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Large-volume intravenous (IV) smart pumps are the most widely used infusion devices in U.S. acute care hospitals due to their versatility in administering both fluids and medications.1,2 Recent data from U.S. acute care settings support an adoption rate of 99% for IV smart pumps with built-in dose error reduction software designed to mitigate medication administration errors.3 Although data support that IV smart pumps can reduce medication administration errors, they have not eliminated error, including serious adverse drug events with high-alert medications.4–10
Secondary medication administration by large-volume IV smart pump is used extensively in U.S. acute care settings for administering IV medications ordered for one-time or intermittent dosing. The most commonly used method for secondary administration requires the primary continuous infusion to pause during the secondary infusion, then resume automatically after the secondary infusion is complete.1,11–13 The secondary infusion delivery method typically is used for administration of antibiotics and electrolyte replacement therapy.14
Research has identified secondary medication infusions as particularly error prone.12,14 Both the setup and usability of most IV smart pump systems are complex, vary among different IV smart pump types, and have numerous associated failure modes that are not easily detected at the point of care.12 The majority of secondary medications are infused using the “head height differential” method, which requires a differential between the top of the fluid level in the primary and secondary fluid containers. These differentials generate the hydrostatic pressure required to close the primary tubing back-check valve and facilitate accurate secondary medication infusion (Figure 1).
Figure 1.
Required components for secondary medication infusion using the head height differential method. Used with permission from Karen K. Giuliano.
[Image Omitted. See PDF.]
IV smart pump systems from BD/Alaris, Baxter/Sigma, B. Braun, and Zyno use this method, with each having specific head height differentials and setup requirements.15–18 In contrast, a cassette pumping mechanism is used for other devices (e.g., manufactured by ICU Medical Plum and Ivenix) pumps. The user setup requirements for these cassette systems do not require a head height differential or back-check valve. Instead, when administering a secondary medication, the cassette provides a separate fluid path for secondary infusion, which is controlled independently from the primary infusion.
It is important for nurses to...