Amount of accidental flush by syringe pump due to inappropriate release of occluded intravenous line.
BACKGROUND
An unintended bolus is delivered by the syringe pump if intravenous line occlusion is released in an inappropriate manner.


OBJECTIVE
The aim of this study was to measure the amount of flushed fluid when an occlusion is inappropriately released and to assess the effect of different syringe pump settings (flow rate, alarm setting, size of syringe and syringe pump model) on the flushed amount.


METHODS
After the stopcock was closed, infusions were started with different model syringe pumps (Terufusion® TE312 and TE332S), different syringe sizes or at different alarm settings. After the occlusion alarm sounded, the occlusion was released and the amount of fluid emerging from the stopcock was measured.


RESULTS
The bolus was significantly lower when the alarm was set at a low-pressure setting. The bolus was significantly lower with a 10-ml than a 50-ml syringe. A significant difference was seen only when a 50-ml syringe was used (TE312: 1.99 ± 0.16 ml vs. TE332S: 0.674 ± 0.116 ml, alarm High, p < 0.001).


CONCLUSIONS
To minimize the amount of accidentally injected medication, a smaller syringe size and a low alarm setting are important. Using a syringe pump capable of reducing the inadvertently administered bolus may be helpful.
Department of Anesthesiology, Yokohama City University Hospital, Yokohama, Japan.
Hiromasa
H
Kawakami
Department of Anesthesiology, Yokohama City University Hospital, Yokohama, Japan.
Tetsuya
T
Miyashita
Department of Anesthesiology, Yokohama City University Hospital, Yokohama, Japan.
Ryota
R
Yanaizumi
Department of Anesthesiology, Yokohama City University Hospital, Yokohama, Japan.
Takahiro
T
Mihara
Department of Anesthesiology, Yokohama City University Hospital, Yokohama, Japan.
Hitoshi
H
Sato
Department of Anesthesiology, Yokohama City University Hospital, Yokohama, Japan.
Takayuki
T
Kariya
Department of Anesthesiology, Yokohama City University Hospital, Yokohama, Japan.
Yusuke
Y
Mizuno
Department of Anesthesiology, Yokohama City University Hospital, Yokohama, Japan.
Takahisa
T
Goto
D000704:Analysis of Variance; D056902:Clinical Alarms / Q000592:standards; D004868:Equipment Failure; D006801:Humans; D006874:Hydrostatic Pressure; D007260:Infusion Pumps / Q000009:adverse effects*; D007262:Infusions, Intravenous / Q000009:adverse effects / Q000295:instrumentation*; D019300:Medical Errors / Q000009:adverse effects / Q000517:prevention & control*; D013594:Syringes
Syringe pump; accidental flush; occluded intravenous line