Syringe pumps...what do you use them for

[WineCountryRN]

We are a 10 bed PICU and 40 peds hospital with just 2 syringe pumps. Thanks to having a new PICU manager we receiving several new syring pumps (FYI-we do not ususally have many infants in our units but that will ebe changing soon). :twocents::chuckleI am planning to write a competency and do an inservice for all the nurses on the use of syringe pumps. For the experienced PICU nurses (few of them here) it is a no brainer but since I am teaching floor nurses and new grads I would like to ask you the general population...

what do you use your syringe pumps for and if you have a competency/ protocol on syringe pumps would you share it?:chuckle

so far I have

titratable gtts like propofol, dopamine, dobutamine,etc

antibiotics (small volumes)

I can't think of other indications for using a syringe pump...(brain fart)

thanks:heartbeat:heartbeat:heartbeat:heartbeat

[NotReady4PrimeTime, RN]

We use our syringe pumps for a lot of things. All of our vasoactive drug infusions (epinephrine, norepinephrine, vasopressin, dopamine, dobutamine, milrinone, soduim nitroprusside, amiodarone, esmolol, labetalol etc) are run on syringe pumps and are not infused into the same lumen of the central line as any infusion running on a volumetric pump. We also run our sedation/analgesia infusions on syringe pumps (morphine, fentanyl, ketamine, midazolam, propofol) and intralipid, heparin, furosemide, nesiritide, magnesium, potassium 1:1, D25W and many antibiotics. We don't have a competency per se, but we do have two nurse checks on every drug we give, and we have standard concentrations.

[gal220RN, BSN, RN]

What makes PICU different from an adult ICU? I know this seems like a stupid question, but I think it helps focus the relevance of syringe pumps in a PICU setting. The concentration of continuous infusions can be so minute compared with adults (fentanyl gtts of 10mcg/cc or vec gtts of 1mg/cc or dopamine at 800 mcg/ml) and are weight based, that any drip less than 1cc/hr might not be accurately infused on a regular infusion pump. We use smart pumps with guardrails and they are programmable at increments of 0.5 cc. I often see many drips running at 0.15cc/hr at maximum concentrations

Also think about the risk of over-infusions. The benefit of syringe pumps is usually the maximum volume that can be infused is in a 60cc syringe. Many antibiotics are such small volumes to be infused. How do you accomplish this, especially on meds like vancomycin that are infused over an hour, or meds like flagyl or abelcet?

If you have limited resources, reserve your syringe pumps for meds that require continuous, small volume infusions at higher concentrations impacting sedation levels or hemodynamic status (PGE, inotropes, pressors, viagra).

Hope this helps! I take for granted having all the syringe pumps I could possibly need at the drop of a hat. Thanks for keeping me grateful for the big things in life

[TexasPediRN]

Expressed Breast Milk.

Seriously. This is a big debate at our hospital, and they are trying to make it policy. In fact, they need to.

The nutritionist tells me that when you put EBM in a feeding bag, all the fat sticks to the sides of the bags. (and shes right, you can clearly see this if you look at the bag)

Therefore, you need to have it a syringe, on a syringe pump, so that the pt receives all of the fat from the EBM.

[gal220RN, BSN, RN]

If you tilt the syringe at a 45 degree angle, the fat will also fall with the rest of the milk.

Been there are done that.

[TexasPediRN]

All of our syringe pumps have the syringe at a 90degree angle..

Also, with being on a pump, it pushes the fat though the tubing..

Yours are at a 45degree angle? Odd..

[elizabells, BSN, RN]

We clamp our EBM syringe pumps to the IV pole upside down. I've seen screaming, crying hungry kids on continuous feeds, and nine times out of ten the syringe is right-side up and all the fat is at the top, and they're basically getting water.