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Toxic concentrations of medications, which may result in a shock-like syndrome (‘speed shock’).
Air embolism, due to containers running dry before expected.
An increase in venous complications, for example chemical phlebitis, caused by reduced dilution of irritant substances (Weinstein and Plumer 2007).
Complications associated with underinfusion
Dehydration.
Metabolic disturbances.
A delayed response to medications or below therapeutic dose.
Occlusion of a cannula/catheter due to slow flow or cessation of flow.
(Quinn 2008, p.195)
Box 13.16 Criteria for selection of an infusion device
Rationalization of devices.
Clinical requirement.
Education.
Compatibility with other equipment.
Disposables.
Product support.
Costs.
Service and maintenance.
Regulatory issues, for example compliance with European Community Directives (Department of Health, Social Services and Public Safety 2006, Health Care Standards Unit, 2007a, 2007b, MHRA 2010b, NHS Litigation Authority 2007, Quinn 2000).
Strategies need to be developed for replacement of old, obsolete or inappropriate devices (Department of Health, Social Services and Public Safety 2006, Health Care Standards Unit 2007a, 2007b, MHRA 2010b, NHS Litigation Authority 2007, Quinn 2000), planned service maintenance programmes and acceptance testing (MHRA 2010b).
Healthcare professionals are personally accountable for their use of infusion devices and they must therefore ensure they have appropriate training before using the pump (MHRA 2008a, Quinn 2008). Records of training should also be maintained.
Improving infusion device safety
A high frequency of human error is reported in the use of infusion device systems, so competence-based training is advocated for users of these systems (MHRA 2010b, NPSA 2004). By rationalizing the range of infusion device types within organizations and the establishment of a centralized equipment library, the number of patient safety incidents will be reduced (MHRA 2010b, NPSA 2004). Smart infusion pumps reduce pump programming errors by the setting of pre-programmed upper and lower dose limits for specific drugs. The pump will alert the nurse when setting the infusion device if the pump has been set outside the preset dose limits (Keohane et al. 2005, Weinstein and Plumer 2007, Wilson and Sullivan 2004). Whatever infusion device is used, the need to monitor the patient and the device remains paramount for patient safety (Quinn 2008, RCN 2010).
Preprocedural considerations
Equipment
Vascular access devices
Administration sets
An administration set is used to administer fluids or medications via an infusion bag into a VAD. The set comprises a number of components (see Figures 13.24, 13.25). At the top is a spike which is inserted into the infusion container via an entry port. This is covered by a sterile plastic lid which is removed just prior to insertion into the container (Downie et al. 2003). The plastic tubing continues from the spike to a drip chamber which may contain a filter. This is filled by squeezing it when attached to the fluid and waiting for the chamber to fill halfway, thus allowing the practitioner to observe the drops. Along the tubing is a roller clamp which allows the tubing to be incrementally occluded by pinching the tubing as the clamp is tightened; this is used to adjust the rate of flow (Hadaway 2010). It is usually positioned on the upper third of the administration set but should be repositioned along the set at intervals as the tubing can develop a ‘memory’ and not regain its shape, making it difficult to regulate (Hadaway 2010). It is opened to allow the fluid along the tubing to remove the air and then closed until attached to the patient’s VAD. Finally the Luer-Lok end is covered with a plastic cap to maintain sterility until ready to be attached (Downie et al. 2003).
Figure 13.24 Fluid administration set.
Figure 13.25 Labelled administration set.
There is a variety of sets. A solution set is used to administer crystalloid solutions (it can be used as a primary or secondary