Intravenous Smart Pumps During Actual Clinical Use

Abstract

This descriptive observational study was conducted to increase understanding of medication administration practices during actual clinical use between 2 commonly used, different types of intravenous (IV) smart pumps. Compliance with manufacturer-recommended setup requirements for both primary and secondary infusions and secondary medication administration delay was compared between a head-height differential system and a cassette system. A total of 301 medication administration observations were included in this study: 102 (34%) for the linear peristaltic IV smart pump (medical–surgical: N = 51; critical care: N = 51) and 199 (66%) for the cassette pump (medical–surgical: N = 88; critical care: N = 111). Results found a 0% compliance for primary line setup and 84% compliance for secondary line setup and 1 omitted medication due to a closed clamp with the linear peristaltic system. For the cassette system, there are no head-height requirements. Two roller clamps were found to be in the closed position on initiation of the secondary infusion, but the clinician was alerted by an alarm, so no medication delays occurred. These findings support that the current system requirements for flow rate accuracy using head-height differential systems are difficult to achieve consistently at the point of care. There is a need for additional human factor designed technology to replace manual actions to improve the process of care for nurses and the safety of care for patients.

Reprint from AJN: Secondary Medication Administration and IV Smart Pump Setup

“…Cassette-regulated flow provides a solution to the most common errors that occur with the head-height differential method. 1 The cassette method isn't free of potential complications, however. If the secondary volume is programmed to deliver less than the actual fluid volume in the secondary bag, the infusion will require reprogramming to complete delivery.…”

“…I n the United States, secondary infusion by largevolume iv smart pump is used extensively in the acute care setting for one-time or intermittent administration of medications including antibiotics, electrolyte replacements, and some oncology drugs. 1 Consistent and accurate delivery of secondary medications requires that nurses have a full understanding of the system and setup requirements of the iv smart pump. [2][3][4] It is not uncommon, however, for nurses to find a secondary medication only partially administered when their programming should have resulted in a complete infusion.…”

Development of smart infusion pumps: State of the art and future perspectives

“…But its infusion rate is affected by gravity, liquid concentration, and human body back pressure. In addition, when using a peristaltic pump for secondary infusion, the system of the head height difference should be considered, which is likely to develop programming or liquid bag placement errors 18 . Further design improvement is needed to replace manual operation, so as to improve the infusion process and ensure patient safety.…”

Intravenous Smart Pumps at the Point of Care: A Descriptive, Observational Study

“…8 We have previously published an observational study of secondary infusion, which included the BD/Alaris IV smart pumps (Becton, Dickinson and Company, Franklin Lakes, NJ). 9 The purposes of this study were to complete the collection of data on the same observations using the Baxter Spectrum IQ IV Smart Pump and to add additional exploratory variables of interest, which are described hereinafter. Hypotheses are based on the complexity of setup requirements for head-height differential systems, complexity of operator's manual, clinical observation, and author experience.…”