overfill/flushing topic from the ISMP Smart Infusion Pump Summit

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Tue, 10/30/2018 - 17:18
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Karen Thompson
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Joined: 05/03/2009 - 02:30
overfill/flushing topic from the ISMP Smart Infusion Pump Summit

Has anyone been successful in tackling this item from the “ISMP National Summit Optimizing Safe Implementation and Use of Smart Infusion Pumps: Post Summit Draft Safe Practice Statements”:

"2.14 Standardize the management of infusion OVERFILL, volume to be infused (VTBI), and FLUSHING parameters (for INTERMITTENT INFUSIONS)."

This topic gets debated at my facility every couple of years, and we've never come to a consensus on how to handle it.

How would your RNs infuse this medication?: vancomycin 1.25 grams in 250mL NS IVPB over 90 minutes.
-drug volume = 12.5mL
-250mL bag NS = 250mL
-overfill in 250mL bag of NS = 12.5-25mL
TOTAL VOLUME OF IVPB = 275-287.5mL

a. 250mL over 90 minutes. (Discard any remaining volume in the bag)
b. 250mL over 90 minutes, then program extra volume over X minutes until the bag runs dry
c. 262.5mL over 90 minutes (EHR/bag label accounts for the added drug volume. Discard any remaining volume in the bag.)
d. other???

Does your answer to the question above change with pre-mixed IVPBs (e.g., levofloxacin 750mg/150mL - administering every last drop, including overfill, would provide > 750mg)?

Our infusion pumps do not currently interface with our EHR. I imagine that will affect our current practice.

Also, do you have a policy for when/how to flush after IVPBs? When administering a 50mL IVPB of medication, the tubing volume can be significant.

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