Hi,
an issue just rose from our haematology dept. They have decided that they will no more infuse chemo (unspecified) with the aid of a pump, if it is given through a PIV. Given through a CVAD it´s OK, they say. Here at the oncology dept, we give everything with the aid of pumps, even through a PIV. My feeling is that the pump gives me extra security, sounding off if there is increased resistance. They claim that the pump will continue to infuse if extravasation occurs, but without a pump it will stop infusing if extravasation occurs, or at least extravasate less. Any views on that? Probably no available evidence, right?
Mats
There is absolutely no infusion pump currently made that will limit, reduce, or mitigate any extravasation event. Infusion pumps will continue to pump regardless of the fluid pathway. So the idea of them indicating that resistance is being encountered to let you know that there is an extravasation is fruitless. Yes, you might get an occlusion alarm but most nurses restart it and ignore what they perceive to be a nuisance alarm. The catheter punctures through the vein wall and there is no resistance any more from the subcutaneous tissue. There are numerous warnings in the US about the misconception that pumps can prevent infiltration/extravasation injury. The fact is that they can not do this and make no claim about doing this in their literature. While pumps do not cause infiltration/extravasation, they do make the event much worse than with a gravity infusion. The evidence is the mechanism of the pump itself and the manufacturer's instructions for use. Anytime I review a legal case involving infiltration/extravasation, the use of a pump is one of the first things I look for. The subcutaneous tissue offers no resistance and in fact, has numerous compartments where fluid can easily be trapped. So I can well understand this change in policy. 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
ð For a vesicant drug in a peripheral vein
o Avoid the use of an IV pump
o Monitor the patient frequently for extravasation – ideally every 5 minutes
o Avoid hanging vesicant agents for extended periods, if possible
To piggyback onto what Kathy said, ONS states that PIV gravity infusions of vesicants should not be for longer than 30-60 min, the nurse should remain with the pt during the infusion to visually monitor the site and verify blood return q 5-10 min. Using a pump is avoided. Question to ask yourself as to why this is the case: what is the normal pressure of the interstitial tissue and what is your pump alarm PSI threshold set at? It usually requires a fair amount of fluid in order to elevate to your pump theshold.