Am I allowed to push the button?

[Kayceee]

I work as a patient care assistant in a hospital in Ohio. I vaguely remember job training telling me to never push the restart or silence button on a patient's iv pump. The reasoning being I'm not licensed and it is not a task that can be delegated. (In other words, illegal) However, I worked under a nurse who insisted I can do it if I know why the pump is beeping. I admit to knowing what the problem was and fixing it. (Unbend patient's arm) however, I refuse to touch button. Am I allowed to touch the button or not?

[adventure_rn, MSN, NP]

I wouldn't. Part of the issue with restarting the pump is that you have to assess the patient (and pump) to fix the problem. Assessment falls outside of the CNA scope.

Here's an example. Let's say your patient's IV keep alarming 'occluded' because the patient keeps bending his arm (like in your scenario). However, there are a lot of other things that can cause the 'occlusion' alarm, like infiltration. In this scenario, it could be that the 'occlusion alarm' is due to an infiltration. You continue to unbend and restart the IV like the nurse delegated, and while the IV continues to run it could be pumping vesicants out into the tissues (which can cause people to lose limbs and require plastic surgery).

In theory, every time the nurse unbends the patient's arms and restarts the fluids, she should be assessing the site for any other complications (like infiltration). As the PCA, you haven't done an assessment on the patient, and have no baseline to tell you how the arm ought to look, or if it's getting worse.

You can always check with your manager; if he or she says no, then you can just tell the nurse who is bugging you that you're following the protocol. If you did decide to restart the pump, I'd be sure get very clear delegation instructions from the nurse (i.e. unbend the arm and restart, if it continues to ring occluded notify the RN; if the occlusion alarms are happening more frequently, notify the RN). You aren't technically allowed to assess, but I'd try to notice if the site is changing (i.e. becoming more swollen and pale) and let the RN know.

[akulahawkRN, ADN, RN, EMT-P]

While this is not "perfect" practice, I will delegate the actual pushing of a button only under very specific circumstances and only in my presence so that I can actually observe the button being pushed. Otherwise I do NOT want anyone pushing a button for any reason whatsoever (unless it's a PCA and the patient is pushing the button themselves as they've been taught). Of course there's the qualifier that if the person is qualified to push said button on their own license, that's OK but I want to know about it. I don't care if you're the attending MD/DO, if you push a button on the pump, just let me know because that helps me keep track of issues with the pump.

[JKL33]

Whether it is legal for PCAs in Ohio to push a button on an IV pump is irrelevant if your employer has informed you that they have not hired you to perform that function and has explicitly told you that you may not do it.

So no. You clearly are not allowed to touch the buttons in your employment situation.

If you are concerned that your training-related recollections may be off, ask your supervisor for clarification. A staff nurse or even a charge nurse may/should/probably does know the kinds of things they can legally delegate to you in your state, but we aren't always completely well aware of particular instruction you were given in orientation - which is a different matter altogether.

Asking your supervisor also gives your employer the opportunity to re-evaluate/change a policy if doing so makes more sense, or uphold the policy they've already established if that is what's best.

[Wuzzie]

You are absolutely correct in your refusal to silence the alarm on the IV pump. The only people who should be pushing buttons on IV pumps are those that have the training/responsibility to assess the IV site and intervene should a problem be found. You have excellent critical thinking skills. Keep up the good work!

[akulahawkRN, ADN, RN, EMT-P]

I should add that if your employer has explicitly told you that you may not, under any circumstances, push any pump buttons, then you are to 100% follow that instruction. Even given my above post, if we were working together at your hospital, I would not get irritated or whatever if you were to refuse to push the button because of your instruction by your employer (which would be the same as mine in that case) and the rules would apply to me in that I wouldn't be able to delegate that to you.

Also just to be perfectly clear, the intent of my above post isn't to delegate the task to another person, it's to use their hand to reach a button that I cannot push myself for whatever reason (usually my arms aren't long enough) and that actual activity would be directly supervised. This is specific to silencing a beeping piece of equipment. I won't direct the push of the silence button until I've noted why the alarm activated. Once I know that, there's no further need for continued beeping. I'll still investigate the problem and take corrective action as needed. In the case of a pump, I'll only ask someone that is authorized to manipulate pump settings to actually restart the pump.

As I see it, it's like using a defibrillator. Sure, I can ask someone to silence the darned thing but it's a whole other thing to manipulate settings and push the "spark" button. Besides, once the equipment is "in alarm" you won't necessarily notice that a new problem has developed if you don't acknowledge the first alarm.

[ComeTogether, LPN]

I have, on occasion, asked my CNA to touch the "silence" button if I've been told of an IV finishing and haven't been able to get in there at that exact moment. That being said, however, I would never want a CNA to decide for themselves whether or not to touch the machine and I really should't even be asking them to hit silent.

[humerusRN]

The techs I work with will silence an IV, but then alert me that it is beeping.

[FeliciaRNCPN]

This is a tough one. While it would be "convenient" for the techs I work with to push the button, I error on the side of caution. I usually just ask them to silence it while they can inform me. Then I can assess the patient and see it there is another issue at hand. Sometimes it needs to be taped because its kinking or there might be an infiltration like others have mentioned.

[applewhitern, BSN, RN]

I certainly wouldn't "push the button" or attempt to re-set an IV pump! Would you even know or recognize if there was a medication in that IV fluid? I would leave that up to the licensed nurse to handle.

[RNikkiF]

Even if you know what the problem is, it is outside of your scope because it requires assessment. You can always straighten the patient's arm and if the pump doesn't stop beeping, then notifiy the nurse. You just don't want to get yourself in trouble. I know it seems like a simple thing, but what if there is something really wrong, even if it looks like a simple problem? You could be opening yourself up to some serious trouble, not to mention potential harm to the patient. If the nurse gets frustrated that you won't do it, just let her/him know it is beyond your scope. If they continue, take it to your manager and let them handle it. You can never go wrong by following your scope of practice.

[RNikkiF]

Honestly, I don't really like it when other nurses touch my pumps. I appreciate their intent to help, but I need to know what's going on with my patient. If my pump is beeping, just call me, I'll handle it.