EBME Forums Forums Maintenance Technical Assistance The use of gravity infusion sets

Yes ... I was generalizing.

Back to your original question:- yes, if you are infusing potent drugs (rather than simply saline et al) it would be wise to use a volumetric pump - rather than just a gravity set - if only because it offers an opportunity for the settings to be recorded; and not, therefore, possibly disputed later on!

PS: by the way (and just out of interest), which volumetric pump do you use? And do you never use syringe pumps at all, then? Or just for very low flow rates (or drugs with a short half-life, whatever)? Which syringe pump do you favour?

I agree that syringe pumps are better for drugs, volumetric pumps are better for fluids in riskier situations, especially if they have additives and gravity infusions can be used for non-hazardous hydration.......but you try telling the Americans that, they like IV pumps for all infusions.
Anyone across the pond like to expand on why that is?

And back to the original question, no there is no guidelines etc about not using them.
Robert

Our friend here is asking if we know some regulations about never to use in any means the IV Gravitation Infusion... and our answer is there is none that we know... and now he is insisting that it is not supposed to be used... seems odd...

Charles,
You seem to be contradicting yourself. Everyone is saying that there is no legislation that says gravity sets should not be used. To clarify the double negative - they can be used as nothing is forbidding their use. And various guidelines mention their use - backing up this assertion.
Robert

Or ... putting it another way - it is up to the medics to decide, and then employ, the most appropriate method (and equipment required) depending upon the particular situation at hand, the fluids (plus drugs, whatever) to be delivered, and the specific needs of the patient concerned.

And ... adding a little more - it is not really a biomedical engineering issue at all!

Yes I agree its not really a biomed issue.

I specialise in infusion devices in a biomedical department. This means that my responsibilities have widened to the safe use of infusion devices within the hospital.

It definitely is up to the medical staff to decide, I just wondered whether there is a directive or legislation out that that comments on it. I know of at least 4 hospitals that have stopped their use of gravity sets within the UK.

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.

Absolutely spot on, Clare. Bravo!

Hello

In answer to the orginal question; i looked into the same issue a few months ago. I couldn't find any regulations, a Trust policy or a procedure on infusions (other than those specific to a particular procedure (Epidural) or specific drug use (Rheumatology)).

However i spoke to our Nurse Education Department who said that the advice from several sources UCL, British National Formulary, Safety In Doses, RCN Standards for Infusion Therapy (titles from memory) appeared to be that all medicines should be controlled, and preferably all infusions should be controlled.

In particular the British National Formulary instructs on how medicines should be given. I was also told that too much saline delivered too quickly can be fatal (although I don't recall whether this is specific to certain medical conditions).

Lee

Yes ... all good "common sense" stuff.

But don't forget that traditional gravity infusions are "controlled" to some extent as well (drip rate, pressure due to bag height etc.), as well as being recorded in patient notes and (in theory, at least) monitored or observed by nursing staff.

Any infusion delivered incorrectly is unlikely to benefit the patient, I would have thought. Although no doubt we can all imagine (dire) situations where hurried infusions might be considered a "reasonable risk".

But "no Trust policy"? Oh dear.