Bolusing sdation medications form the syringe pump

[RNNPICU, BSN, RN]

Hi all. I was wondering what other hospitals are doing in the PICU rgarding sedation for intubated pts.

We have a sedation protocol that has been in place for a few years, I don't want to go into detail here.

We are thinking of implementing a new policy that would allow us to bolus medications off the syringe pump. We have done a survey, timed retrieving med from medication pyxis to administration, and surveyed another unit that already has this in practice.

We have specific guidelines on how this would work, i.e no inotropes or pressors can be running in the same line as the sedation medications, it can only be the sedation meds either by themselves or with standard iv fluids, plus a few other requirements

What I would like to know is how are other PICUs implementing this, what are the benefits besides time, easier access, and what hav been some of the issues.

Thanks in advance

[AlabamaBelle]

We have been doing this for several years. We love bolusing off the pump and we are generally very good about documenting those boluses. The big advantage is that the patient doesn't have to wait on us to go to PYXIS, get a witness to witness the waste and the dose and get back to the patient more quickly.

[Mommy_of_3_in_AL..RN]

dont know about PICU, but i have done it in adult ICU..its not really part of our policy, and some nurses look down on it..itisnt something we do often, but there are some patients that it is a benefit to...

[PICNICRN, BSN, RN]

We've been doing it since we have started using the "smart pumps"- I love it! No need to run to the pixys while someone lays on your kid so they don't extubate themselves. Also no more need to take a pocket full of sedation to CT or wherever. Much more convenient and safer for the patient. The only sacrifice you have to make is not running your "drips" with your sedation, like you said. Sometimes, if access is a problem- we still have to run all the drips together and hand bolus the sedation like the good old days.

[tryingtohaveitall]

We've done this for years. We ask a 2nd RN to come in and witness with us that we're entering the bolus in correctly and then also that we return the continuous infusion to the correct rate. Our forms are scaled for this, there's places for two RNs to sign to witness the bolus dose. Much better than the old days!

[AlabamaBelle]

Our attendings are usually really good about giving us good access, ie, cvl, if we need to run pressors. We have learned the hard way not to mix pressors with sedation gtts that you'll be giving pump boluses. We also usually have at least 2 PIVs at all times.

[tryingtohaveitall]

Our attendings are usually really good about giving us good access, ie, cvl, if we need to run pressors. We have learned the hard way not to mix pressors with sedation gtts that you'll be giving pump boluses. We also usually have at least 2 PIVs at all times.

Right. I didn't specify, but we don't run our sedation with anything that might be bolused. This winter, we had a little bit of a pt. whose pressors were running just with their MIVF. The RN changed the rate on the IV slightly and that was enough to cause a huge spike in BP and a drop in the HR. Freaked her out! No harm done to the pt. but it made a HUGE impact on the newer nurses and residents.

[AlabamaBelle]

Right. I didn't specify, but we don't run our sedation with anything that might be bolused. This winter, we had a little bit of a pt. whose pressors were running just with their MIVF. The RN changed the rate on the IV slightly and that was enough to cause a huge spike in BP and a drop in the HR. Freaked her out! No harm done to the pt. but it made a HUGE impact on the newer nurses and residents.

Yeah, know what you mean! Nothing quite like that spike in BP and suddenly that HR craps out. Took only 1 of those for us to get really picky about what goes where!