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Syringe Infusion Pumps: a Comprehensive Overview and Considerations for Use at Low Delivery Rates

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Syringe Infusion Pumps: a Comprehensive Overview and Considerations for Use at Low Delivery Rates Syringe Infusion Pumps: A Comprehensive Overview and Considerations for Use at Low Delivery Rates Released November 2, 2020 | Expires November 1, 2023 FACULTY Nathaniel M. Sims, M.D. Sylvia Okrzesik, Pharm.D., BCPPS Research Faculty, Department of Anesthesia, Pediatric Clinical Pharmacist‐PICU/NICU/ED Critical Care, and Pain Medicine Massachusetts General Hospital Massachusetts General Hospital Coordinator, Longitudinal Advanced Pharmacy Associate Professor, Anesthesiology Practice (LAPP) Program Harvard Medical School Boston, Massachusetts Boston, Massachusetts Kimberly Whalen, R.N., M.S., CCRN Christopher Colvin, MHSc Nursing Practice Specialist Clinical Engineer Massachusetts General Hospital Massachusetts General Hospital Boston, Massachusetts Boston, Massachusetts Healthcare Human Factors & Instructional Design Physicians, Nurses, and others access CME/CNE: Consultant www.mycme.com/courses/syringe-infusion-pumps- Toronto, Ontario, Canada a-comprehensive-overview-7345 Pharmacists access CPE: elearning.ashp.org/ products/8373 ACCREDITATION The American Society of Health‐System Pharmacists designates this enduring material for a maximum of Accreditation for Pharmacists 1.5 AMA PRA Category 1 Credits™. Physicians The American Society of Health‐System should claim only the credit commensurate with the Pharmacists is accredited by the extent of their participation in the activity. Accreditation Council for Pharmacy Education as a provider of continuing pharmacy Accreditation for Nurses education. This nursing continuing professional development activity was approved by the Maryland Nurses ACPE #: 0204‐0000‐20‐429‐H05‐P Association, which is an accredited approver by the 1.5 hr, application‐based American Nurses Credentialing Center’s Accreditation for Physicians Commission on Accreditation. The American Society of Health System Pharmacists is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. Provided by ASHP Supported by an educational grant from Baxter Healthcare Corporation Claim CE Within 60 Days To receive CE credit, complete the steps below within 60 days of completing the activity. 1. View the entire presentation and answer all polling questions. 2. Click "Complete Activity" on last slide to complete assessment and evaluation and claim credit. 3. Verify credits were successfully transferred to CPE Monitor before the ACPE 60‐day deadline by checking your NABP eProfile account. After the 60‐day deadline, ASHP will no longer be able to report credit(s). ASHP FINANCIAL RELATIONSHIP DISCLOSURE STATEMENT Planners, presenters, reviewers, ASHP staff, and others with an opportunity to control CE content are required to disclose relevant financial relationships with ACCME‐defined commercial interests. All actual conflicts of interest have been resolved prior to the continuing education activity taking place. ASHP will disclose financial relationship information prior to the beginning of the activity. A relevant financial relationship is defined as a financial relationship between an individual (or spouse/partner) in control of content and a commercial interest, in any amount, in the past 12 months, and products and/or services of the commercial interest (with which they have the financial relationship) are related to the continuing education activity. An ACCME‐defined commercial interest is any entity producing, marketing re‐selling, or distributing healthcare goods or services consumed by, or used on, patients. The ACCME does not consider providers of clinical service directly to patients to be commercial interests—unless the provider of clinical service is owned, or controlled by, an ACCME‐defined commercial interest. © Massachusetts General Hospital. All rights reserved. 1 SYRINGE INFUSION PUMPS: A Comprehensive Overview & Considerations for Use at Low Delivery Rates SLIDE 1 SLIDE 2 © Massachusetts General Hospital. All rights reserved. 2 SYRINGE INFUSION PUMPS: A Comprehensive Overview & Considerations for Use at Low Delivery Rates SLIDE 3 SLIDE 4 © Massachusetts General Hospital. All rights reserved. 3 SYRINGE INFUSION PUMPS: A Comprehensive Overview & Considerations for Use at Low Delivery Rates SLIDE 5 SLIDE 6 © Massachusetts General Hospital. All rights reserved. 4 SYRINGE INFUSION PUMPS: A Comprehensive Overview & Considerations for Use at Low Delivery Rates SLIDE 7 SLIDE 8 © Massachusetts General Hospital. All rights reserved. 5 SYRINGE INFUSION PUMPS: A Comprehensive Overview & Considerations for Use at Low Delivery Rates SLIDE 9 SLIDE 10 © Massachusetts General Hospital. All rights reserved. 6 SYRINGE INFUSION PUMPS: A Comprehensive Overview & Considerations for Use at Low Delivery Rates SLIDE 11 SLIDE 12 © Massachusetts General Hospital. All rights reserved. 7 SYRINGE INFUSION PUMPS: A Comprehensive Overview & Considerations for Use at Low Delivery Rates SLIDE 13 SLIDE 14 © Massachusetts General Hospital. All rights reserved. 8 SYRINGE INFUSION PUMPS: A Comprehensive Overview & Considerations for Use at Low Delivery Rates SLIDE 15 SLIDE 16 © Massachusetts General Hospital. All rights reserved. 9 SYRINGE INFUSION PUMPS: A Comprehensive Overview & Considerations for Use at Low Delivery Rates SLIDE 17 SLIDE 18 © Massachusetts General Hospital. All rights reserved. 10 SYRINGE INFUSION PUMPS: A Comprehensive Overview & Considerations for Use at Low Delivery Rates SLIDE 19 SLIDE 20 © Massachusetts General Hospital. All rights reserved. 11 SYRINGE INFUSION PUMPS: A Comprehensive Overview & Considerations for Use at Low Delivery Rates SLIDE 21 SLIDE 22 © Massachusetts General Hospital. All rights reserved. 12 SYRINGE INFUSION PUMPS: A Comprehensive Overview & Considerations for Use at Low Delivery Rates SLIDE 23 SLIDE 24 © Massachusetts General Hospital. All rights reserved. 13 SYRINGE INFUSION PUMPS: A Comprehensive Overview & Considerations for Use at Low Delivery Rates SLIDE 25 SLIDE 26 © Massachusetts General Hospital. All rights reserved. 14 SYRINGE INFUSION PUMPS: A Comprehensive Overview & Considerations for Use at Low Delivery Rates SLIDE 27 SLIDE 28 © Massachusetts General Hospital. All rights reserved. 15 SYRINGE INFUSION PUMPS: A Comprehensive Overview & Considerations for Use at Low Delivery Rates SLIDES 29 & 30 QUESTION SLIDE SLIDE 31 © Massachusetts General Hospital. All rights reserved. 16 SYRINGE INFUSION PUMPS: A Comprehensive Overview & Considerations for Use at Low Delivery Rates SLIDE 32 SLIDE 33 © Massachusetts General Hospital. All rights reserved. 17 SYRINGE INFUSION PUMPS: A Comprehensive Overview & Considerations for Use at Low Delivery Rates SLIDE 34 SLIDE 35 © Massachusetts General Hospital. All rights reserved. 18 SYRINGE INFUSION PUMPS: A Comprehensive Overview & Considerations for Use at Low Delivery Rates SLIDE 36 SLIDE 37 © Massachusetts General Hospital. All rights reserved. 19 SYRINGE INFUSION PUMPS: A Comprehensive Overview & Considerations for Use at Low Delivery Rates SLIDE 38 SLIDE 39 © Massachusetts General Hospital. All rights reserved. 20 SYRINGE INFUSION PUMPS: A Comprehensive Overview & Considerations for Use at Low Delivery Rates SLIDE 40 SLIDE 41 © Massachusetts General Hospital. All rights reserved. 21 SYRINGE INFUSION PUMPS: A Comprehensive Overview & Considerations for Use at Low Delivery Rates SLIDE 42 SLIDE 43 © Massachusetts General Hospital. All rights reserved. 22 SYRINGE INFUSION PUMPS: A Comprehensive Overview & Considerations for Use at Low Delivery Rates SLIDE 44 SLIDE 45 © Massachusetts General Hospital. All rights reserved. 23 SYRINGE INFUSION PUMPS: A Comprehensive Overview & Considerations for Use at Low Delivery Rates SLIDE 46 SLIDE 47 © Massachusetts General Hospital. All rights reserved. 24 SYRINGE INFUSION PUMPS: A Comprehensive Overview & Considerations for Use at Low Delivery Rates SLIDE 48 SLIDE 49 © Massachusetts General Hospital. All rights reserved. 25 SYRINGE INFUSION PUMPS: A Comprehensive Overview & Considerations for Use at Low Delivery Rates SLIDE 50 SLIDES 51 & 52 QUESTION SLIDE © Massachusetts General Hospital. All rights reserved. 26 SYRINGE INFUSION PUMPS: A Comprehensive Overview & Considerations for Use at Low Delivery Rates SLIDES 53 & 54 QUESTION SLIDE SLIDE 55 © Massachusetts General Hospital. All rights reserved. 27 SYRINGE INFUSION PUMPS: A Comprehensive Overview & Considerations for Use at Low Delivery Rates SLIDE 56 SLIDE 57 © Massachusetts General Hospital. All rights reserved. 28 SYRINGE INFUSION PUMPS: A Comprehensive Overview & Considerations for Use at Low Delivery Rates High Level Course Summary When using syringe infusion pumps to deliver at low infusion rates there can be delivery issues that arise from the inherent nature of how the system operates. 2016 FDA Safety Communication noted fluid flow continuity/uniformity concerns when using syringe infusion pump at low delivery rates. What are these issues? Startup Delays (i.e., slack, breakout force, compliance) Post-occlusion Boluses Flow Uniformity Concerns During Delivery (e.g. stick-slip flow) Temporary Delivery Deviations Due to Height Changes Occlusion Alarm Delays Gravity Siphoning What are some steps you can take to mitigate these issues? Most of these issues are more pronounced when ... Delivering at low flow rates Using larger syringe sizes (pump mechanisms moving slower) (greater compliance and less linear travel of the plunger head) Therefore... Therefore... Adopt standardized concentrations Consider how you select the (e.g. ASHP’s Standardize4Safety) optimal syringe size A fixed selection
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