How do you manage medication drips

[firemed665]

I have to eyeball it in the rig. Kind of sucks, but I'm old school and never really had the opportunity to do it any other way. However, when I'm working in the ER at the hospital we are required to use pumps for all fluids.

[Just Plain Ruff]

Until last year dial-a-flows were state-required equipment. Then the state decided they were innacurate, banned them, and required all med drips be on a pump.

But since all drip meds are optional, whoever had them just pulled them instead of spending the money on pumps. The private services still have them on their paramedic units for cath lab runs though (nitro, heprin, etc).

Eventually the officers on my 911 department convinced the chief that with a 15-20 minute transport time, and no protocol-sanctioned treatment for stable VT without a pump, it's probably something we want to have. So we're getting pumps for each truck.

One thing I would recommend if you are going to get new pumps for your trucks and your trucks have never had them, is to contact the hospitals that you take patients to and see what Kind of tubing they use. If you get a pump that will fit the majority of the hospitals tubing then you save some money for the patient.

If the hospitals do not use the same tubing then make sure you are starting IV locks on patients because nothing frustrates me more than a EMS service who tape down IV's that I have to untape to get to the hub of the IV. If you have a lock started then it's a simple unscrew and pull your tubing and replace with my tubing.

I personally never start and IV without starting a lock first.

[akroeze]

What does everyone prefer for a pump? Anyone have a favourite? Ones to avoid?

[crotchitymedic1986]

They are all built by the same three kids in China. If you have a main hospital that you transport to, try to get the same one they have to reduce "tubing waste" -- sometimes they will give or sell you their old ones cheap when they upgrade. Those are bulkier than the 3 channel pumps that most ground and air ambulances use, but I find them easier to operate, and they usually have more features (calculate drug dosages for you).

[CBEMT]

One thing I would recommend if you are going to get new pumps for your trucks and your trucks have never had them, is to contact the hospitals that you take patients to and see what Kind of tubing they use. If you get a pump that will fit the majority of the hospitals tubing then you save some money for the patient.

If the hospitals do not use the same tubing then make sure you are starting IV locks on patients because nothing frustrates me more than a EMS service who tape down IV's that I have to untape to get to the hub of the IV. If you have a lock started then it's a simple unscrew and pull your tubing and replace with my tubing.

I personally never start and IV without starting a lock first.

We transport to 7 hospitals, who use 4-5 different pumps. Even if we bought the pump of the two hospitals we'd be most likely to transport a patient with a drip to, I'm certain it would be cost-prohibitive. They've got top of the line stuff, way out of our budget.

I also always use a lock, and I'd go so far as to say 90% of our providers do as well.

[CTXMEDIC]

ding ding.....ding ding ding....ding.... ding ding.....ding....

[celticcare]

If we are transfering a patient, we take our own pumps. There is a standard pump used in all the hospitals in my area now and its lightweight and easier to carry.

Ambulance themselves dont carry pumps, as the meds given are on a titrate effect and gauge with the dropper. Interhospital transfer etc, the nurse is to take a pump so problem solved.

[krumel]

<<< krumel is a big fan of the goood old syringe pump.

B.Braun's

[WANTYNU]

Seems to me, all answers are right, it’s the scenario that changes, is it 911 / stat job / short transport to hospital.

Or a interfaculty transport / ICU to ICU / ER to Cath lab / etc.

One the patient is unstable and has not had a Dr’s evaluation / treatment, the goal is to get to definitive care, so the old “Titrate to effect” is what is needed and called for.

The other, is a “Stabilized” Patient who is on and has been on meds for a specific time and rate, where a therapeutic dose has been reached and just needs maintenance as per a prescription.

Or am I over simplifying?

IMHO

-w

[Ridryder 911]

Seems to me, all answers are right, it’s the scenario that changes, is it 911 / stat job / short transport to hospital.

Or a interfaculty transport / ICU to ICU / ER to Cath lab / etc.

One the patient is unstable and has not had a Dr’s evaluation / treatment, the goal is to get to definitive care, so the old “Titrate to effect” is what is needed and called for.

The other, is a “Stabilized” Patient who is on and has been on meds for a specific time and rate, where a therapeutic dose has been reached and just needs maintenance as per a prescription.

Or am I over simplifying?

IMHO

-w

I hope your not considering transporting Levophed or even NTG not on a pump. Even their manufacture informs that it has to be performed as such. Titrate to effect = I can't perform pharmacological equations. Sorry, that is like saying give Epi until it works or any other medication until you see your desired effect which may over or under dosing the patient. Many medications alike Dopamine are dose dependent that varies its actions dependent upon the dosage.

Does no one carry micro or mini drips anymore?

I have been an expert witness against Paramedics transporting even considered simple drips such as K+ or Heparin. Sorry, one cannot give a precise measurement then they do not need to be transporting and allow someone else that can. Remember as well, if you are not familiar with the equipment (i.e. hospitals pump) and there is failure or problems, you better be able to trouble shoot the device.

R/r 911