When should an infusion pump indicate an alarm

NurseRatched67 · Feb 17, 2008

I think most RN's on here will tell you that the pumps beep TOO MUCH! :lol2:

To clarify your situation...yes the pump will be if you are trying to infuse a piggyback without the clamp on that line open.

Let's say you have a mainline (line A) of .9NS infusing and you are going to hang another medication as a piggyback (line B). You can program an infusion pump to run a few different ways. One way is to run both lines (A&B) concurrently, another is to program (B) to run, while (A) is on a delay. When you do it this way, then once your piggyback infuses, your mainline (A) will restart on it's own. The third way is to run line (B) only.

If you want to infuse line (B), then you have to make sure the clamp is open on your piggyback or else the machine will beep. It will beep if you run line (B) alone and let the line run dry, and the pump "cassette" backs up with air.

The machine will not necessarily stop and beep if there is a large amount of air already past the cassette (i.e. you didn't prime line well enough).

The pump will also beep if the line is occluded...that is if it is pinched off or there is air backed up in the cassette.

If your pump beeps, then stop all lines...check your settings and restart.

Take your time on pumps... I see too many new nurses rushing through pump settings and making simple errors in programming.

Breathe and slow down. Don't always trust the pump to do ALL the work for you...make sure your lines are primed, right tubing is used, clamps are properly open or closed and the pump is not malfunctioning before you start your infusion.

:nurse:

seanpdent, ADN, BSN, MSN, APRN, NP · Feb 17, 2008

I am uncertain about the dependability of an infusion indicating trouble if there were a blockage in the line.
For example if a Nurse were to hang an IV Piggyback and the clamp was closed should the pump sound an alarm? Or would it move over to the primary bag and never indicate a problem?
\

It REALLY depends on the type of machine you have. Some pumps have the piggyback bag actually connected to the top of the machine (pump), while other pumps infuse the piggyback bag via gravity (meaning not a direct connection to the actual pump)

I agree with the previous post, never trust a pump. Use your best nursing judgement and if in doubt test your theory before you hook it up to a patient.

Best of luck.

:paw:

glasgow3 · Feb 17, 2008

On the Baxter Colleague infusion pump, failure to unclamp the piggyback line will in fact result in the infusion being "pulled" from the primary bag (instead of the piggyback) and no alarm will sound. I have always regarded this as a design flaw, however, the powers that be do not.

That is, of course, the least of the problems with those pumps as a simple Google search would show.

R

Dolce, RN · Feb 17, 2008

The pumps that I usually use will not alarm if the piggyback line is clamped. Thus, the patient will receive the maintenance fluid at the piggyback rate for 30 minutes and then switch back to the normal rate, leaving the piggyback hanging there, not given, and me clueless.

CritterLover, BSN, RN · Feb 17, 2008

it really does depend on the setup of the infusion pump.

most infusion pumps infuse the secondary med passivly. the pump doesn't recognize that it is giving the secondary med; that is set up by the nurse by using gravity to determine which med is infusing. if there is an upstream occlusion on the secondary med (ie, the roller clamp still closed), the fluid from the primary will infuse, and no one knows until someone realizes that the piggyback is still full.

however, pumps that pull the secondary (piggyback) activy will beep when that clamp is closed. because the secondary tubing is attaced to the blue port on the cassette, the pump activly infuses the secondary med, and it will "know" if there is an upstream occlusion on the secondary med.

seanpdent, ADN, BSN, MSN, APRN, NP · Feb 17, 2008

On the Baxter Colleague infusion pump, failure to unclamp the piggyback line will in fact result in the infusion being "pulled" from the primary bag (instead of the piggyback) and no alarm will sound. I have always regarded this as a design flaw, however, the powers that be do not.
That is, of course, the least of the problems with those pumps as a simple Google search would show.
R

Those are the pumps I was precisely referring to. They do not have a direct connection to the pump itself, and simply infuse by gravity.

:paw:

Trauma1RN · Feb 17, 2008

The pumps we have at work are pretty neat. When pharmacy doses a high risk med such as insulin, heparin, vasopressin etc. it is labeled as a "guardrail" drug. The IV pumps are preprogrammed with concentrations and safe dose ranges. When you hang a guardrail drug the IV pump asks for the concentration of the IV solution and the drug, then does not let you run it at a rate that is higher or lower than its predetermined ranges. It also has memory of what has been entered, and you can download it for analysis. In the first year alone over 9000 errors were avoided in a 300 bed hospital. Pretty awesome system, and if you need another pump, you can just snap another one on the side of the machine, with up to five I believe on one pump. For PCA's, just snap one on the side of the machine. Heres a link.

http://www.cardinalhealth.com/alaris/products/infusion/AlarisSystem/

lsyorke, RN · Feb 17, 2008

On the Baxter Colleague infusion pump, failure to unclamp the piggyback line will in fact result in the infusion being "pulled" from the primary bag (instead of the piggyback) and no alarm will sound. I have always regarded this as a design flaw, however, the powers that be do not.
That is, of course, the least of the problems with those pumps as a simple Google search would show.
R

And how many of us have gone back to see that full piggyback bag sitting there!!

seanpdent, ADN, BSN, MSN, APRN, NP · Feb 17, 2008

The pumps we have at work are pretty neat. When pharmacy doses a high risk med such as insulin, heparin, vasopressin etc. it is labeled as a "guardrail" drug. The IV pumps are preprogrammed with concentrations and safe dose ranges. When you hang a guardrail drug the IV pump asks for the concentration of the IV solution and the drug, then does not let you run it at a rate that is higher or lower than its predetermined ranges. It also has memory of what has been entered, and you can download it for analysis. In the first year alone over 9000 errors were avoided in a 300 bed hospital. Pretty awesome system, and if you need another pump, you can just snap another one on the side of the machine, with up to five I believe on one pump. For PCA's, just snap one on the side of the machine. Heres a link.
http://www.cardinalhealth.com/alaris/products/infusion/AlarisSystem/

Heh heh.. I used these pumps in MD, and now my facility is actually in the process of changing over to them.

:up:

MikeyJ, RN · Feb 18, 2008

This actually just happened to me on Friday in clinicals. I was using a single pump infuser, thus the piggybacks run by gravity. There was a line already there to use, so I flushed the line and then put up the new piggyback antibiotic. I set the "Secondary" pump to run the antibiotic over 30 minutes. I came back an hour later to hang a mag rider and found a full bag of antibiotics. I forgot to unclamp the piggyback. And of course the pump is not going to beep because it was by gravity.

SteveNNP, MSN, NP · Feb 18, 2008

that's why most pumps will tell you on the screen to "unclamp secondary line and hit start." There's no way to sense it unless it's running through a channel.