Friday, January 11, 2008

Friday January 11, 2008
Changeovers of vasoactive drug infusion pumps

Hemodynamic instability during the changeover of vasoactive infusion pump (CVIP) is a common site in ICUs. Interesting article published very recently in Critical Care 1 in which the impact of a "quick change method" of CVIP (2 syringes) was assessed and compared with regular (single syringe) method.

Study was done (compared) in 2 phases.

Phase 1: In this phase, nurses were free to choose the method of changeover of CVIP they usually practice.

Phase 2: In this phase, strategy called “quick change method” is applied. using two syringe drivers. This consisted loading the new infusion with a new line into a new syringe pump, and priming the line when the running infusion was about to finish.
Nurses started the pump and chose a high flow rate until a drop of vasoactive drug appeared on the end of the line, in order to avoid a start up delay. Next, they programmed the pump to same rate and setting as the previous infusion. After that, they removed the cap from the spare port of the three-way stopcock and connected it the new infusion pump. Then, they turned the three-way stopcock on to the new infusion, which closed the lumen of the old infusion. Lastly, they had to disconnect the old infusion and put a cap on the new spare port.

913 changeovers of infusion pumps were evaluated: 435 in phase 1 and 478 in phase 2.

Results: The frequency of incidents was significantly reduced in phase 2 (5.9%, n=28) versus phase 1 (17.8%, n=78) with 98% of incidents were blood pressure variations.

References: click to get abstract / article

1. Changeovers of vasoactive drug infusion pumps: impact of a quality improvement program - pdf file, Critical Care 2007, 11:R133

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