Changing the syringe pump: A challenging procedure in critically ill patients

Abstract

Introduction: In the literature, the change of a syringe pump is described as a dangerous situation, especially in the case of vasoactive drug administration. Methods: Different variables have been studied (central venous pressure, pump displacement in relation to the patient position, utilization of a stopcock, or a neutral displacement needle-free connector between the syringe and the infusion tubing) to understand their influence on medication administration in terms of backflow or bolus creation when changing the syringe. Results: We performed 576 measurements with different combinations. With respect to all the observations, in comparison with “time zero,” we found the following differences expressed in microliters: 0 (±1) at the plunger opening; 0 (±3) at the syringe extraction from the pump; 0 (±7) at the syringe disconnection from the infusion tubing; 0 (±11) at the syringe reconnection to the infusion tubing; 1 (±7) at the syringe insertion in the pump; 3 (±23) at the plunger closing; 8 (±33) at the stabilization at the maneuver end. Conclusion: The syringe change can be a very critical moment given different influencing variables. Syringe pump position, displaced higher than the patient level, always generates a medication bolus that is higher at the lowering of the central venous pressure value. The presence of a neutral displacement needle-free connector reduces the incidence of boluses. When the pump is placed at the patient level, the presence of neutral displacement needle-free connector reduces the establishment of boluses, even in a central venous pressure of −5 mmHg simulations.

Effects of infusion tubing line lengths and syringe sizes on infusion system compliance: an experimental study using a syringe-type infusion pump at low flow rate

“…In the syringe-type infusion pump system, the use of a smaller syringe would be ideal to minimize system compliance and ow irregularity. However, in real-world clinical practice, the use of small-volume syringes presents issues that inevitably accompany frequent syringe exchanges causing discontinuation of drugs with subsequent start-up delays, increasing the workload of the caregivers as well as the risks of contamination or human errors [24][25][26]. For this reason, syringe-type infusion pumps are frequently used with large-sized syringes.…”

Effect of central venous pressure on fluid delivery during start‐up of syringe infusion pumps for microinfusion

“…Recent clinical data demonstrates that, independent of the syringe pump changeover strategy used, at least 25% of critical hemodynamic events in all three approaches tested occurred around changeover when administrating norepinephrine to critically ill adult patients 21 . As an explanation to these clinical findings, Russotto and coworkers argued that central venous pressure may have caused backflow and bolus events during vasopressor syringe changeover independently of the strategy used 24,25 . So far, the CVP level has not been included in studies investigating predictors of hemodynamic instability during changeovers of norepinephrine infusion pumps and certainly needs further alertness and research 26 …”

“…21 As an explanation to these clinical findings, Russotto and coworkers argued that central venous pressure may have caused backflow and bolus events during vasopressor syringe changeover independently of the strategy used. 24,25 So far, the CVP level has not been included in studies investigating predictors of hemodynamic instability during changeovers of norepinephrine infusion pumps and certainly needs further alertness and research. 26 Some limitations of this study must be acknowledged.…”

10 clinical tips for advancing patient safety when using syringe pump systems for microinfusion intravenous drug therapy

“…Beside start-up delays, dead volume effects and pressure differences between the i.v. catheter and the newly connected syringe pump also seem to be responsible for the observed under or over infusion 17,22 . In addition, needle-free connectors have been demonstrated to cause significant volume shifts when manipulating infusion lines 23 …”

“…catheter and the newly connected syringe pump also seem to be responsible for the observed under or over infusion. 17,22 In addition, needlefree connectors have been demonstrated to cause significant volume shifts when manipulating infusion lines. 23 Recommendations: (1) To speed up syringe pump start-up, ensure that the syringe is firmly secured in the syringe pump.…”