A syringe driver (or pump) is a small powered (mains and battery) infusion pump that gradually administers small amounts of a drug or luid contained within a syringe by driving the plunger of the syringe at an accurately control-led rate thereby maintaining constant blood levels of the drug. Tubing connects the syringe to the needleless port of the cannula and this is primed as for any other I.V. tubing prior to use. The syringe contains a drug that is usually prediluted to a speciic strength and this should not be diluted further, although the initial dilution can be made up in the clinical area. A 60-mL syringe is usually the largest size syringe that can be accommodated with these devices and most pumps can use smaller syringes.
Errors in the use of syringe drivers occur in a number of areas – incorrect drug calculation, drug incompatibility and instability, equipment failure, incorrect infusion rate, inad-equate user training, inadinad-equate documentation and poor servicing of equipment (Kain et al 2006). Thus it is vital the midwife has received training in how to use the equip-ment (particularly how to correctly insert the syringe), can use a second checker to conirm the infusion rate and that the device has been serviced according to manufacturer’s instructions.
The majority of new syringe drivers use mL/hr to calcu-late the administration rate. Many pumps are programma-ble and each NHS Trust will have a number of regimes programmed so that all the midwife needs to do is ind the appropriate programme.
However, older ambulatory syringe drivers may use mil-limetres to calculate the administration rate which is not intuitive. Their use is not common in the Western world.
The length of luid to be administered must be known and the drug is diluted so that the total length is divisible by 12. Instruction booklets will be provided with each driver, but the general rule is:
{ }
(
Length of fluid (mm) Delivery time (hours) rate setting mm h
= oour)
For example, if 36 mm of luid is to be infused over 12 hours then the rate would be 3 mm/hour.
The setting up of the pump relies on several standard principles:
•
use of an ANTT•
calculation of the amount of drug required over the given period of time with appropriate solution for dilution•
use of a sterile syringe, correctly sized to it the driver and inserted so that the plunger is secure•
sterile preparation and dilution of the drug (may be supplied pre-prepared)SUMMARY
•
I.V. drugs have a swift effect which, whileadvantageous, can also be problematic if an adverse drug reaction occurs.
•
An ANTT should be used throughout the setting up and administration of an I.V. drug.•
I.V. drugs may be given in the following ways:■ intermittent direct bolus or ‘push’ injection
■ intermittent infusion
■ additives to an infusion
ROLE AND RESPONSIBILITIES OF THE MIDWIFE These can be summarized as:
• adherence to local regimes for training and updating of skills
• using an ANTT for all procedures
• correct administration procedure, as per the NMC (2008) and local regimes
• observation of the woman for any unexpected or adverse responses
• contemporaneous record keeping. SELF-ASSESSMENT EXERCISES
The answers to the following questions may be found in the text:
1. What are the advantages and disadvantages of administering drugs via the I.V. route?
2. Discuss the ways in which I.V. drugs can be administered.
3. Describe how you would administer a bolus dose of I.V.
antibiotics.
4. How do the principles of ANTT apply to I.V. drug administration?
5. Discuss the advantages of patient-controlled analgesia.
6. Summarize the role and responsibilities of the midwife when administering drugs intravenously.
■ syringe driver 12- or 24-hour infusion
■ syringe driver with patient control.
•
The midwife needs to be competent in theadministration of medication I.V. and the correct use of all devices used in her clinical area of practice and maintain this competency.
•
When given as a ‘bolus’ injection, it is important to administer the drug slowly to reduce the risk of phlebitis and adverse reactions.REFERENCES
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Carefusion Suppl: 22 (14), 15–21.
Ansell, L., Dougherty, L., 2011. Medicines management. In: Dougherty, L., Lister, S. (Eds.), The Royal Marsden Manual of Clinical Nursing Procedures, eighth ed. Wiley-Blackwell, Chichester.
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Cousins, D.H., Sabatier, B., Begue, D., et al., 2005. Medication errors in intravenous drug preparation and administration: a multicentre audit in the UK, Germany and France. Qual.
Saf. Health Care 14 (3), 190–195.
Demirel, I., Ozer, A.B., Atilgan, R., et al., 2014. Comparison of patient-controlled analgesia versus continuous infusion of tramadol in post-cesarean section pain management. J. Obstet. Gynaecol.
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Hall, A., 2015. Administering medications. In: Potter, P.A., Perry, A.G., Stockert, P.A., Hall, A. (Eds.), Essentials for Nursing Practice, eighth ed. Elsevier, St. Louis, pp. 423–458.
Hayes, C., Williamson, E., 1998.
Injection technique: intravenous 2.
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intravenous patient controlled
analgesia versus conventional continuous infusion. Open J.
Anesthesiol. 2, 120–126.
ISMP (Institute for Safe Medication Practice), 2015. ISMP’s National Summit on safe practices associated with intravenous push medication administrations for adults: Draft Consensus Statement. Available online: <www.ismp.org/Tools/
guidelines/IVSummitPush/
statements.aspx> (accessed 8 February 2015).
Kain, V.J., Yates, P.M., Barrett, L., et al., 2006. Developing guidelines for syringe driver management. Int. J.
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McKenna, L., Lim, A.G., 2014.
Medications. In: Dempsey, J., Hillege, S., Hill, R. (Eds.), Fundamentals of Nursing and Midwifery second Australian and New Zealand Edn. Lippincott
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Principles of drug administration: intravenous drug administration
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MHRA (Medicines and Healthcare products Regulatory Agency), 2010.
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<https://www.gov.uk/drug-device -alerts/medical-device-alert -intravenous-iv-extension-sets-with -multiple-ports-risk-of-backtracking>
(accessed 8 February 2015).
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Principles of drug administration: inhalational analgesia: Entonox
Chapter
analgesic effect is achieved with only minimal side effects for the mother and fetus. Entonox is used increasingly across other areas of medical care including paediatrics and trauma care. This chapter reviews its safe use and the role and responsibilities of the midwife.