Comparative Analysis of Intravenous Pumps Relocation for Critically Ill Isolated COVID-19 Patients From Bedside to Outside the Patient Room

Abstract

Objectives: To quantify the impact of IV pump relocation for COVID-19 patients from the bedside to outside the patient room on nurse exposure to COVID-19 and conservation of PPE. Design: Original Article Setting: Intensive care units at a single-center teaching hospital. Patients: Critically ill COVID-19 patients under contact and special droplet precautions. Interventions: Relocation of intravenous pumps for COVID-19 patients from bedside to outside the patient room using extension tubing. Measurements and Main Results: The primary objective of the study was to measure the impact of this strategy on COVID-19 exposure, utilizing the number of nurse entries into the patient room as a surrogate endpoint, and extrapolation of this data to determine the reduction or PPE usage. Secondary endpoints included incidence of extravasation, hyperglycemia, hypotension, and diagnosis of CLABSI/bacteremia. A statistically significant reduction in the primary endpoint of the study was observed as room entries prior to pump relocation averaged 15.36 (± 4.10) as opposed to an average of 7.92 (± 2.19) following pump relocation (p < 0.0001). In both pre- and post-pump relocation groups, there was no incidence of extravasation or CLABSI. No significant differences were noted in number of patients experiencing hyperglycemia, hypotensive episodes, or bacteremia. Conclusions: There was a significant decrease in COVID-19 exposure based on the number of nurse entries following the relocation of intravenous pumps from inside to outside of the patient room. These results may be cautiously extrapolated to suggest a decrease in personal protective equipment utilization. Future prospective, randomized controlled trials investigating the impact of this strategy are required.

Using a Patient Safety Analysis to Guide Infusion Therapy for Patients With COVID-19

“…With a current pandemic and limited resources, “This practice should be given consideration, 17 ” although cautions were also offered about this practice: it is not ideal and is not recommended under typical circumstances. Shah et al 18 then studied the impact of this practice on 18 patients with COVID-19 before and after pump location inside and outside COVID-19 ICU patient rooms. They found significantly fewer nurse entries into the COVID-19 ICU rooms after pumps were situated outside the rooms ( P < .0001); this was cautiously extrapolated into a corresponding decrease in PPE use.…”

“…Also, there were no reports of CLABSI or extravasation for these patients, mirroring the HFMEA pump team's experience of no reported CLABSIs. 18 …”

Extending tubing to place intravenous smart pumps outside of patient rooms during COVID-19: an innovation that increases medication dead volume and risk to patients

“…In addition, recent data support that this practice can significantly decrease in COVID-19 exposure based on a reduction of the number of nurse entries into the patient's room following the relocation of intravenous pumps from inside to outside of the room. 13 There are numerous concerns related to elongated tubing, including physical safety and tripping hazards for clinicians. Potential patient safety issues include increased infection risk, line dislodgement and challenges associated with ensuring the five rights of medication administration.…”

Assessment of the Value of a Carriage System to Organize and Elevate Intravenous Tubing

“…Early after the COVID-19 pandemic began, intensive care nurses placed intravenous (IV) pumps outside of patients' rooms to save personal protective equipment and reduce caregiver exposure. 1,2…”