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

Abstract

The COVID-19 pandemic has stretched hospitals to capacity with highly contagious patients. Acute care hospitals around the world have needed to develop ways to conserve dwindling supplies of personal protective equipment (PPE) while front-line clinicians struggle to reduce risk of exposure. By placing intravenous smart pumps (IVSP) outside patient rooms, nurses can more quickly attend to alarms, rate adjustments and bag changes with reduced personal risk and without the delay of donning necessary PPE to enter the room. The lengthy tubing required to place IVSP outside of patient rooms comes with important clinical implications which increase the risk to patient safety for the already error-prone intravenous medication administration process. This article focuses on the implications of increasing medication dead volume as intravenous tubing lengths increase. The use of extended intravenous tubing will lead to higher medication volumes held in the tubing which comes with significant safety implications related to unintended alterations in drug delivery. Safe intravenous medication administration is a collaborative responsibility across the team of nurses, pharmacists and ordering providers. This article discusses the importance and safety implications for each role when dead volume is increased due to IVSP placement outside of patient rooms during the COVID-19 pandemic.

The initial and lingering impact of coronavirus disease 2019 (COVID-19) on catheter-associated infections in a large healthcare system in New York City

“…4,[6][7][8] The use of extension tubing to allow for adjustment of pumps outside patient rooms may have also contributed to a decrease in catheter checks. 9 Both staffing and personal protection equipment shortages have been proposed as contributory factors for increased catheter-associated infections. 4,7,8,10 From February 2020 to May 2021, decreases in registered and licensed practical nurses occurred in the NYC Health þ Hospitals Enterprise (www.osc.state.ny.us/files/reports/osdc/pdf/report-9-2022.pdf).…”

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

“…The authors noted that it is essential to prevent transmission of infections, to keep patients safe, and to protect clinicians during a pandemic 19. Last, implications for nurses, pharmacists, and providers when IV pumps are situated outside COVID-19 ICU patient rooms were summarized by an interprofessional team 20. An important point was that nurses need more information and education when working with remotely situated IV pumps, although during a crisis time is at a premium.…”

Intravenous Smart Pumps at the Point of Care: A Descriptive, Observational Study

“…Hang the primary container above the pump, ensuring the top of the fluid line is 24 ± 2 inches above the center of the pump. 22 …”

“…Our work is based on a human factor perspective, 20 and in our previous work, we have outlined the limitations of current technology, 1,6,21,22 studied clinician knowledge, 23 studied the impact of interruptions, 24 and looked at the use of the BD/Alaris, ICU Medical (ICU Medical, Inc., San Clemente, CA), and Ivenix large volume IV smart pumps (50 High St Suite 50, North Andover, MA) during actual clinical use. 9,25 Thus, for this study, we again chose to use a real-world approach to observe how the Baxter/Sigma IV smart pumps (One Baxter Parkway Deerfield, IL) are used during actual clinical use.…”