Placing IV pumps outside the patient’s room was an innovative idea early in the pandemic to reduce nurses’ exposure to the virus causing COVID-19. It also served as a measure to conserve the availability of personal protective equipment (PPE), which was in short supply. Originally, the Food and Drug Administration (FDA) issued an emergency use authorization (EUA) for the practice but revoked that EUA in September 2020. According to the revocation, “instead, FDA may issue individual EUAs for infusion pumps and infusion pump accessories that meet the requisite EUA statutory criteria.” Some facilities have continued the practice, and I’ve seen recent questions posted about it on the AACN Clinical Practice Community.
Institutes and journals have provided research and guidance on this practice. The Emergency Care Research Institute (ECRI) published “Large-Volume Infusion Pumps — Considerations When Used with Long Extension Sets Outside Patient Rooms to Help Reduce Staff PPE Use,” which I found helpful in evaluating whether to use microbore or macrobore extension set tubing (I provide more details for each in the pros and cons below). “Flow Accuracy of IV Smart Pumps Outside of Patient Rooms During COVID-19,” published in Advanced Critical Care, provides a great summary describing how the IV smart pump delivers fluid either with pressure or peristalsis and the potential problems with intake and outtake pressures.
In Critical Care Nurse, “Extension of Intravenous Tubing and Pumps Outside Rooms for Safety and Efficiency” describes the steps and procedure to use pumps outside the patient’s room. The authors also describe the evaluation they undertook to assess the effects on their quality and safety measures. The authors demonstrated:
- Reductions in nursing time due to less donning and doffing of PPE
- Reduced exposure to COVID-19
- Safe administration of IV fluids and medications from outside the room
- No reported incidents of harm
According to the ECRI guidance and articles above, here are the pros and cons for placing IV pumps outside the patient’s room for patients with COVID-19:
- Staff can reduced exposure to COVID-19
- Donning and doffing PPE time is reduced, saving nursing time and money
- PPE use is reduced, allowing for conservation of PPE
- Microbore tubing has a lower priming volume than macrobore tubing
- Microbore tubing is less compliant than macrobore tubing, so it offers timelier downstream occlusion alarms
- Visually verifying patient identity may be more difficult
- Visually assessing IV sites at regular intervals may be more difficult
- IV extension tubing has been in short supply
- Using less compliant microbore extension tubing increases fluid flow resistance, which may impair the pump’s ability to accurately deliver fluids at high flow rates (> 300 mL/h)
- Macrobore tubing is more compliant, which may delay downstream occlusion alarms
- Macrobore requires a higher priming volume than microbore tubing
- Flow accuracy may be impaired
- Routing IV tubing into the room can create tripping hazards
- IV tubing on the floor (even when protected by pool noodles or other devices) may be damaged by other portable equipment (x-ray machines, etc.)
I reached out to several nursing colleagues to talk about what they thought were the pros and cons of this practice. Here’s what they had to say:
- Maureen shared that they used the practice early in the pandemic but stopped for a variety of reasons. Nursing preference and workflow played a large part in the decision to stop using it. The nurses found that the IV pumps were usually on the opposite side of the door the nurse was on when needing to titrate. The nurses are also now more proficient with donning and doffing their PPE, and PPE supply issues have resolved. The policy Maureen shared with me outlines guiding principles for when the practice may or may not be appropriate. She also shared that it is extremely important, when making the decision to use pumps outside the room, to do so collaboratively to ensure the best use of the nurses’ time and resources, and to ensure quality and safety.
- Sonya shared with me that they never adopted the practice. In one ICU, if the pumps were outside the room, the sliding doors could not be closed, eliminating the negative pressure effect of the isolation room. In another ICU, the large-sized rooms would have required too much tubing to bridge the distance from the patient to outside the room, rendering the pumps ineffective.
Whether you choose to use the pumps inside or outside the patient’s room, keep in mind that quality and safety are essential to ensure accurate IV infusion delivery. Include your quality department as stakeholders when making these decisions to help collect data for future decision-making.
We’d love to hear from you: How have you and your teams used IV pumps during the COVID-19 pandemic?
Are you sure you want to delete this Comment?