The following are some tips to keep in mind when working with the Medsystem III pumps. There are also some general tips not applying specifically to these pumps, but which make moving patients with multiple infusions running easier.
- The key to making this system work in the transport environment is to avoid “air in line” alarms. Properly prime all lines by purging the air from bags and lines before installing the cassette into the pump. The procedure is similar to setting up an invasive line transducer. If there is no air in the system, there cannot be air in the line. This has the additional benefit of allowing the bags to be placed in any position—for example, laid down between the patient’s legs while moving between beds.
- Use half sets with syringes for small-volume or slow-running infusions. It is much easier to draw the remaining 20 cc’s of fluid out of a 100 cc bag and run the infusion off the syringe than to attempt to purge all the air in the bag through the line.
- If there is a “Check Fluid Side” alarm, and everything appears to be set up correctly, confirm it rather than canceling it. This will display a check mark on the main display. Simply canceling/clearing the alarm will cause it to recur in a few minutes.
- When setting the Alaris pump(s) up for a patient who must be moved from a bed to the gurney, use a dedicated IV pole positioned at the foot of the beds. This will allow all lines to be routed down one leg and avoid tangling them as the patient is moved.
- Check drug compatibility and use stopcock manifolds to combine as many drips as possible in as few lines as possible. While not ideal in the ICU setting, this simplifies transport greatly. Ensure that there is always one IV available for bolus injections.
- Label lines at the patient and the pump (if necessary).
- A ventilator circuit cut to length and cut lengthwise makes an improvised sheath for combining and cleaning up easily tangled lines.
- Before removing a bag of medication from a bedside pump, fill the drip chamber. You may then secure the drip chamber in an upright position (tape it to the pole/wall/etc.) and it will continue running from the chamber, allowing a window of time to set up the transport pump and transition the infusion.
- To bolus a medication from a continuous infusion, set the volume remaining (VR) to the amount of fluid to bolus, and then set the rate to 999 cc/hr. Once the bolus is complete, change these settings to their prior values to resume the original infusion. If frequent or fast boluses are required, it may be easier to use a separate syringe in the line on a three way stopcock to administer boluses from.