Resetting IV pump volumes: Dangerous or common safety practice?

[aepoisson]

Just wanted to know what other NICUs are doing out there about resetting your IV pump volumes for your main fluid line. We have a practice of only inputting 2 hours worth of fluids on our main IV pump which is TPN or dextrose clear fluids. At the end of 2 hours, the pump alarms and we have to reprogram the pump for 2 more hours of fluids. This is the only pump we program that way. We don't do this for lipids, pressors, Fentanyl or any other fluids. The rationale is that we don't want anyone messing with the pumps for highly toxic drips and accidentally reprogram it wrong and no one would catch it for a time. The nurses want to do the same thing with our TPN or clear fluids line. Less chance of accidentally inputting the wrong data on the pump with less touches of the pump, fewer alarms etc. People against the idea are concerned that if the main IV fluid pump is programmed wrong, it won't be caught for 12 hours until the next shift comes in and the baby would get a fluid and electrolyte overdose since these fluids are the majority of the total fluids.

What do you do in your unit? I work at UNC Chapel Hill, NC. Thanks so much for your input.

[vintage_RN, BSN, RN]

Continuous fluids are reset every hour, where we assess the site, rate and fluid. Medications are pushed on a secondary D5W line and programmed only to run as long as needed to administer the medication.

[NICU Guy, BSN, RN]

We set our pumps to alarm every 8 hrs. The total fluids for the 8 hour period are recorded and the pumps are reset for another 8 hr period.

[TeenyTiny, ADN, BSN]

We use 4 hour volumes for anything that runs over a pump so we reset it three times a shift. The resoning is that if the pump were to malfunction or be programed incorrectly it would not be a huge bolus and we decrease the number of alarms. We have had significant med errors from IL not being set that way.

[KelRN215, BSN, RN]

When I worked inpatient peds, the official rule was to program continuous fluids for 2 hours VTBI only. I don't think most people followed that rule, all it did was cause the pump to beep q 2 hrs and annoy everyone. This was a floor where we had 3:1 during the day and 4:1 overnight and most kids on IV fluids were pre-op patients who were NPO, post-op patients who hadn't picked up on their POs yet or chemo patients who needed huge volumes of pre or post-hydration. The idea behind the policy, IIRC, was to force people to check their IVs at least q 2hr. The policy was to assess running IV sites hourly.

[adventure_rn, MSN, NP]

I've worked in different places that do it different ways (VTBI for 12 hours, resetting VTBI q 4, and never resetting the VTBI but clearing the volume q 2).

I will say that I have seen a situation in which a nurse went to put the new 4-hour volume into the VTBI, and accidentally put it in as the rate instead (so the patient was getting fluid 4 times as quickly). Fortunately it was just D10 and not TPN, so they didn't get any crazy electrolyte imbalances. It was caught incidentially after about 1.5 hours when the blood sugar was 200.

The part that seems unsafe to me is that the 'set VTBI' function is usually on same page as the 'set Rate' function on the pumps, so it would be easy to interchange them.

[Coffee Nurse, BSN, RN]

I was taught to set a 4-hour VTBI and I still do this. That said, everywhere I've worked has always had hourly documentation of the total volume infused, which should be another catch of a pump set incorrectly. Is this not widespread practice?

My current job also has the Baxter Sigma pumps, which alarm if there's a rate change greater than 50% (so if I accidentally set the rate for a 4-hour amount instead of the VTBI, it would tell me).

[nurse1432]

We do q1 hour pump resets as to not miss an infiltration for IV's. I believe our policy says the same for PICCs/UVC. Our UAC fluid runs on a syringe pump that is only reset when the fluid expires, but is checked at the beginning and end of the shift.

[bananas1]

We run 4-hrs worth of volume through, with hourly site observation and documentation of volume infused.

[calinicumurse]

At my main job we verify rate, volume infused, and access site condition every hour. Now making sure everybody is actually looking at their pump and not just typing stuff in is a task on its own... We also use buretrols which should prevent fluid overload if the rate is input incorrectly, however people tend to overfill those anyways.

Another hospital I work at just inputs volumes infused q4, however does assess the IV site qhour.