Relocating IV Pumps for Critically Ill Isolated Coronavirus Disease 2019 Patients From Bedside to Outside the Patient Room

Abstract

Objectives: Discuss advantages and disadvantages of relocating IV pumps for coronavirus disease 2019 patients from bedside to outside the patient room and characterize reproducible details of an external infusion pump model. Design: Brief report. Setting: ICUs at a single-center teaching hospital. Patients: Critically ill coronavirus disease 2019 patients under contact and special droplet precautions. Interventions: Relocation of IV pumps for coronavirus disease 2019 patients from bedside to outside the patient room using extension tubing. Measurements and Main Results: Infusion pumps secured to a rolling IV pole are moved immediately outside the patient room with extension tubing, reaching the patient through a closed door. It is anticipated that this practice may reduce unnecessary coronavirus disease 2019 exposure for healthcare professionals, reduce the consumption of personal protective equipment, and promote patient safety by limiting delays of donning personal protective equipment to initiate or adjust medications. Conclusions: Risks of situating IV pumps outside the patient room must be carefully weighed against the benefits. Relocation of IV pumps outside the patient room may be considered given shortages of personal protective equipment and high risk of healthcare professional exposure. Institutional review-approved studies investigating the measured impact on decreased exposure, personal protective equipment usage, and patient safety are required.

Comparative Analysis of Intravenous Pumps Relocation for Critically Ill Isolated COVID-19 Patients From Bedside to Outside the Patient Room

“…This included pump alarm occurrence, as recording the number of alarms was not performed prior to pump relocation and would have been unfeasible. Furthermore, while the apparatus set-up described in in Shah et al 4 aimed to minimize rate accuracy and delays in infusion initiation, a quantitative analysis of intake/outlet pressures, dead volume, and infusion time to initiation was impractical and unable to be collected. 11 An additional limitation to this study included the small sample size and short duration.…”

“…One novel contingency strategy is to relocate intravenous (IV) infusion pumps from beside to outside the patient room. [4][5][6][7][8] This approach may reduce entry requirements into the patient room, reduce HCP exposure to COVID-19, and thus strategically conserve PPE. In addition, the increased accessibility of IV pumps may promote patient safety by decreasing response time via eliminating the time needed to don PPE to initiate or adjust IV medications.…”

“…However, some potential concerns to consider when relocating IV pumps include: intuition approval and implementation of temporary processes to scan the patient's identification bracelet from outside the patient room, fewer opportunities to directly monitor/interact with the patient, delayed medication delivery due to extended tubing lengths, increased medication waste, identifying alternative power sources outside of the patient room, and potential for increased risk of central line-associated bloodstream infections (CLABSI). [4][5]7,8 Additional considerations include limitations of the specific tubing utilized to extend the IV pump to the outside of the patient room. For example, special consideration should be given to the tubing's caliber size and rigidity, which may require occlusion limit adjustments, as well as increased medication usage due to the additional volume of circuitry.…”

“…For example, special consideration should be given to the tubing's caliber size and rigidity, which may require occlusion limit adjustments, as well as increased medication usage due to the additional volume of circuitry. 4 Furthermore, the impact on resources should also be taken into consideration, as pump manufacturers have reported shortages of extension sets and IV tubing. 5 Despite these theoretical advantages and disadvantages, a formal investigation is needed to objectively evaluate this novel contingency strategy.…”

Extending tubing to place intravenous smart pumps outside of patient rooms during COVID-19: an innovation that increases medication dead volume and risk to patients

“…As described by Shah et al 8 from Mt Sinai, the physical manifold, often a 'gang of 4-way stopcocks', is located outside the patient room, as depicted in figure 2A. In this published example, connection to the patient was made with two lengths of non-compliant, kinkresistant, transducer extension tubing.…”