Introduction
This is a method of intermittent IV infusion in which the drug is mixed with a small amount of the IV solution (50-100 mL) and administered over a short period at the prescribed interval.
Definition
Syringe pump is otherwise called “mini infusion pump.” It is an electronic or battery-powered piston to push the plunger continuously at a selected milliliter per hour rate. These pumps are used to hold the liquid drug in the reservoir of the syringe and to provide a controlled fluid supply through the movable piston. These are suitable for infusion of potent drugs in a concentrated form at very low rates (down to 0.1 mL/h).
These devices are suitable for intravenous, intra-arterial, subcutaneous infusion, or enterogastric feeding, being particularly suitable for use in infants and neonates. They are not suited for use of large volumes and offer no safeguard against extravasations unless an overpressure alarm is incorporated.
Mechanism
Syringe pump delivers the medication to the patient through the primary line by applying mechanical pressure on the syringe plunger.
Purposes
- To reduce the risk of rapid dose infusion.
- To facilitate easy administration of a small amount of medication for a long duration.
- To benefit the patient on fluid restriction.
Procedure: Assessment
| Steps | Rationale | |
| 1. | Check the doctor’s order for the accuracy and completeness of each medication to be administered. | The order sheet is the most reliable source and the only legal record of medications the patient is to receive. |
| 2. | Check patient’s name, drug name, dosage, route, and time for administration. Check with the physician or nursing supervisor if order is illegible. | Ensures that the patient receives the correct medications. Illegible records are a source of medication errors. |
| 3. | Assess the patient’s medical and medication history. | Indicates type of appropriate IV solution to be used and patient’s need for medication. |
| 4. | Review medication reference information, including action, purpose, side effects, normal dose, time of peak onset, and nursing implications. | Allows the nurse to give medication safely and to monitor patient’s response to therapy. |
| 5. | Assess compatibility of the ordered medication with existing IV solution. | Medication that is incompatible with IV solutions results in clouding or crystallization of solution in the IV tubing which could harm the patient. |
| 6. | Assess patency of patient’s existing IV infusion line or saline lock. | For medication to reach venous circulation effectively. IV line must be patent and fluids must infuse easily. |
| 7. | Assess IV site for signs of infiltration or phlebitis, redness, pallor, swelling, pain, tenderness, coolness, leakage of fluid at the site. | Confirmation of placement of IV needle or catheter and integrity of surrounding tissues ensures that medication is administered safely. |
| 8. | Assess the patient’s history of drug allergies; know type of allergens, and normal allergic reactions. | Effects of medications can develop rapidly after IV infusion. Be aware of the patient at risk. |
| 9. | Assess the patient’s symptoms before initiating medication therapy. | Provides information to evaluate the desired effects of medication. |
| 10. | Assess the patient’s knowledge regarding medication. | If there is knowledge deficit, begin education about the medication. |
Procedure: Articles
| Articles | Purpose |
| A sterile tray containing: | |
| 50-mL syringe. | To load the medication. |
| Stopcock or three-way adapter. | To administer medication. |
| Syringe pump and tubing. | To infuse the medication. |
| Antiseptic swab. | To clean the site syringe and connecting tube. |
| IV pole or rack. | To hold the syringe pump. |
| Adhesive tape (optional). | To secure the IV line. |
| Medication administration record (MAR) or drug chart. | To check with the physician’s record. |
Procedure
| SN | Nursing Action | Rationale |
| 1. | Collect all the necessary equipment. Check each medication with the physician’s order based on hospital policy: Clarify any doubt. Clarify with the patient’s chart for allergies. | Comparison helps to identify any error that may have occurred when orders are transcribed. The physician’s order in the case sheet is the legal document for each hospital. |
| 2. | Nurse should know the medication’s action, safe dosage calculation, purpose, adverse effects, and special nursing considerations for medication to be administered. | Helps the nurse to evaluate the therapeutic effect of the medication and is also utilized to educate the patient about the medication. |
| 3. | Perform hand hygiene. | To prevent cross-infection. |
| 4. | Prepare the medication in the drug preparation area. | Facilitates easy access of diluents, medication, IV sets. syringes, etc. |
| 5. | Prepare the medication for one patient at a time. | Avoids the error in medication administration. |
| 6. | Read the drug chart and select the proper medication from the patient’s medication cupboard or ward. | This is the first check of the label to choose the right drug. |
| 7. | Compare the label with the drug chart. Check the expiry date and caution information. Do the drug calculation and confirm the appropriate infusion rate. Calculate the drug flow rate. | This is the second check of the label to choose the right drug. Verify calculation with the ward in-charge to ensure safety. Infuse medication at appropriate rate to prevent drug error. |
| 8. | When all the medications have been prepared for one patient, recheck the label with drug chart before taking them to the patient. | This is the third check to ensure accuracy and to prevent error. |
| 9. | Close the medication cupboard before leaving the drug preparation area. | Locking the cupboard safeguards the patient’s medication supply. |
| 10. | Take the medication to the bedside carefully and keep the medication in sight. | Careful handling and close observation prevents accidental disarrangements of medication. |
| 11. | Check to ensure that it is the right time for medication. | To ensure the correct drug at the correct time. |
| 12. | Identify the patient by asking the name and compare with the patient’s case sheet and also ask the patient to state his or her name. If doubtful, compare it with the other staff. | Ensures that the right patient receives the right drug and prevents errors. |
| 13. | Perform hand hygiene. | Prevents cross-infection. |
| 14. | Reassess the patient before administering medication; check again if there is any allergy to the medication. Assess the IV site for any sign of inflammation or infiltration. | |
| 15. | Use aseptic technique to remove the cap on the tubing and on the syringe, without contaminating either end. | To maintain sterility of the tubing and syringe; prevents contamination. |
| 16. | Connect infusion tubing to the prefilled syringe without contaminating either end. | To prevent contamination and to maintain sterility of the tubing and medication port. |
| 17. | Place the label on tubing or syringe with correct date and connect needle or needleless device to the end of the tubing according to the manufacturer’s directions. | Label allows for tracking of the next date to change. |
| 18. | Carefully apply pressure to syringe plunger, allowing tubing to fill with medication. | Ensure tubing is free of air bubble to prevent air embolism. |
| 19. | Insert and fix the syringe into the syringe pump. | To facilitate proper operation. Proper connection allows IV medication to follow into primary line. |
| 20. | Use antimicrobial swab to clean the stopcock or access port. | To maintain aseptic technique throughout the procedure near to the IV insertion site. |
| 21. | Connect the syringe pump tubing to the primary infusion at the cleaned port. | Allows for delivery of medication. |
| 22. | Set pump to the appropriate rate and begin infusion. Set alarm if recommended. | Pump delivers medication at controlled rate. Alarm is recommended for use with IV lock apparatus. |
| 23. | After infusion, stop and disconnect the tubing. Flush the line with normal saline and close the main IV line. | Maintains the patency of the IV line. |
| 24. | Perform hand washing. | |
| 25. | Follow the hospital policy regarding disposal of equipment. | |
| 26. | Observe for signs and symptoms of adverse reaction. | Helps to identify any complication at the earliest. |
| 27. | During the infusion, periodically check infusion rate and condition of IV site. | Prevents fluid overload and infiltration at the insertion site. |
Special Considerations
Syringe pumps are essential for precise medication delivery, especially in critical care settings. Here are some special considerations when using a syringe pump with volume-controlled administration:
1. Accuracy in Volume Measurement
- Ensure the correct syringe size is selected, as different sizes affect flow rate accuracy.
- Regularly check for air bubbles in the syringe to prevent dosing errors.
2. Controlled Flow Rate
- Set the infusion rate carefully, especially for low-volume medications.
- Monitor for delays in drug delivery, which can occur due to syringe plunger resistance.
3. Compatibility with Medications
- Some drugs require light protection or specific tubing materials to prevent degradation.
- Verify that the medication is suitable for syringe pump infusion.
4. Patient Monitoring
- Assess for signs of infusion-related complications, such as infiltration or extravasation.
- Monitor vital signs to ensure the medication is being tolerated.
5. Infection Control
- Use aseptic technique when handling the syringe and tubing.
- Regularly change syringes and infusion sets to prevent contamination.
REFERENCES
- Annamma Jacob, Rekha, Jhadav Sonali Tarachand: Clinical Nursing Procedures: The Art of Nursing Practice, 5th Edition, March 2023, Jaypee Publishers, ISBN-13: 978-9356961845 ISBN-10: 9356961840
- Omayalachi CON, Manual of Nursing Procedures and Practice, Vol 1, 3 Edition 2023, Published by Wolters Kluwer’s, ISBN: 978-9393553294
- Sandra Nettina, Lippincott Manual of Nursing Practice, 11th Edition, January 2019, Published by Wolters Kluwers, ISBN-13:978-9388313285
- Adrianne Dill Linton, Medical-Surgical Nursing, 8th Edition, 2023, Elsevier Publications, ISBN: 978-0323826716
- Donna Ignatavicius, Medical-Surgical Nursing: Concepts for Clinical Judgment and Collaborative Care, 11th Edition ,2024, Elsevier Publications, ISBN: 978-0323878265
- Lewis’s Medical-Surgical Nursing, 12th Edition,2024, Elsevier Publications, ISBN: 978-0323789615
- AACN Essentials of Critical Care Nursing, 5th Ed. Sarah. Delgado, 2023, Published by American Association of Critical-Care Nurses ISBN: 978-1264269884
- Ernstmeyer K, Christman E, editors. Nursing Fundamentals [Internet]. 2nd edition. Eau Claire (WI): Chippewa Valley Technical College; 2024. PART IV, NURSING PROCESS. Available from: https://www.ncbi.nlm.nih.gov/books/NBK610818/
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