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™. 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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. 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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