Pressure bag pump flush systems

walkingthecow · Apr 22, 2015

In my unit, they use pressure bags in the OR and we put the transduced line on a pump when they roll out. Problem solved--then we know exactly how much volume they are getting :) I work peds, though, so 3mL/hr adds up faster than it does with adults, and we run it slower based on weight.

MunoRN, RN · Apr 23, 2015

In my unit, they use pressure bags in the OR and we put the transduced line on a pump when they roll out. Problem solved--then we know exactly how much volume they are getting :) I work peds, though, so 3mL/hr adds up faster than it does with adults, and we run it slower based on weight.

You're putting a transduced line in a pump? I'm not sure how that would work since the stiffer tubing wouldn't work in a pump to begin with, but also it wouldn't be usable as a transduced line since the pump would interfere with the continuous fluid column between the patient and the transducer.

MunoRN, RN · Apr 23, 2015

I'm not really sure what you're asking OP. There are a couple of ways of connecting multiple transducers to a pressure bag. One would be to directly connect two transducers to the two ports on a fluid bag, another would be use a splitter that connects usually 3 different transducers (Art, PA, CVP) to a single pressure bag using a single spike. If the pressure bag is at 300, then the pressure upstream of each transducer will also be 300, which will typically result in about 3ml/hr going through each transducer. The only reason that 3ml/hr would be split is if you split the pressure lines below the transducer, which wouldn't be of much use.

suzikjg · Apr 23, 2015

So, if we use a 1 spike with multiple transducer and put it on 300mmHg pressure, it will still give the same exact volume to the patient's line? for example pressure at 300mmHg will give 3mL/hr each lines, right? Please correct me if I'm wrong.

What do you mean by "split the pressure lines below the transducer"? Can you explain it more? Thank you.

chare · Apr 23, 2015

You're putting a transduced line in a pump? I'm not sure how that would work since the stiffer tubing wouldn't work in a pump to begin with, but also it wouldn't be usable as a transduced line since the pump would interfere with the continuous fluid column between the patient and the transducer.

You still have a continuous fluid column from the patient to the transducer. Aside from the fact that it lacks the fast flush device, from the transducer distal to the patient there is not difference. However, unlike the standard set, you connect a standard IV administration set to the proximal side of the transducer.

chare · Apr 23, 2015

So, if we use a 1 spike with multiple transducer and put it on 300mmHg pressure, it will still give the same exact volume to the patient's line? for example pressure at 300mmHg will give 3mL/hr each lines, right? Please correct me if I'm wrong.

Correct.

What do you mean by "split the pressure lines below the transducer"? Can you explain it more? Thank you.

If you had two separate lines distal to the transducer; one line to the ABP and one line to the CVP. I have never seen of heard of this, and doubt that it exists unless assembled on the unit. At best, it might provide a reading of the highest pressure, the ABP. I agree with MunoRN that it wouldn't be of much use, and would likely be a worthless value.

MunoRN, RN · Apr 23, 2015

You still have a continuous fluid column from the patient to the transducer. Aside from the fact that it lacks the fast flush device, from the transducer distal to the patient there is not difference. However, unlike the standard set, you connect a standard IV administration set to the proximal side of the transducer.

I was referring to the idea of putting the pump distal to the transducer, although I don't see how it would work to put the pump between the pressure bag and the transducer since then you would loose the 300 mmhg pressure at the transducer, which is needs to transduce accurately.

MunoRN, RN · Apr 23, 2015

So, if we use a 1 spike with multiple transducer and put it on 300mmHg pressure, it will still give the same exact volume to the patient's line? for example pressure at 300mmHg will give 3mL/hr each lines, right? Please correct me if I'm wrong.

Each transducer allows an intentional small leak to pass through continuously, which ends up being about 3ml/hr. So if you've got 3 different transducers all connected to a pressure bag (by splitter or otherwise) then you'll have three different lines all flowing at 3ml/hr.

What do you mean by "split the pressure lines below the transducer"? Can you explain it more? Thank you.

I was suggesting the only way that you could split that 3ml/hr of flow into fragments of that 3mls, I've never seen pressure lines split below the transducer into multiple continuously open lines, and it wouldn't really work as a transduced line if you did.

chare · Apr 23, 2015

I was referring to the idea of putting the pump distal to the transducer, although I don't see how it would work to put the pump between the pressure bag and the transducer since then you would loose the 300 mmhg pressure at the transducer, which is needs to transduce accurately.

If you use the standard transducer it always delivers 3 mL/hour. The neonatal transducer is designed to be used with an infusion pump, at rates as low as 1 mL/hour.

When we receive patients post op, anesthesia always uses the flush bag. If the patient weighs less than 15 kg we routinely change the transducer. While it is anectdotal at best, I have yet to see any difference in either ABP or CVP.

MunoRN, RN · Apr 23, 2015

If you use the standard transducer it always delivers 3 mL/hour. The neonatal transducer is designed to be used with an infusion pump, at rates as low as 1 mL/hour.
When we receive patients post op, anesthesia always uses the flush bag. If the patient weighs less than 15 kg we routinely change the transducer. While it is anectdotal at best, I have yet to see any difference in either ABP or CVP.

Do neonatal transducers not require an elevated pressure upstream from the transducer?

chare · Apr 23, 2015

Do neonatal transducers not require an elevated pressure upstream from the transducer?

Apparently not. We've used these for the over 5 years I have been in the PICU and have not had any problems. As they are made to attach to regular IV tubing I assume this is acceptable. I am unsure what the infusion rate is it attached to a pressure bag, but believe it is 30 mL/hour.

The next time I am at work I will review the package for a manufacturers recommendation.