN · Jul 16, 2006

There is nothing inherent about central lines that require IV pumps. Pumps are used to control rates of infusion. If anything, central lines allow for better flow and a pump would less likely be needed.

Unless of course, there is a need to limit fluids. But again, that is a 'rate control' issue and not a central line issue.

If control of rate is not at issue, it is not necessary to use a pump. (The caveat being that many hospital policies REQUIRE use of pumps on all IVs.)

I routinely run abt in by gravity. Ancef can be infused over 10 minutes. Even if I don't 'calculate' the gtt rate, 100 ml will normally not infuse over ten minutes with even just a 'glance' adjustment.

I only sometimes use pumps for blood. I was 'trained' not to use them. Now, it's a standard for many.

Not to be jaded, but the requirement to use a pump creates the need for an additional charge. Because it's a 'standard of care' in many places, it's a valid 'charge'. And that pays your salary.

As far as bubbles, it would take a large amount of 'bubbles' to cause an issue with a venous line.

~faith,

Timothy.

Antikigirl, ASN, RN · Jul 16, 2006

OH heck...I take it down to what works for the RN's and their schedules! A pump certainly helps for maintaining rate and being able to check volumes infused with a touch of a button! I like them (even if they are beeping all the darn time..LOL!).

The only med error I have on record was a central line on gravity!...the patient changed positions and the bag went in fast! I checked on the patient after a code situation in another room I had to attend and the bag was gone...it was not set to do that...it was a positional change....and from this day I like the pumps to regulate these things when I can't be there...not that they are perfect or I can depend 100% on them (I trust my own clinical assessments and judgement vs machines)...but at least I know a full bag won't go in with a change in position!

The patient was fine thank goodness...D5 1/2 ns only in a 30 year old pt with no complications...but wow..that could have been easily different!

Crocuta, RN · Jul 16, 2006

The only med error I have on record was a central line on gravity!...the patient changed positions and the bag went in fast!

Mine was a Protonix IV in a central line. It was set up by an LPN with 20+ years exp, she always does those IV's with a non pump set. I glanced at it on my way out of the room and came back in three minutes later. The fluid was *gone*. Pt must have shifted and it just dumped in. Pt was fine, but I don't run anything on gravity on the floor. People scoff at me, but my hide is tough enough to handle it.

Home Health Columnist / Guide · Jul 17, 2006

sounding the alarm for iv infiltration [color=#6f6f6f]file format: pdf/adobe acrobat - view as html

iv pumps have pressure settings. that can be adjusted for an adult or ... when possible, use central lines. to infuse hypertonic, vasoconstrict- ...

www.fda.gov/cdrh/medicaldevicesafety/tipsarticles/nj/0405.pdf

medication safety alert! acute care edition

steelydanfan · Jul 17, 2006

Timothy has a point about infusion pumps being required in many hospitals for all iv infusions, the rationale being that infusion rate mistakes are less likely to occur. The simplest rationale for pumps being mandated for central line infusion is the inference that a patient needing a central line is most likely sicker, more hemodynamically unstable, has TPN or some other med infusing that requires careful rate control.

I can't think of anything infused through an IV line where rate control is NOT an issue. Hence, a nurse who can't be everywhere at once has a backup system to help.The only area is most hospitals to NOT use pumps is in OR, where you have an anesthesiologist at the head of bed to monitor everything continuously.

BTW, the first generation pumps worked off a system where a rubber diaphragm was applied to the line to control rate. These could cause RBC cell rupture, so that is why transfusions were not run on pumps. The newer technology omits that problem.

rn29306 · Jul 17, 2006

The only area is most hospitals to NOT use pumps is in OR, where you have an anesthesiologist at the head of bed to monitor everything continuously.

Or perhaps a CRNA.

steelydanfan · Jul 17, 2006

I stand corrected!

Larry77, RN · Jul 17, 2006

We frequently infuse low risk meds/fluids with drip method, central or no central, usually if we hook up a pump it is because the fluid won't free drip fast enough.

High risk meds are always pump infused however.

BTW I work in the ED but started on the floors where most nurses would never even infuse NS or LR without a pump and would even wait hours to get one from central supply before starting the ordered fluids :smackingf

Pediatric Critical Care Columnist · Jul 17, 2006

As far as bubbles, it would take a large amount of 'bubbles' to cause an issue with a venous line.

Except of course in the case of a child with cyanotic heart disease. Even a small bubble can cause great problems... cerebral arterial air embolism for one.

ZASHAGALKA, RN · Jul 17, 2006

Except of course in the case of a child with cyanotic heart disease. Even a small bubble can cause great problems... cerebral arterial air embolism for one.

My focus isn't PICU.

Of course, with a small child, 'rate control' would take on even more important characteristics. This is why, in children, there is a 2-fold control: a rate controlled pump AND a buretrol or syringe to limit amount of fluids that can infuse EVEN DURING PUMP FAILURE.

~faith,

Timothy.