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Prolonged time to alarm in infusion devices operated at low flow rates

Ilan, Roy MD, MSc; Fowler, Robert A. MD, MSc, FRCP(C); Ferguson, Niall D. MD, MSc, FRCP(C); Parshuram, Christopher S. MB, ChB, DPhil, FRACP; Friedrich, Jan O. MD, DPhil, FRCP(C); Lapinsky, Stephen E. MB, BCh, MSc, FRCP(C); Biason, Ron; Pinto, Ruxandra PhD; Etchells, Edward E. MD, MSc, FRCP(C)

doi: 10.1097/CCM.0b013e31818698e3
Clinical Investigations
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Objective: To evaluate the time to occlusion alarm for peristaltic infusion devices used in Toronto adult critical care units.

Design: Cross-sectional study.

Setting: Biomedical engineering departments of four Toronto teaching hospitals.

Subjects: Twenty peristaltic infusion devices (five Sigma 8000-plus, five Graseby 3000, five Baxter Colleague, and five Alaris 7230B).

Interventions: None.

Measurements: Time to occlusion alarm at flow rates of 2, 10, and 100 mL/hr at a full range of available pressure thresholds for occlusion detection, and with commonly used tubing sets.

Main Results: At default (mid-range) pressure thresholds, mean (sd) time to occlusion alarm was 0.3 (0.1) min at a flow rate of 100 mL/hr, 2.3 (0.5) min at a flow rate of 10 mL/hr, and 11.7 (3.1) min at a flow rate of 2 mL/hr.

Conclusions: Time to occlusion alarm in peristaltic infusion devices is long at low flow rates. Patients receiving important medications with short half-lives at low flow rates could experience clinically important interruptions in treatment. Time to occlusion alarm at high flow rates is short, which could lead to excessive alarms and “alarm mistrust” by clinical staff.

From the Department of Medicine (RI), Queen’s University and Kingston General Hospital, Kingston, ON, Canada; Sunnybrook Health Sciences Centre (RAF, RB, RP, EEE), Toronto, ON, Canada; Interdepartmental Division of Critical Care Medicine (RAF, NDF, CSP, JOF, SEL, RP), University of Toronto, Toronto, ON, Canada; Department of Health Policy (RAF, CSP, EEE), Management and Evaluation, University of Toronto, Toronto, ON, Canada; Department of Medicine (NDF), Division of Respirology, University of Toronto, Toronto, ON, Canada; University Health Network (NDF), Toronto, ON, Canada; Hospital for Sick Children (CSP), Toronto, ON, Canada; Critical Care and Medicine Departments (JOF), St. Michael’s Hospital, Toronto, ON, Canada; and Mount Sinai Hospital, Toronto (SEL), ON, Canada.

Supported, in part, by the Program in Innovations in Patient Safety and Knowledge Translation, Faculty of Medicine, University of Toronto (to RI), a Canadian Institutes of Health Research RCT Mentoring Program Award (to NDF), and by a Canadian Institutes of Health Research (CIHR) Clinician-Scientist Award (to JOF). Dr. Fowler is an Ontario Ministry of Health and Long-term Care Career Scientist.

The authors have not disclosed any potential conflicts of interest.

For information regarding this article, E-mail: ilanr@kgh.kari.net

© 2008 by the Society of Critical Care Medicine and Lippincott Williams & Wilkins