Pump vs. Gravity

[nurmac]

Can't seems to get responses in IV nursing so I will post here...

I have been working in oncology/hematology part time for the past 5 years. I work in an infusion room. When I first started I was amazed that they had NO pumps. All chemo and biologics are run via gravity only. Is this unusual??? If you give chemo and biologics do you use a pump or gravity?

[nurmac]

It is the setting that you are in that makes this practice allowable and understandable.. There is no current standard that states that you must use a pump to deliver chemotherapy unless you are giving a continuous chemotherapy. So if the patient is receiving 5FU over a week(s) they need to be using an ambulatory pump. If it is continuous vesicant chemotherapy...this must be give though a central line.

I think that they probably are trying to save money as the pump will cost as well as the tubing is a bit more expensive than gravity tubing. This puts the safe administration all on the nurse with little or no protections in place. I am personally fond of the protections but make no mistake either way the responsibility is all yours for the safe administration of the chemotherapy and you will have to keep close tabs on the rate and site. What I see as a more important safety feature that may save you from a medication error or even a fatal error is the use of medication libraries in smart pumps. This allows you set up libraries in clinical areas with soft and hard limits for drugs and drips so if you input a dose that is incorrect that could harm the patient it will alert you to the input error. Does the facility have access to smart pumps because you can advocate for their use with some really good arguments !

In the meantime you need to be hypervigilant with setting the rate and monitoring it and make sure you poles are set at least 3 feet above venipuncture sites and not much more unless you need that (decide this case by case) . You will get more consistent rates this way.

Ask for dial-a flow type tubing if you are not already using these.

iluvivt....great information I no longer work at the facility but I finally have an answer. Thank you

[sistrmoon, BSN, RN]

I've worked Onc for 6 years, 2 different hospitals. Everything except platelets is done on a pump.

[mluvsgnc]

Thank you for the rationale, iluvit. I agree that either way, it comes down to the human(s) initially calculating the correct dose, regardless of whether it's gravity or pump administered.

[iluvivt, BSN, RN]

You are welcome!