INFUSION THERAPY PUMPS USE

POLICY Physician/ Registered Midwives order infusion therapy including the solution and rate. Registered Nurses establish and maintain infusion therapy to manage hypovolemia.

Applicability: Infusion therapy for women occurs in the Acute Perinatal Program.

PROCEDURE 1.1 Preparation Check physician/ Registered Midwife’s (RM) orders for initiating intravenous (IV) infusion therapy, ordered solutions and rate.

Assemble equipment:  Chlorhexidine 2% in 70% alcohol swabs  Infusion pump as required (Alaris® )  Intravenous (IV) administration sets – see Administration Set Table 2.6  Solution bag/ mini-bag (s) as ordered  Sterile dead-end cap as needed  Tubing Labels

1.2 Prime tubings using aseptic technique Close all roller clamps before priming.  Fill drip chamber two thirds ( 2/3 ) full and slowly open roller clamp  Prime slowly while inverting and tapping air out of Y-sites (ports), ensure tubing is clear of air throughout. After priming, close roller clamps and tubing clamps  Connect primed IV administration set to the intravenous catheter, protect end of tubings with dead-end cap, as needed  Label tubings with date and time prepared and when due for next tubing change.

1.3 Load administration sets into Alaris® volumetric infusion module:  Open module door latch  Position upper fitment into fitment recess  Insert Safety Clamp on the pumping mechanism recess  Using fingertip, firmly push tubing toward back of Air-in-Line detector  Close door latch  Open roller clamp.  Initiate pump infusion at ordered/desired rate

1.4 Intermittent Intravenous Medication Administration via Secondary Line Gather equipment:  Chlorhexidine 2% in 70% alcohol swabs  Infusion pump (additional) as required (Alaris® )  Medication added labels  Primed secondary IV administration sets

Prepare ordered medication in bag or mini-bag and connect secondary (piggyback) medication tubing.

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INFUSION THERAPY PUMPS USE

Connecting the primary and secondary lines When connecting for the first time, swab the port on the primary line with chlorhexidine/alcohol swab for 2 - 3 seconds. Allow the port to air dry for 30 seconds before connecting the secondary tubing.  If a secondary line exists already, prime or clear secondary tubing by backflushing (see 2.5) with compatible primary solution as indicated.  Swab connection between secondary set and old flush bag with the chlorhexidine/alcohol swab for 2 - 3 seconds. Allow to dry for 30 seconds.  Remove old bag and discard. Attach medication bag.  Connect secondary set to mainline. Use hanger to lower primary infusion bag:  Check the primary solution bag is hung lower than secondary solution bag using 1 - 2 hangers depending on size of primary solution bag.  Primary bag should hang 50 centimetres (20 inches) above infusion pump and 24 centimetres (9.5 inches) below secondary solution bag.  Ensure head height difference between medication bag and primary bag is at least 24 centimetres (9.5 inches). The distance between the medication bag and the primary bag will determine the amount of remaining fluid left in piggyback tubing.

Program pump using Guardrails® software, if available for ordered medication. Enter medication information:  Dosage  Volume

1.4 Backflushing Ensure the drip chamber remains empty by clamping the secondary medication set line until the minibag is lowered and completely inverted.  Unclamp and allow the minibag to fill slightly (5 – 10 mL)  Clamp the line while the bag and drip chamber remains inverted.  Squeeze and release the drip chamber to empty most of the fluid in the minibag.

1.5 Administration Set Table Administration Set and Frequency of Tubing Type of Infusion add-ons required Change Fluid infusion only, no medications Basic straight set with ports Every 96 hours Primary infusion set with 2-3 ports Secondary medications Every 96 hours Secondary medication Set Infusion set for intermittent Primary infusion with secondary set medication delivery, disconnected Every 24 hours Smart site from woman between medications PCA tubing PCA infusions Every 96 hours Y-extension with back-check valves

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INFUSION THERAPY PUMPS USE

DOCUMENTATION  Detailed Fluid Balance Record  Interprofessional Progress Notes  12 Hour Fluid Balance Record

REFERENCES Alaris® System Quick reference Guides (QRG) hang tags v 8, PCU pump module. (2006). QRG: Alaris® PC unit - pump module, supports Guardrails® Suite MX (v8) Alaris® System Training (MX). (2007). BC Women’s public internet site > For Professionals > Education and Training > E-Learning Courses > Alaris® Pump Computer Training. HealthStream Learning Center. http://www.cmecourses.com/wchcbc/login.cfm?ao_key=2264&break=true Cardinal Health, Skill Tasks for the Alaris® Pump Module with Guardrails® Suite MX, (2007, January). http://www.cardinal.com/alaris/brochure/spodfuAlarisSystemv8DFU.pdf Centres for Disease Control and Prevention. (2006).Guidelines for the Prevention of Intravascular Catheter-Related Infections. MMWR 2002; 51(No. RR-10): page 51. Retrieved January 18, 2006, from www.cdc.gov/mmwr/PDF/rr/rr5110.pdf Infusion Nurses Society. (2006). Infusion Nursing Standards of Practice: Standard 48. Journal of Infusion Nursing. 29(1S). Intravenous Therapy Peripheral: Woman Ontario, R. N. A. O. (2005). Care and Maintenance to Reduce Vascular Access Complications (guideline). Toronto, Canada: Registered Nurses Association of Ontario. http://www.rnao.org/bestpractices

WW.03.05 Fetal Maternal Newborn and Family Health Policy & Procedure Manual Effective Date: 06-SEP-2007 Page 3 of 3 Refer to online version – Print copy may not be current – Discard after use