Our facility is looking at our current practice of hanging all small volume IV medications as secondaries. We currently consider any volume less than 500 mls to be "small volume". This is to minimize waste, but for patients without a primary, fluid must be hung to use as that primary in order to flush the line. I have not been able to find anything in the literature or the internet that gives any guidance for this practice. We use the Alaris pumps; the volume for the primary tubing is 25 ml; the secondary (Baxter) is small (probably less than 10 mls).
Can people please share their policy for infusion of small volume minibags? Thank you, Nan
Are you talking about allowing this fluid to remain connected to the IV catheter? Or are you planning to disconnect it after the fluid has flushed the med from the set? I would not recommend the first option as this could easily prevent the patient from ambulation and working toward discharge due to encumberance of pump, set, etc. Also, this fluid requires either a patient-specific prescription or a written and approved protocol that the nurse would initiate. Fluid volume needs to be documented also. Lynn
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
We disconnect the fluid after the flush, if the primary is only being used for this purpose. We have a protocol in place which covers the order for the fluid for the flush. We document any volume that is noted in the IV pump as infused.
Is there an amount of volume in the minibag that would be considered sufficient to just run it as a primary? I can see doing this for 50 and 100 ml bags, but when we do it for 250 ml bags, it seems like the percentage waste may not be enough to warrant the extra bag for flushing. The tubing container states that it holds 25 ml, so that would be too much, but if it were allowed to run through, there would be much less waste. Thanks, Nan
No there is no specific amoutn of volume in the minibag that would allow you to infuse it as the primary. That minibag would have the medication compounded in it, therefore the entire volume must be infused at the time the dose is due. An electronic infusion pump set will hold a significant portion of that dose and must be flushed out with a compatible fluid. In home care, small ambulatory infusion pumps are used for delivery of IV meds with only the solution containing the med connected to the pump and patient. This system is used when this type of pump is in the best interest of the patient because they can not manage the connection and disconnection and manual flushing of the VAD with each dose. A nurse will change this system usually on a daily basis. Between intermittent doses, the rate drops to 0.2 to 0.4 mL per hour, then is programmed to ramp up to the med infusion rate at the time the med is due. Large volumetric pumps used in hospitals do not allow for this extremely slow flow rate unless it is a pump used for neonates/pediatrics. I have my doubts about whether an electronic infusion pump is necessary for intermittent infusion in the hospital. It adds questions such as what you are dealing with in this message. It adds costs. I am not so sure it adds enough benefit to outweigh these issues, but there is no evidence to answer that question. For far more years that I care to think about, we infused these intermittent doses of meds by gravity infusion in the hospital. That would require nurses learning to count drops and regulated rates manually. Again no evidence to weight risk vs benefits. kLynn
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