I did a pilot City and Guilds course in infusion devices a few years ago, which included quite a bit of instruction on how to select the most appropriate device with which to deliver various things. The only part of the course I didn't do, as a non-clinician, was the bit where you learn the correct technique for inserting the IV access device.
From observation of procedures, I think that gravitational infusions are usually solely for rehydration or restoring a fluid volume in emergency care. There they have a clear use and speed is of the essence. In a hospital situation in the UK where there are usually plenty of pumps around, then protocols are likely to demand that infusions are done through a pump for maximum control, monitoring and safety. It makes sense.
It also makes sense that in some hospital situations around this unequal planet of ours that sometimes the ideal course of care is simply impossible, so you just have to do your best in the circumstances.
As to inotropes - they should not be infused using a volumetric device because they are delivered at very low rates. This is directly from the training on that C&G course. The volumetric pumps tend to be far less smooth in their delivery at low rates, which makes for an unstable reaction in the patient's blood pressure; the one thing the inotropes are supposed to stabilise, and therefore the worst possible outcome!
Yet some hospital staff still insist on using volumetric pumps because even when they have a really well staffed ICU, they cannot be bothered to swap over the syringes every five or six hours. So, clinician convenience over patient care...
I'm sure someone will object to this assessment, but you know what? Tough! I've seen what I have seen, I have completed the incident reports on the allegedly faulty pumps that were perfectly OK. They were just being used inappropriately.
