syringe pumps and mechanical slack

Specialties NICU


I am curious if my neonatal nurse friends are familiar with the concept of "priming" a syringe pump in order to remove mechanical slack. In a letter from the FDA dated 8/24/2016, safe use of syringe pumps was discussed and they mentioned that using the pumps priming feature will remove the mechanical slack of the pump and decrease friction that affects start up times especially at low flow rates. I was always taught to prime by hand, then after loading the syringe and before connecting to the patient, priming another drop or two to the end of the set, just as the FDA recommends, but I am told by some of my colleagues that they are not familiar with this practice. I would love to know if this is common practice and any comments this group may have.

Specializes in Home Health.

32 years ago in NICU, we manually primed tubing before connecting to stringe pump, but things may have changed as awareness of potential problems become evident. All I can say is, remember every machine is just a machine, keep an Eagle eye on all equipment used in the care of your neonate patient to make sure they are working with precision. Don't trust machines in the care of your neonate patient. Example: I had a neonate on a ventilator who was not responding well, O2 sats were staying low, lungs were clear, tube was in place. As we moved the neonate to the area to be placed on ECMO, we were manuallly bagging him, sats rose and he was well. The ventilator was not functioning properly!!! What an eye opener that was. I never fully trusted the machines again.

Pumps well at least the newer alaris ones have a "prime set syringe" function which primes a few drops through to reduce the start up time it takes for the syringe to engage. This function is most important when you are running fluids at less than a ml and for critical infusions (inotropes). If you were running 0.3ml/hr of an inotrope without prime setting the syringe, it could be quite a while until the syringe engages and starts delivering that drip.

While I work PICU, and not NICU, we frequently care for neonatal patients requiring ECMO or CT surgery, as well as those patients admitted from home, and this is definitely a problem within the PICU. The majority of our nurses are under the impression that this function is solely for priming the syringe. As our practice is similar to yours where we manually prime the tubing, most of our nurses fail to use this function. The FDA letter you refer to can be found here: FDA Labeling Change Request.

Thanks for calling attention to, and posting this.

Thanks all for your replies. This is a very important practice that I am finding many nurses don't understand. I am hoping that clinicians can make the connection between low rates and delayed start up time and if they don't, I want to start the conversation so they do. There is a reason why syringe pump manufacturers have the prime feature and it isn't just to fill the tubing with fluid. Any suggestions on how we can get the word out?

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