The “WHY” Behind Infusion Pump Alarms Tim Vanderveen, PharmD, MS Med Safe Practices LLC San Diego, CA April, 2017

The following short term strategies are Tim Vanderveen’s opinion

Short Term Strategies With high percentage of air alarms right after infusion start, reinforce slow priming of IV tubing. Closing roller clamp before priming and filling drip chamber 2/3rd full improves priming and does not waste fluid. Do not “Burp” the air from IV bags. This can lead to significant air in the tubing that comes from the air in the drip chamber. Always Pause an infusion before changing an IV container. Turning the IV spike upside down allows air to enter the set. Refrigerated infusions warm up and outgas: consider preparation and storage practices and warm fluids to room temperature where possible. Certain drugs and fluids tend to have multiple air alarms; consider adding anti-siphon valve for drugs such as etoposide, albumin, IVIG. Volumes to be infused are frequently used as reminders to visit the patient; 2 and 4 hour VTBI limits. Battery alarms are frequent – check to see if transport attendants, physical therapists, are assisting by plugging in pumps upon patient return

Short Term Strategies Frequent occlusions can be due to catheter placement. Consider arm boards or limited motion dressings to reduce catheter kinking, catheter location. Certain fluids and drugs in bottles (proteins, lipids, high surfactant content) can wet IV spike filter and cause fluid side occlusions alarms. Bottles must be vented. More frequent IV set changes may be required if the infusions are stopped for extended periods or multiple bottles are administered with same set With high percentage of pump alarms occurring while caregivers are at the pump, consider distribution of tips to reduce these alarms (example: manually close flo-stop clamp before installing the set). Consider reducing alarm loudness during night shift. Review practices that lead to alarms; example is infusing antibiotics as primaries rather than secondary infusions. Evaluate the need for certain alerts, such as near end of infusion (NEOI), secondary to primary 6 beeps at transition

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