Large Percentage of CCT is about – LOGISTICS!
Signs: 1 Set of vitals gives you a snap shot, 2 sets give you a comparison, 3 sets facilitates trending. You need 3 data points to trend.
If the patient has >3 infusions going at once, and you can only accommodate 3 channels don’t rush to ask the nurse or physician “What can we “dc” for the transport?” Only make that determination after accessing hemodynamics.
Goal is to conduct ICU-to-ICU patient care of equivalent or higher standard that the patient never feels they have left the ICU!
CVC or Central venous catheter refers to a catheter that is designed for cannulation of the: subclavian vein, internal jugular vein, femoral vein.
Catheters are much longer than the catheters used to cannulate peripheral veins and are typically 15 to 25 cm (6 to 10 inches) in length. They also are available with two or three separate infusion channels, which is advantageous when multiple medications are required.1
Outside diameter of 2.3 mm (7 French) and houses one 16 gauge channel and two smaller 18 gauge channels. The distal opening of each channel is separated from the others by at least one centimeter to prevent mixing of infusate solutions.1
1Marino MD PhD FCCM, Paul L. (2012-01-12 00:00:00-08:00). The ICU Book (Kindle Locations 2530-2534). Lippincot (Wolters Kluwer Health). Kindle Edition.
- The MedSystem III with pole clamp weighs just over 5 pounds (2.3kg).
- The instrument combines three independent infusion channels.
- Accommodates 20cc to 60 cc syringes Monoject and BD Brands. The pump has sufficient pull to overcome the syringe plunger. It’s manufacturer approved. (Advantage is less tubing and no IV bags)
- Rates from 0.1 to 999 milliliters per hour.
- A new fully-charged battery provides ~6 hours of operating time with rates at 125 ml/h per channel.
- Do not assume ~6 hours, take AC power cord to the floor if expecting a long transfer (2 IVAC Pumps etc.)
Logistics of Critical Care 101: “All equipment must be connected to AC power adapters during transport: IV Pump, Ventilator, Isolette, IABP etc.)
Always power on the MedSystem III before inserting the set.
Do not insert a cassette into a channel with a SERVICE prompt. (It needs to be serviced)
Ensure the cassette is properly installed before starting infusions.
For IV push medication (put Instrument on hold), clamp tubing above the port.
Links to the manuals:
Youtube video explanations and demonstration
(Part 1) Basic set up of ALARIS MedSystem III IV PUMP for CCT
(Part 2) Basic set up of ALARIS MedSystem III IV PUMP for CCT
(Part 3) Basic set up of ALARIS MedSystem III IV PUMP for CCT
(Part 4 Basic set up of ALARIS MedSystem III IV PUMP for CCT
(Part 5) Basic set up of ALARIS MedSystem III IV PUMP for CCT
Q and A
I received a good question via Email and I think it’s important to post it here so others may also benefit from the response.
Question: I did have one question. When you were presenting the techniques for minimizing time between the transition of IV pumps, you stated that we could use any size needle to withdraw fluids from the facility’s medication IV bag in order to prime the tubes for your pump. I was under the impression that there was a limit in the needle gauge because if it was too big it could damage the extraction port, causing it to leak. Then again, I might have just overheard this in passing from another medic with no real backing to that statement.
Reply: There is no limit on the needle gauge because that rubber material that is used for the injection port is designed to occlude back the injection port once the needle is withdrawn. If the injection port is pierced hundredth of times it may lose that occlusion ability, but for our purposes it’s not something we have to concern ourselves with. If you use smaller than 18 gauge needle for withdrawing medication from the bag it will be difficult to pull back on the plunger and extend your extraction time. I routinely use 16-18 gauge needles to extract my medications without any leakage issues.
If the IV bag has 2 ports, one where administration drip chamber is spikes into and an injection port for adding medications use 16-18 gauge needles for extraction. If the IV bag only has 1 port for administration drip chamber and no injection port, what you will do in that case is fill the administration drip chamber to the top by squeezing, invert the bag and remove the drip chamber and tape it to the IV pole (as was demonstrated in the video, so the patient is not off the IV pump). You will then simply connect the 60 cc syringe without a needle to the port and withdraw the medication. Have your partner help you steady the bag slightly bellow horizontal level and do it over a emesis basin or bucket to minimize spillage. Once you extracted the medication simply connect the IV bag back to the administration drip chamber.
Photos that outline the process.