E 10 Use of the Syringe Driver (Pump) – Kasupe

This equipment is important for IV fluids as decribed in Fluid Management in a NYI

Subsection of this chapter:

1. Clinical Problem
2. Assessment
3. Management
4. Infection Prevention
5. Complications
6. Care & Maintenance
7. Troubleshooting & Repair

Here the principles of using a syringe driver (pump) are presented.

Syringe drivers are available from many manufacturers and may differ in the type and size of syringe that can be used, the position of the control switches and layout of the LED display. The user needs to follow the manufacturer’s instructions for the device in their department.

Clinical Problem

All babies who require administration of intravenous fluids, especially for maintenance or resuscitation will need a syringe driver to deliver the fluids.

Assessment

Patients who are not being fed are at risk of developing hypoglycaemia and dehydration. Syringe drivers are used for the controlled infusion of small volumes of intravenous fluids over minutes or hours.

A syringe driver uses an internal motor to push a syringe plunger at very slow rates to ensure controlled delivery of low volumes of fluid. Syringe drivers may be calibrated for specific syringe brands and sizes and may have internal medicine libraries that can store flow rates and delivery volumes for specific types of fluids.

Normal standards related to care

Patients should receive intravenous fluid per hour, based on their weight and age. Due to their small weights, neonates should never be given fluid too quickly or in too large volumes.

Management

Management of a syringe pump covers how to use the device in a variety of settings, including set up for a patient, patient preparation & commencement, care whilst on the device & removal of the patient from the device.

SETTING UP FOR A PATIENT

1. Collect:
• Syringe driver
• Power cable
• Clearly labelled syringe of treatment fluid
• Extension tubing
2. Connect the power cable to the syringe driver. Plug into socket and turn on socket.
3. Place the syringe in the syringe channel. Secure with the syringe clamp. Move the syringe pusher to the top of the syringe plunger.
4. Turn on the syringe driver. Set the desired flow rate and volume on the syringe driver. Press start.
5. Check that fluid is coming out of the tip of the syringe. Connect extension tubing to the end of the syringe and allow fluid to flush through the extension tubing. Ensure fluid is coming from the end of the extension tube and that there are no air bubbles in the system.

PREPARING A PATIENT

If the patient is cannulated:

1. Collect:
• Gloves
• 70% alcohol
• Cotton swab
• Labelled syringe of normal saline
2. Wash hands and put on gloves.
3. Clean end of cannula using cotton swabs soaked in 70% alcohol.
4. Flush cannula with 1 ml normal saline .If the site provides pressure as it is flushed or if the skin around the site becomes puffy, the line may not have been placed correctly. Reassess or replace line.

If the patient is not cannulated:

1. Collect:
• Gloves
• Gauze or cotton swabs
• 70% alcohol
• Intravenous cannula (24 gauge)
• Tape
• Syringe of normal saline
2. Wash hands and put on gloves.
3. Clean patient’s arm using cotton swabs or gauze soaked in alcohol. Grip patient’s arm, to create a gentle tourniquet. Never use an elastic band or thin gloved sleeve to create a neonatal tourniquet. Insert intravenous cannula into vein. Wait for flash of blood.
4. Continue inserting cannula while gently pulling needle out of the patient’s arm. Blood should continue coming out of the cannula.
5. Flush cannula with 1 ml normal saline. If the site provides pressure as it is flushed or if the skin around the site becomes puffy, the line may not have been placed correctly. Reassess or replace line.
6. If the cannula flushes correctly, cap cannula.
7. Tape the cannula in place using tape to ensure it is secure. View of the cannula should not be obstructed. Never encircle the limb with tape as this can cause vascular compromise.
8. Apply a splint if needed to prevent occlusion of the extension tubing

STARTING A PATIENT

1. Check that the extension tubing is full of fluid. There should be NO AIR GOING INTO THE CANNULA.
2. Set syringe driver to appropriate rate and delivery volume. Wait until a drop of fluid forms on the end of the extension tubing.
3. Attach the tubing to the cannula.
4. After 30 minutes, assess the cannula site for redness, swelling or cannula displacement. If the site is puffy, the fluid is not running or the syringe driver is alarming:
   • Stop the syringe driver.
   • Flush the cannula to assess patency. If not patent, remove cannula and replace on a different extremity

CARING FOR A PATIENT

As a minimum the patient should be assessed no less frequently than 4 hourly for:

1. Any puffiness or redness around the cannula site
2. Cannula displacement
3. Vital signs, including respiratory rate, heart rate, oxygen saturation and temperature
4. Fluid balance using input/output charts
5. Blood sugar

The time of the treatment should be carefully recorded. The syringe driver should be monitored frequently to check:

1. Remaining syringe fluid volume
2. Any alarms, including occlusions or similar

If the syringe volume finishes and the patient requires additional fluids, repeat the process for Starting a patient on a syringe driver.

REMOVING A PATIENT

If the delivery of fluids is complete and the patient does not require more fluid, press Stop on the syringe driver. Remove the extension tubing and cap the cannula.

Infection Prevention

Routine and adequate cleaning of medical devices is critical to prevent hospital-acquired infections in newborn care units. If devices and equipment are not disinfected or reprocessed promptly or adequately between patients, they may pose a significant infection risk.

GENERAL INFECTION PREVENTION

1. Clean hands with soap and water or alcohol before and after assessing a patient for commencement on a syringe driver or handling any materials that will be used on a patient (e.g. an intravenous catheter). Gloves should be worn throughout the process of inserting or adjusting a catheter and disposed of immediately after concluding the procedure.
2. Always thoroughly clean the patient’s skin before inserting or adjusting a cannula. Inadequate cleaning of the skin may result in an infection.
3. Ensure that all patient-related consumables (including syringes, extension tubing and intravenous cannulas) are new before use. Materials used in intravenous delivery that have come in contact with biofluids may never be reused for multiple patients.
4. All patient-related consumables should be stored in a clean, dry location.

DISINFECTION AFTER USE

1. Turn off and unplug the syringe driver.
2. Dispose of the tubing and syringe in hazardous waste container or bin. Clean the LCD controls and syringe clamp with a cotton swab soaked in alcohol after every use.
3. Housing of the syringe driver should be cleaned according to ward guidelines for disinfecting surfaces.

Complications

Introduction of equipment in newborn care units poses clinical and device complications for patients. Awareness of potential complications is critical to maximise patient safety.

CLINICAL COMPLICATIONS

• Infection: inadequate cleaning of the skin prior to cannula insertion, use of a longterm indwelling cannula and contamination of the extension tubing or syringe are all risks for infection.
• Extravasation injury: if the cannula stops working or becomes displaced but fluid administration continues, there is risk of an extravasation injury which may cause damage to the surrounding skin, tissues, muscles and nerves. It is important to frequently reassess the cannula site and respond to syringe driver alarms to prevent this.
• Fluid overload: delivery of intravenous fluid at too fast a rate or in too large a volume may result in fluid overload leading to oedema or respiratory distress.
• Dehydration and hypoglycaemia: if the cannula is displaced or stops working, the tubing is occluded or the syringe driver malfunctions, delivery of fluid may become obstructed. This can result in dehydration or hypoglycaemia.
• Air emboli: if there is air in the syringe or the tubing an air embolus may occur. Severe air emboli can cause respiratory difficulties, heart failure or death.

DEVICE COMPLICATIONS

Errors related to syringe type: may cause inaccurate volumes of fluid to be delivered due to calibration for a specific brand of syringe.

Care & Maintenance

Users are responsible for basic first-line care and maintenance to ensure equipment lasts to their potential lifetime.

POWER SOURCE

Usually mains-powered with a rechargeable battery. A syringe driver should be taken off its charger only as necessary to ensure that it is charged for use in the event of a power blackout

WARD LOCATION

Syringe drivers may be mounted on a wall or pole for easy access. Multiple syringe drivers may be used on a single patient at once. Care should be taken to ensure the syringe drivers are secured in place while in use and syringes are clearly labelled by content.

USER PREVENTIVE MAINTENANCE

The syringe driver should be set up as if to prepare for a patient and allowed to run for 15 minutes a week if not in use. Visually inspect the syringe driver for any missing parts or alarms during this testing period.

Troubleshooting & Repair

Although users are not responsible for repairing their devices, there are steps that may be taken to troubleshoot first-line errors that may occur before contacting maintenance or engineering support.