Introduction
Infusion pump is an electromechanical device developed to overcome the deficiencies of gravity based IV infusion sets. This enables constant and accurate infusion of predetermined volumes.
Purposes
- They can be programmed to deliver continuous or intermittent infusions based on treatment needs.
- Medications can be administered at a steady rate, preventing fluctuations that could impact patient safety.
- This is especially important for critical drugs like insulin, chemotherapy agents, and pain management medications.
- Automated infusion pumps minimize manual errors in drug administration.
- Built-in safety alerts notify healthcare providers of potential issues, such as occlusions or incorrect settings.
- Infusion pumps provide consistent medication delivery, reducing discomfort from sudden bolus injections.
- They allow for patient-controlled analgesia (PCA), enabling patients to manage their pain safely.
Types
Based on Volume
- Large-volume pumps usually use some form of peristaltic pump. Classically, they use computer-controlled rollers comprising a silicone-rubber tube through which the medicine flows. Another common form is a set of fingers that press on the tube in sequence.
- Small-volume pumps usually use a computer-controlled motor turning a screw that pushes the plunger on a syringe.
Based on Utility
- Ambulatory pumps: These are small pocket-sized pumps which are designed for portability wherein the patients require wearing them for a longer period. They have linear peristaltic machinery with a small fluid container like a cassette or floppy bag.
- Enteral pump: This pump is largely used to dispense fluid medications and nutrients to the gastrointestinal tract.
- Insulin pumps: These are mostly used at home to dispense insulin to people suffering from diabetes.
- Syringe pumps: 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.
- Patient-controlled analgesia (PCA) pumps: They help in delivering analgesics and are designed in such a way that the patient himself/herself can dispense a controlled quantity of drug required. These pumps are preprogrammed and instill on demand to prevent intoxication. The flow of the medication is controlled by a pressure pad or switch that the patient can activate when required.
- Elastomeric pumps: These pumps are equipped in such a pattern that an expandable balloon reservoir holds the medication in it and delivers it when the elastic balloon walls put pressure on the fluid.
- Multichannel infusion pump: This pump is designed in such a way that fluids can be delivered into the patient’s body through multiple channels and at different rates. It permits two to three infusions at the same time through the multiple channels. But one major risk is mismatched mixing.
Procedure
| Nursing action | Rationale | |
| 1. | Wash hands. | Reduces the transmission of microorganisms. |
| 2. | Calculate flow rate. | Calculations are done to obtain correct rate. |
| 3. | Know calibration in drops/mL. Microdrip: 60 gtt/mL.Macrodrip: 10-15 gtt/mL. | Microdrip tubing universally delivers 60 gtt/mL. There are different commercial parenteral administration sets for macrodrip tubing. |
| 4. | Calculate mL/h by dividing volumes by hour ml/h total infusion (mL)/hour of infusion Or if 3 L is ordered for 24 hours, then 3000 mL/24 h = 125 mL/h. | Provides even infusion of fluid over prescribed hourly rate. |
| 5. | Select one of the following formulae to calculate minute flow rate based on drop factor of infusion set. gtt = drops. mL/h/60 min-mL/min. Drop factors and ml/h = drops/min. ml/h and drop factors/60 min = drops/min. For example, use the following formula to calculate minute flow rate for bag 1:1000 ml with 20 mEq of KCI and 125 ml/h. Microdrip 125 mL/h × 60 gtt/ml = 7500 gtt/h.7500 drops/60 min = 125 drops/min. Macrodrip: 125 mL/h x 15 gtt/mL = 1875 gtt/h.1875 gtt/60 min = 31-32 drops/min. | Once you determine the hourly rate, these formulas compute correct flow rate. When using microdrip, ml/h always equals drop/min. Multiply volume by drop factor and divide the products by time. |
| 6. | Confirm hourly infusion rate, and place marked adhesive tape or commercial fluid indicator tape on existing IV container next to volume marking. | Provides a visual scale to assess progress of hourly infusion. |
| 7. | For use of electronic intravenous infusion devices (EID) for infusion. It delivers a measured amount of fluid over a period of time (e.g., 100 ml/h). Follow the manufacturer guidelines for setting of EID. Consult manufacturer’s direction for setting of the infusion pump. If using gravity controller, ensure that IV container is 36 inches above IV site. Insert IV tubing into chamber of control mechanism. Turn on power button, select required drops/min or volume/h. close the door to control chamber, and press start button. Open drip regulator completely while EID is in use. Assess patency of system when alarm signals. | IV controller works by gravity. Height of 35-48 inches will overcome venous pressure and other resistance from tubing and catheter. Most electronic infusion pumps use positive pressure to infuse. Infusion pumps propel fluid through tubing by compressing and milking the IV tubing. Ensures that pump freely regulates infusion rate. Alarm indicates some blockage in system. |
| 8. | Instruct the patient about the purpose of alarms, to avoid raising hand or arms that affects flow rate, and to avoid touching the control clamp. | Information allows to protect IV site and informs about rationale for not altering control rate. |
| 9. | Monitor IV infusion rate at every hour. | Ensures the correct volume and infuses every hour. |
| 10. | Observe the patient for any signs of overhydration or dehydration. | Warns changing rate of fluid infused. |
| 11. | Evaluate for signs of complication related to flow rate. | Prevents complications that decrease or stop flow rate. |
| 12. | Maintain I/O chart according to hospital policy. | Helps to know the hydration status of the patient. |
| 13. | Record the rate of infusion in drops/min or mL/h, route and time of administration on drug chart, any adverse reaction, and nurse’s note. | Acts as a legal document and facilitates to plan continuous care. |
Special Considerations
Setting up an infusion pump requires careful attention to ensure accurate medication delivery and patient safety. Here are some special considerations to keep in mind:
1. Equipment Preparation
- Select the appropriate infusion pump based on the therapy required.
- Ensure the pump is connected to a reliable power source or has a fully charged battery.
- Verify that the IV tubing is compatible with the pump and properly primed to remove air bubbles.
2. Programming and Calibration
- Input the prescribed infusion rate and volume to be infused.
- Double-check settings for accuracy to prevent medication errors.
- Configure safety alarms for occlusion detection, air-in-line alerts, and dose limits.
3. Patient Assessment
- Confirm vascular access is secure and functioning properly.
- Monitor for signs of infiltration, phlebitis, or extravasation.
- Assess the patient’s fluid balance and response to therapy.
4. Infection Control
- Use aseptic technique when handling IV tubing and connections.
- Regularly disinfect the pump surfaces to prevent contamination.
- Change IV tubing according to hospital protocols to reduce infection risk.
5. Troubleshooting and Maintenance
- Perform routine checks to ensure the pump is functioning correctly.
- Address alarm alerts promptly to prevent infusion interruptions.
- Keep a backup power source available in case of electrical failure.
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
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