Hi Folks
we have the Infusomat infusion pumps at our hospital and we are having major problems infusing blood. The problem is when infusing blood the accumalative air alarm keeps activating.i am dealing with Braun concerning this problem and their atitude is that our staff are not following the correct proceedures and there is nothing wronge with the pumps.

Are any of you having the same problem?
if yes what is being done to correct the problem?

your comments are apprieciated.

richard

Hello Richard,

One of our departments here had exactly the same problem.

Talks with Braun revealed the problem is with the giving set and not the pump, therefore Braun are in the process of producing a new giving set primarily for giving blood.

Nothing to do with your staff or procedures whatsoever.

Hope this helps

Rob

Hi Rob

thanks for your reply
what hospital do you work for?

regards

richard

We have special b braun pumps for blood on the paediatric unit and different sets. Not sure how the pumps are different to the normal ones, they look the same, I think it is in the programing.

Hi Richard
We have a good number here in Edinburgh and have set the accumulative alarm to the max of 3.8ml/hr. Have you done the same? In saying that we still have alarms regarding this. At the moment I am looking into a Datix report on this very point but similar to everyone else I am sooooo busy!
Dave D

Hi Dave

What is the Datix report?
is there any chance you can send me a copy or let me know where i can get it?
we have set all our pumps to 3.8ml per hour but the problem is persistant.

regards

richard

Hi, We have these pumps and the Blood giving sets. The problem is also when giving TPN. I have been in contact with Braun loads of times also gave more indepth training to our staff here (teaching some of them was like teaching granny to suck eggs) but i covered all bases regarding Braun saying it was user error!. However we still do have a problem sometimes. We have cranked up the setings as much as poss but still probs. I was told a while ago that some new software might have to put on them .... but as yet i havnt heard anymore.
so now i just hand over any 'faulty' pump to the boys at meed
and smile.

Richard
"Datix" is our in-house incident reprorting system. I would be unable to send any reports because of that, sorry.

Dave

Hi All

i am meeting with B-Braun in two weeks concerning our problems with blood transfusions.If anybody else out there has the same problems with bood/tpn infusions i would like to hear from you also if you use th B-Braun and have no problems with blood/tpn infusions.the more info i get the better position i will be in when we meet B-Braun.

regards

richard

Hi Richard,
I have started an audit of my 'faulty' pumps, so can keep you in touch with my findings.
Good luck with Braun and any different answers they come up with I will definatly like too hear if thats ok?

Regards Liz.

Hi Liz

no problem i have a meeting this Friday i will let you know.

would still like to hear from anybody experiencing the same problem or not.

richard

Hi Richard,

Well ,one of our tech guys here has found one of the problems,(he's still awaiting the nobel prize for it),he has found that some of the giving sets in certain batches has a coating on the outside of the tubing, because they use ultrasound to detect 'air in line',this coating is stopping the ultrasound penetrating through and causing false alarms i.e. 'air in line'
Company does know,but have heard nothing from them as such at the moment, its something to do with the way in which they steralize the sets before use!

Very impressive guys, well done. Pls keep us informed (globally) as to how this goes. This is the kind of stuff that makes it all worth while !!


and my apologies to Liz for the use of the term "guys" !!

Hi Rob

we had a major problem at christmas where all our chemo sets were faulty due to a production fault with one fo the machines in the factory in Germany.All the sets were giving false air in line alarms.B-Braun were made aware of this and we eventually received replacement sets.As this machine was used to make the pipe for a range of sets it might have been what caused your problem.

regards

richard

P.S DaveC do you have these pumps and are you having any problems?would also like to know what infusion pumps you use in your neonatal department?

Hi Richard,

I/we operate under a somewhat different system to the NHS trust/public hospital system so the answer to what we have in the NICU is not a simple as it may at first seem. Let me explain.

I work for a private biomed company who work across many different private hospital sites (15 in the area I manage alone). This means we have a wide variation in the makes of equipment used. This depends on different group purchasing policies as well as the individual clinicians preferences. There is little or no standardisation across the board.

The second difference is, perhaps, that as these are private hospitals the units tend more towards the low acuity end of things, not true NICU but more special care units. If the bub is really sick, they get shipped out to one of the high level NICUs at the specialist public units.

With regards to pumps etc, there are (volumetric) Baxters (god help us all), Abbott plum, Imeds, etc. One of our clients have just taken delivery of the Carefusion (Cardinal) system so we shall see how that goes. There are none in my area who use BBraun volumetrics (that I am aware of anyway) but they will come I'm sure. Braun syringe pumps are however quite popular, especially in the SCN areana. Still, in my role as "advisor" on the more technical aspects of equipment purchasing, the notification of problems with giving sets or any other aspect is valuable indeed.

I will have a look through our national database tomorrow and see if anyone else "under our care" is using BBraun volumetrics and get some feedback from them if you wish.

Could people who are using the BBraun Perfusor syringe pump with rev G software contact me off board as I think I have identified a software problem and would like to discuss it with people.
Especially if you are using the drug library software.
Thanks
Robert

cheers dave

rob if you want to give me a call 01493 452468 between 7.30am-15.30pm

richard

We are using the drug library software and still on revision E. How did you get revision G is that how they came or have you been updating the software. We have had nothing from Bbraun in this field.

Billy

We are just commissioning the pumps hence the latest software
Robert

Hi All

conclusion of the meeting with B-Braun concerning the problems with infusing blood: the problems start when the second unit of blood is infused because the blood is taken out of the fridge and the infusion is started within a few minutes, this means initially that cold blood is pumped throught the set, as the blood travels throught the set it warms and then expands and thus release any air trapped when the blood was refridgerated.the pumps senses this air and if it sees more than 0.95 micro litres in a 15 minute period it will alarm accumalated air.the ie regs state that the accumalative air alarm has a maximum of 1 milli litre per 15 minutes(4 milli litres per hour). we have been told to reset the pump after every unit of blood, this will clear the accumalated air.we are going to implement this and i will let you know the outcome.

does anybody out there use a different manufactuer of pump with an accumalative air alarm have the same problems with blood or tpn?

regards

richard

Blood Warmer?

It sounds like the pump is behaving exactly as it should, Richard. Perhaps B.Braun will incorporate an "on the fly" AIL reset button in the next version! Although I'm not so sure that would be a good idea in general, would it? Opinions welcome.

We had a problem at Hereford with air in line during blood infusions using Graseby 500 pumps Link
Hopefully I've put the link in correctly.

Lee

As I say, I believe that the real issue is with the procedure. Shouldn't the blood be pre-warmed? Or am I missing something here?

(which could well be the case, as my own life force is a bit chilled this morning)

Geoff

the ail is reset when a new infusion/therapy starts.
the use of blood warmers for every blood infusion is not practical.

Lee

thanks for the link not familar with the graseby 500 does this pump have an accumalative alarm or is it just air bubble size?

regards

richard

The Graseby giving set has three bubbles which are squeezed in sequence to give the required rate, air detection is by amount of air measured by IR in the top bubble.

Air in the circuit or bubbles produced above the pump accumulates in the top giving set bubble. The problem we had was that micro bubbles were gassing off below the pump then accumulating in the bend above the cannula.

Lee

Hi Lee

the air will be released as the blood warms in the set, one suggestion was to let the blood warm up for approximately 10 mins before primming the line, this did not go down to well with our staff.

it takes approximately 20ml of air to kill somebody,adult that is.the accumalative air alarm is set to 3.8ml on the B-Braun pump because the pump can be used on peads.

even when blood is gravity fed the small bubbles are still there.one thing which can lead to more air in the blood is the wrough handling of the blood before being set up for infusion.

hope this is of some help!

I WOULD STILL LIKE TO HEAR FROM PEOPLE USING PUMPS OTHER THAN B-BRAUN AND HAVE AN ACCUMALATIVE AIR ALARM.I NEED TO KNOW IF YOU DO OR DON'T HAVE PROBLEMS WHILE INFUSING BLOOD.

Richard

From memory I'm pretty sure that the Graseby 500 does not add up the air bubbles to give an accumulated total. As with most contemporary pumps it simply triggers an alarm (and stops pumping) when air bubbles of a certain size are detected. I don't know the size off hand, as I don't have the specs with me.

However ... our old (and much maligned) friend the Baxter Colleague does have an accumulated AIL feature! It also has the (clever) "Advance Air" feature which pumps a bit more to let you inspect the air bubble. Here is an extract from the Colleague manual:-


It would be nice to see a chart showing the AIL characteristics of all the current pumps.

Meanwhile, see here.

OK ... also the Alaris GW.

Single bubble configurable:-

50, 100, 250, 500 microlitres (100 default)

Accumulation:-

Fixed at 500 microlitres (over 15 minutes)

Notice that (like the Colleague) the GW has a horizontal pumping mechanism. Could this be significant here, I wonder?

The design of the Graseby giving set ensures that any air bubbles from above the pump accumulates in the top bubble (I tried very hard to beat this feature but failed)so it does operate as an accumulated alarm.

What it and none of the other pumps I have come across do is to measure the air close to where it goes into the patient.

The maximum amount of air we saw was 0.3mL which according to the figures I’ve seen should not be a problem. What was particularly worrying for us was that when this was occurring no one else appeared to have seen the same problem.

Lee

Hopefully we will be seeing something like this in the next generation of pumps. As I have mentioned before (but I'm still waiting for the Royalties), surely we need a miniature monitoring device (flow, pressure, bubble detection) ... plus a relief valve to release dangerous conditions as necessary ... sitting at the actual infusion site!

OK ... where's my drawing board?

as someone once said to me "if air bubbles were that dangerous, there would not be a live junkie in the world" (and yes, I do understand the difference between the arterial and venous sides of the system).

discuss............

... not to mention neonate "junkies"!

Hi, We have seemed to solve some of the problems re air in line etc......
when air in line or air bubble alarm is alarming , prime the line as per usual.... if the problem is still there and there is no visable signs etc of air and it still keeps alarming... reset the pump with new volumes etc (as your setting it up for a new patient) then the pump should then be ok. been told its to do with the memory data for the previous alarm setings. obviously not all pumps will mend itself , if the alarm is still there then ok it is faulty and needs attending to.
Was told this by Braun and my medical electronics manager .

Hi,
I'm experiencing the same problem, lots of small bubbles post the pump and causing endless accumulation alarms.
Blood is from fridge, no heating performed, one unit delivered in 1 hour.
As previous discussion outlines, the rising temp of blood releases gas but should the set not remove the gas via maybe a double bubble trap.
I have repeated excercise with Baxter Colleague - no problems encountered, obviously not as sensitive as the BBRaun but there were no bubbles forming to cause an alarm.
Any solutions, suggestions, help appreciated.
Thanks,
Noel

BBraun admit that there is a micro-bubble problem with cold blood. As it warms up micro-bubbles are formed and these exceed the alarm limit. It is possible to raise the accumulation alarm limit.

The bubble trap will remove bubbles but these micro-bubbles come from disolved gas so will not be removed by the trap.

One problem is that these are micro-bubbles and you will not see them so it seems the air-in-line is going off incorrectly. So the staff often report a faulty pump.

The solution is for the staff to let the blood reach room temperature before infusing it - as they should do but most often do not.


RoJo

I can't help but wonder how the patient feels about (reacts to) that?

Surely blood needs to be warmed before infusion?

There is also the issue with the Air in line on the Braun pumps, which is caused by weakened plastic coating which effected a batch at the time - email me for more information.

Thanks for your replies!

Just a few comments:
Out accumulation alarm has been increased to max - 3.8
The bubbles which form in our sets are easy to see- could not be mistaken.
In relation to temperature, I have done a bit of reading on this, our hospital policy does not advise to warm the blood unless
•Patients with high titres of cold agglutinins
•Patients receiving massive transfusions at/in excess of 50ml/kg/hr

I have also read a number of UK guidelines and the same is indicated. It looks like one of the big risks with blood transfusions is bacteria, therefore increasing the blood temp could let to bacteria growth?? I have included a few comments from guidelines below.

I would be very interested in info related to a issue with the plastic coating, I will make contact for info.
Thanks,
Noel


Red cells
1. Complete the transfusion of the unit
within four hours after it is removed from
controlled temperature storage (CTS).
2. A red cell unit that has been out of CTS
for longer than 30 minutes should not
be accepted back into stock by the
blood bank, unless there is a validated
local procedure to ensure that any unit
returned to blood bank stock is suitable
for transfusion.
3. Red cell units must not be warmed
other than in an approved device, nor
left in sunshine or near a heat source.
Rationale
Once it is out of CTS, the risk of bacterial
proliferation increases with time,
especially in a warm ambient temperature.
Even a short period of exposure to high
temperature may be deleterious.

Blood should be transfused within four hours of its removal from storage (there is a risk of bacterial proliferation and red call metabolism if the blood reaches an ambient temperature for a sustained period of time) (RCN 2005)

the reason for the alarms is that the b-braun pumps accumilated air alarm counts bubbles down to 0.1 micro litres all other manufactuers i contacted state they count bubbles down to 0.45 micro litres. when i was shown the eu requirements for air it states all bubbles less than 0.45 mico litres can be ignored. when i mentioned counting bubbles down to 0.1 microlitres they all said this would cause nonsense alarms. our cancer department got so frustrated with the brauns they chucked them out and went back to baxter.