We have recently switched to using the Hospira Plum A pump and we are having issues with our psi settings. I was wondering if anyone could help me. What are your current psi settings for your adults and for children, and where might I find more information about this? Thanks for your help.
What is the range of possible psi settings? You are actually setting the level for an occlusion alarm to occur, which is the amount of back pressure the pump is measuring. You are not setting the actual pumping pressure. These settings are usually around 5 psi or less. Normal venous pressure in the hand and forearm is around 35 mm Hg or 0.7 psi. Pressure in the SVC is 0. Infusion by gravity at 3-4 feet above the site is ~2 psi. So an occlusion pressure of 4 to 5 psi should be adequate to avoid a lot of unnecessary nuissance alarms. Can you be more specific about the problems you are having?
Lynn Hadaway, M.Ed., RN, NPD-BC, CRNI
Lynn Hadaway Associates, Inc.
PO Box 10
Milner, GA 30257
Website http://www.hadawayassociates.com
Office Phone 770-358-7861
The pumps came preset at 6psi. The first 24-48 hours was pure heck for nursing with alarms constantly going off. They have since tamed down, but I was told that nursing is going in and manually changing the psi rates on each pump. I was told the range of psi on these pumps is 6-15? I believe our psi on our last pumps was set at 12-14 for adults and 6 for children and infants. I am not familiar enough with the ranging of psi that I feel comfortable telling them what a "normal" psi should be. Is there a safety issue involved with nursing changing these settings manually with each different patient? We never had this issue with our old pumps (Alaris) and never had to change the psi rates. Could you please address if there is a safety issue with this?
Thank you!
Kimberly Masser CRNI
Vascular Access Services
Frederick Memorial Hospital
Frederick, MD 21702
For peripheral infusions, all infusion pumps will continue to pump fluid regardless of where that fluid is going. So if there is an infiltration/extravasation occuring, the only thing that will stop any pump is an astute nurse finding it and stopping the pump. When the occlusion pressure is set very high and I would consider above 10 psi to be very high, there will be more fluids pumped into the tissue before the back pressure is detected and the alarm occurs. Many nurses have the mistaken idea that the alarms are to indicate when there is a problem such as infiltration but this could not be more wrong!!
For central venous catheters, the venous pressure is zero, so you do not need the high psi for the occlusion setting.
The only time you would need a high psi setting is for arterial infusions because the pumping pressure must overcome arterial pressure.
I do think that having the same psi setting is the best route. Some pumps do not allow the nurses to change the psi settings while others do. Is there a way for your biomedical engineers to override this setting and set all pumps at the same psi and take this control away from the nurse?
PSI settings that are too low will produce more nuissance alarms, causing alarm fatigue and the nurses ignore the alarms. This will also cause the nurse to change to a high setting which could lead to some nasty infiltration and extravasation injuries if they are not monitoring those sites very closely at least every 2 hours. What are you most common rates? Probably 125 mls per hour. In 2 hours there could be 250 mls in the tissue. What are your policies for site monitoring? If it is only once a shift and you work 12 horus shifts, there could be a whole liter for fluid in the tissue before it is found when using a high psi setting.
Lynn Hadaway, M.Ed., RN, NPD-BC, CRNI
Lynn Hadaway Associates, Inc.
PO Box 10
Milner, GA 30257
Website http://www.hadawayassociates.com
Office Phone 770-358-7861