25.1 Infusion Control Device + TCI Flashcards
a) What types of infusion control devices are used in clinical settings? (15%)
Non-electrical:
» Manually adjustable clamps,
e.g. roller clamp on standard fluid
administration set.
> > Elastomeric pumps.
Electrical:
» Volumetric pumps.
> > Syringe drivers.
b) What are the general (35%) characteristics of pumps used for target controlled infusion (TCI) anaesthesia?
General:
> > Mains and rechargeable battery powered
with alarm if threat of power loss.
> > Clear user interface,
control buttons and screen.
> > Clamp or other fixing device to position pump close to the level of the patient.
> > Short- and long-term accuracy in infusion rate.
> > Able to deliver a bolus with accuracy of volume.
> > Able to be purged.
> > High-pressure detection with
alarm in the event of occlusion.
> > Minimal post-occlusion bolus (‘back-off’ facility).
> > Alarm/notification of user in event
of incorrectly inserted syringe.
> > Alarm in the event of infusion nearing end.
> > Ability to program small variations
in flow rate over a wide range of rates.
> > Secure fitting of syringe into driver mechanism.
What are the specific (20%) characteristics of pumps used for target controlled infusion (TCI) anaesthesia?
Specific:
> > Programmed with TCI algorithms
(some only programmed for a specific
drug, others have a range of algorithms).
> > Ability to input patient’s weight and age.
> > Screen that clearly shows the drug and algorithm
in use as well as other
key information such as
effect site or plasma concentration.
> > Specific syringe compatibilities
(some only work with specific syringes,
e.g. the Diprifusor with propofol in
pre-prepared syringes with magnetic strip).
c) What precautions should be undertaken to guarantee drug delivery when administering total
intravenous anaesthesia (TIVA)? (30%)
Organisational:
» Pumps should undergo regular maintenance checks.
> > Staff should be trained in pump use.
> > Anaesthetist should have adequate training
in TIVA prior to using TIVA solo.
> > Pumps to be plugged in to charge when not in use.
> > Pumps should be standardised within each trust.
Prior to use:
» Check that the pump is functioning
and has run self-check.
> > Correct entry of patient data.
> > Correct drug in syringe,
correctly drawn up (check with second person)
and correct algorithm entered.
> > Syringe intact and correctly seated
in the mechanism to avoid siphoning.
> > Priming of line to minimise ‘backlash’
and to eliminate air bubbles.
> > Dedicated line/multilumen
connector with low compliance tubing –
anti-reflux valve in any other line,
correctly orientated. Monitor for disconnections.
During use:
> > Cannula visible at all times to check for disconnection/extravasation.
> > Pump at similar height to the patient
to minimise risk of siphoning or
under-delivery of drug.
> > Keep pump plugged in when possible.
> > Intermittent check that the expected
volume of drug has been infused.
> > Respond appropriately to pump alarms.
