This may seem like a rather odd set of questions, but bear with me.
1) Do you prepare your drug infusions or does pharmacy prepare them for you? If pharmacy prepares them for you, you may or may not have responses for the remaining questions.
2) If you prepare your own, how often do you change the bag or syringe containing your infusions?
3) If you prepare your own, do you have a variety of "standard" concentrations to choose from, based on the size of your patient?
4) If you prepare your own, do you prepare a fixed amount of fluid and then decant what you'll need for the hang time of that infusion into a smaller syringe, discarding the rest?
5) Do you use heparin in your pressure lines?
6) Do you use dextrose-containing solutions for your CVP and/or LAP monitoring lines?
7) Do you run your pressure lines on pumps, and if so, which type - volumetric or syringe?
8) How often do you change the flush solution you're using for these pressure lines?
9) What would you say your CRBSI rate is?
We've just moved to the use of standard concentrations for our infusions. But we have as many as six different "standard" concentrations for some drugs, based on the patient's size. For our smaller patients we can expect even the most dilute concentration to run at a very low rate, and therefore for accuracy we're using the smallest syringe that will hold the volume we'll need for the hang time of the drug - for RN-prepared meds it's only 24 hours where it used to be 72 hours before we made this change. But we're expected to mix up 50 or 100 mL of a solution then decant the amount needed for 24 hours into that smaller syringe. The reason for this we're told is that because we mixed it and not pharmacy or a factory, we might have contaminated the solution in the preparation.
Nothing has been said about stability and in fact, if pharmacy prepares it, we can let it hang for 48 hours, while commercially-prepared solutions can hang for 96 hours. We get virtually nothing prepared by pharmacy other than TPN, immunosuppressants and unit doses of some antibiotics. The only commercially-prepared infusions we have are some antibiotics (Cipro, Flagyl), dopamine and heparin in dextrose 100 units/mL. Where we used to waste hundreds of thousands of dollars' worth of drugs and supplies annually, we'll now be wasting millions.
We still use heparin in our pressure lines, 1-2 units per mL NS (500 mL prepared) for art lines and either 1 unit per mL D5W or D10W (500 mL prepared) depending on the patient's size. This we prepare at the bedside and are now being required to change the bag q24h on the off chance it may have been contaminated when we mixed it. We run our patients
We were just congratulated on going more than 66 days without a CRBSI - we've been following this new practice for only 48 days. These changes have greatly added to our workload, having first to look up what the variations of "standard" exist for our infusions, choosing the most appropriate one for the patient, looking up the recipe, mixing up the "standard" volume then decanting into the desired size syringe, documenting everything and then hanging the new infusions. When you've got a bunch of drugs infusing in the same lumen as your epinephrine and you've got to change every one of them every day... If we were running everything on a volumetric pump where it was just swapping out the bag, like they do with adults, no harm no foul. But we are required to run anything with vasoactive properties plus anything driving it on syringe pumps. No quick swaps there. I think we're just asking for trouble. Thoughts?
