Transcript ภาพนิ่ง 1 - Ministry of Public Health

ผศ. ต่ อตระกูล อภัยวงศ์
โครงการวิจัยและพัฒนาอุปกรณ์ ชีวการแพทย์ มหาวิทยาลัย มหิดล
รายละเอียดในการบรรยาย
1. Downstream
Occlusion Alarm
2. Infusion pump
performance
3. Free-flow protection
โครงสร้ างการทางาน
Alarm
Occlusion Detection
Downstream Occlusion
Upstream Occlusion
Pressure
Increments
Alarm
1. Interruption to therapy
2. Ineffective therapy
3. A potential sudden
injection of unwanted
bolus, on release of
the occlusion.
BAXTER Colleague
Adjustable downstream
occlusion pressure
2 - 15 PSIG
Rate
1mL/hr
Occlusion Alarm
Pressure Setting
Time to
Alarm
Bolus
Volume
2 psig
4 – 8 min
0.05 – 0.16 mL
9 psig
12 – 27 min
0.18 – 0.26 mL
เวลาทีเ่ ตือนหลังจากการอุดตัน
เครื่อง ARCOMED AG mVP5005
Rate
Pressure
Pressure
(ml / h)
( 2.5 bar )
( 500 mbar )
Bolus
2.3 ml
0.45 ml
1
20
100
999
>120 min
10 min
100 sec
12 sec
45 min
100 sec
25 sec
2.5 sec
การตั้งระดับสั ญญาณเตือนการอุดตัน
ไว้ ที่ระดับต่า ทาให้ สามารถทราบการ
อุดตันได้ เร็วขึน้ และปริมาตรทีป่ ล่ อย
ออกสู่ ผู้ป่วยหลังจากการอุดตันมี
ขนาดลดลง
Most intravenous infusion pumps are
specified to deliver within +/- 5 %
Is this the volume
or
flowrate accuracy ?
Most intravenous infusion pumps are
specified to deliver within 5 % of flow
setting , 10 % is acceptable for most
applications ; for critical applications,
the error should not exceed 5 %
Inspection and Preventive Maintenance System
2001 ECRI . All Rights Reserved.
AIR BUBBLE
BAXTER Colleague
Air detection Sen. (25 - 150mL)
Air Bubble
Setting
Accumulation
Volume
25 mL
0.83 mL
50 mL
1.67 mL
100 mL
3.33 mL
150 mL
5.00 mL
Infusion pump
performance
parameters
Infusion pump performance parameters
Good long term accuracy
Good short term accuracy
Rapid alarm after occlusion
Small occlusion bolus
Able to detect very
small air embolus
Small flow rate increments
Good bolus accuracy
Good long term accuracy
Alarm after occlusion
Small occlusion bolus
Able to detect small air
embolus
Small flow rate increments
Bolus accuracy
Long term accuracy
Alarm after occlusion
Small occlusion bolus
Able to detect small
air embolus
Increments flow rate
START
N
Is a drug
being
delivered ?
is the patient
a neonate ?
Y
Y
Y
The drug
have a short
half life or
narrow
therapeutic
index
?
N
Is the drug
diamorphine
?
Y
N
A
N
B
Is the patient
volume
sensitive ?
Y
N
C
In the early 1990s
First reported in the early 1990s
by ISMP and the ECRI Institute ,
accidental, uncontrolled free-flow
of IV solutions after removal of
administration sets from infusion
pumps was recognized as a
serious problem that led to death
and patient injury
www.ismp.org/Newsletters/acutecare/articles/20070614.asp 22k -
In September 1992
ECRI , issued a recommendation
against purchasing any infusion
device that dose not have a free
flow protection built in to the
administration sets
In 1994
FDA published an advisory
with its own suggestions
for preventing
infusion-related errors.
In November 2000
JCAHO released a Sentinel
Event Alert on infusion
pump risks, noting that
at least six deaths
because of free-flow
accidents.
2003 JCAHO
National Patient Safety Goals:
Goal 5 :
Improve the safety of infusion pumps
Ensure free-flow protection
on all general-use and PCA
intravenous infusion pumps
used in organization.
2003 JCAHO
National Patient Safety Goals:
Free-flow protection
refer to a design in which
the protection is built in
to the administration set
used with the pump
Infusion Pump
Requirement Dropped
from 2006 JCAHO
National Patient
Safety Goals:
IV set
primed
Infusion pump
turn off
Loaded in
the infusion pump
All the
tubing clamps
are opened
No fluid flows out of the set
Then removed the
set from the device
( with all the tubing
clamps still open )
.....no fluid flows
out of the set
ECRI Health Devices Inspection
and Preventive Maintenance System
To avoid freeflow,
fallow the manufacture’s
recommendations and,
whenever possible,count the
drops in the drop chamber,
to check the drip rate ,
before leaving the patient.
เอกสารอ้ างอิง
1. MDA : Medical Device Agency , Infusion Systems
MDA DB 2003 ( 02 ) March 2003
2. Health Devices Inspection and Preventive Maintenance
System , 2001 ECRI.
3. BAXTER Operator’s manual Colleague Volumetric
Infusion Pump; 1996 – 2000
4. Environment of Care® News, November 2005,
Volume 8, Issue 11 Copyright 2005 Joint Commission
on Accreditation of Healthcare Organizations
www.jcrinc.com/media/pubs/PSPPDFs/PE-23-ECN-1105-Infusion%20Pump.pdf