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PC UNIT
SYRINGE LOADED
SYRINGE PUMP
SET LOADED
COMPACT PUMP
SET LOADED
AB
SELECT
CASSETTE PUMP · 2 LINES
Single-channel pump
LARGE VOLUME PUMP
SET LOADED
Bedside: tubing, clamps and bags
This practice library works like a hospital's Guardrails library. Each care-area profile has its own list and its own limits. A soft limit asks you to confirm, and you override only after checking the order. A hard limit cannot be overridden. Values are teaching examples. Your facility's pharmacy builds the real library.
Dual-line cassette pump: this pump's drug list has names only, with no limits. The table below is still the teaching reference for concentrations and safe dose ranges. The pump will not warn you if you go outside them.
| Drug | Concentration(s) | Dosing unit | Soft min | Soft max | Hard max | Notes |
|---|
Parts of the pump
- PC unit (center): the screen, 5 soft keys on each side, 4 soft keys under the screen, number keys, CLEAR, SILENCE, OPTIONS and SYSTEM ON.
- Pump modules: Channel A is on the left, Channel B on the right. CHANNEL SELECT opens that channel on the screen. PAUSE, RESTART and CHANNEL OFF control only that channel.
- Soft keys: blank arrow keys. Their job is written on the screen next to them (for example RATE, VTBI, DOSE, START).
- Prompt line: the line starting with > tells you the next step, such as >Select Drug or >Press START.
- Module display: scrolls the drug name and dose and shows the rate, even when the screen is on another channel.
Programming a primary infusion
- Check the order, the patient (two identifiers) and the bag label.
- Spike the bag, prime the tubing, and load the set in a channel.
- SYSTEM ON → watch the self test → New Patient? Yes → select the unit profile → Yes.
- Type the patient ID from the armband → CONFIRM.
- Press CHANNEL SELECT on the module → Infusion Menu → Guardrails Drugs or Guardrails IV Fluids.
- Use the letter keys (A-E … U-Z) or PAGE DOWN to find the drug. Pick the concentration that matches the bag → Yes.
- For high-alert drugs read the advisory → CONFIRM. On Drug Setup enter PATIENT WEIGHT if asked → NEXT.
- Press RATE or DOSE and type the value. Press VTBI and type the volume.
- Trace the line, open the clamp, check the screen against the order, press the START soft key.
Secondary (IVPB) set-up
- Connect secondary tubing to the port above the pump on the primary line.
- Hang the secondary bag higher than the primary (lower the primary with the extension hook).
- Open the secondary clamp. A closed clamp means the pump pulls primary fluid instead.
- CHANNEL SELECT → SECONDARY soft key → drug → Yes.
- VTBI fills in with the bag volume. Type the DURATION (for 30 min type 30; for 1 h 30 min type 130).
- Prompt reads >Verify Secondary Clamp Open, Then Press START. Callback ON makes the pump alert when it finishes.
- The primary resumes automatically at its own rate.
Parts of the pump
- Color screen (top): the blue title bar shows the care area. The drug name and concentration sit under it.
- Four round soft keys under the screen. Their job is printed on the screen just above each key (for example yes, no, back, dose change).
- Hard keys: ON/OFF, SCAN (barcode), OK (confirms the highlighted field or list choice) and RUN/STOP (starts or stops the infusion).
- Keypad: numbers 0–9 and a decimal point. On the Drug Search screen the same keys type letters: press 1 once for A, twice for B, three times for C.
- Door on the right holds the IV set. One pump runs one channel. A secondary runs through the same channel and the primary resumes when it ends.
Programming a primary infusion
- Check the order, the patient (two identifiers) and the bag label. Prime the set, load it and close the door.
- ON/OFF → New Patient? yes → use ▲ ▼ to pick the care area → OK.
- Drug Search: type the first two letters of the drug name on the keypad (the letters wait about a second, then lock in). Or type one letter and press OK.
- Pick the drug with ▲ ▼ → OK. Pick the concentration that matches the bag → OK. CONFIRM → yes. Read any clinical advisory → continue.
- Drug Setup: type Patient Weight → OK (if asked), then Dose (or Rate) → OK, then VTBI → OK. Time calculates for you.
- Check every value against the order, press RUN/STOP, answer Check Flow (clamps open, no kinks, drops falling) → yes.
- Titrate from the RUN screen with dose change (or rate change): type the new value → OK → RUN/STOP.
Secondary (IVPB) set-up
- Connect the secondary set to the upper Y-site on the primary line. Lower the primary bag on the hanger so the secondary hangs higher. Open the secondary clamp.
- A secondary can only be programmed while the pump is stopped. Press RUN/STOP → program pri/sec → review the primary → program secndry.
- Search for the drug → OK → yes. A watermark 2 shows you are on the secondary.
- VTBI fills in with the bag volume → OK. The reminder says secondary VTBI should equal the bag volume → OK.
- Type the Time as hours and minutes (30 min = 30, 1 h 30 min = 130) → OK. The rate calculates.
- RUN/STOP → Secondary Check Flow: drops falling in the secondary chamber and not the primary → yes. The primary resumes by itself when the secondary is done.
Parts of the pump
- Cassette (left): one cassette with two inlets. Line A is the primary inlet, Line B the secondary inlet. One line goes to the patient.
- Screen: the main delivery screen shows A on the left and B on the right (status, rate, volume infused). The drop symbols above the screen flash while a line is pumping.
- Four soft keys (▲) under the screen: their job is printed just above them (for example A, B, Therapy, Cancel/Back).
- SELECT ▲▼ moves the highlight between fields and list items. Typing replaces the highlighted value. CLEAR empties the field.
- START starts or accepts a change, STOP stops a line, SILENCE quiets an alarm.
Programming a line
- ON/OFF → self test → New Patient? Yes → select the unit (SELECT ▲▼) → Choose.
- Press [A]: the unit's medication list opens. Scroll with SELECT ▲▼ or Page Down, or jump by letter on the number keys (1 = A, B, C; 2 = D, E, F …) → Enter.
- Fluids and IVPB: type the Rate → ▼ → type the VTBI. Duration calculates. Press START.
- Dose-based drips: after the drug, choose the dose units → Choose → container units → Choose.
- Type the drug amount and bag volume from the bag label, and the weight if the dose is per kg. Then the Dose and VTBI. Rate calculates.
- START → Confirm Program? check dose, drug, concentration and weight → Yes.
- Titrate: [A] while running, type the new Dose (or Rate), START.
- Duration is typed as hours and minutes: 30 = 30 min, 130 = 1 hr 30 min.
Piggyback on Line B
- Attach the secondary container to the secondary inlet of the cassette (no need to hang it higher).
- With Line A pumping, press [B]: the medication list comes up again. Pick the drug → Enter. The program screen shows Mode Piggyback (Change Mode switches to Concurrent).
- Type the Rate and VTBI (or VTBI and Duration). Press START.
- Line A shows DELAYED while B runs, then restarts by itself when B's VTBI is done.
- Concurrent runs A and B at the same time, each at its own rate.
No dose limits on this pump
This model's drug list holds drug names only. It has no soft or hard limits, so it will not stop a wrong dose, a wrong concentration or a wrong weight. You type the concentration yourself, so check it against the bag label and get an independent double check for high-alert drugs.
Parts of the pump
- Display: four lines, white on black. The top line shows PRIM or SEC, the drug and START when the program is ready. The highlighted (white) row is the one you are on.
- No number keys. Values are dialed in: ◀ ▶ move to a digit (the white box), ▲ ▼ change it, OK confirms. Example: 9.5 = ▲ 9 times on the ones digit, ▶ once, ▲ 5 times.
- ◀ also selects: it opens the highlighted value or picks a list item, the same as OK.
- C clears a value (press again to leave the editor), or goes back one screen. Start/Stop starts or stops. BOL is bolus.
- Lights above the display: yellow pre-alarm/reminder, green infusing, red alarm.
Programming a primary
- On/Off → Self-test → New patient? Yes ▲ → Press OK to program an infusion → OK.
- Select the Care Unit (▲▼, OK). Drug list: ▲▼ through the list, ▶ jumps ABC → DEF → GHI. OK to select, then the concentration that matches the bag.
- High-alert drugs show an advisory: OK. For per-kg doses the Weight editor opens first.
- The Doserate (or Rate) editor opens: dial the value, OK. A soft limit asks Override? ▲ Yes / ▼ No. A hard limit stops the editor at the limit and shows a message.
- ▼ to VTBI (required), OK, dial it, OK. Time calculates. START appears on the top line.
- Check everything against the order, press Start/Stop.
- Titrate while running: press ◀, dial the new doserate, OK. It is not active until you press OK.
SECondary (piggyback)
- Hang the secondary at least 8 inches above the primary and connect it to the port above the pump.
- Press Start/Stop to stop the primary. ▼ to SECondary → OK → New SECondary → OK.
- Pick the drug and concentration. VTBI fills in with the bag volume: check it, OK, OK.
- ▼ to Time, dial hours:minutes, OK. The rate calculates.
- Start/Stop → Check bag height, open SECondary clamp → Start/Stop again. The primary resumes on its own when the SEC is done.
Parts of the syringe pump
- Syringe on top: the barrel clamp holds the barrel, the plunger driver pushes the plunger. The pump reads the syringe brand and size: check it on the Load syringe screen.
- Green screen: the drug program name across the top, the profile (NICU, PICU) on the right. Menus are numbered: press the number to pick.
- Four orange soft keys under the screen (CHG PROFILE, MORE, CHG DOSE, OPTIONS …) and BACK.
- Keypad: type numbers, ENTER confirms. START, STOP, BOLUS across the top; POWER and SILENCE on the left.
Programming the syringe pump
- POWER → self test (do not touch the plunger driver).
- Select the profile (care area) by its number: NICU, PICU/CCU, Heme/Onc and AcuteCare each have a Continuous and an Intermittent profile. MORE shows AcuteCare, Transport and ER.
- Library menu: pick the drug's letter group (A-B, C-D, E-G, H-L, M-O, P-R, S-Z), then the drug program. 8 = Blood Products. MORE shows mL/hr, Volume/Time and Recall last settings (no library limits). CHG PROFILE goes back to the profiles.
- Select syringe type: B-D, Monoject or Terumo.
- Load the syringe: barrel clamp up, flange in the clip, plunger driver against the plunger, clamp down. The pump recognizes the size; 1 mL and 3 mL syringes must be confirmed.
- Patient weight → ENTER, then re-enter the weight to confirm it. Then the dose (HIGH and LOW limits show on the screen) → ENTER, and the time for intermittent doses (30 = 30 min, 130 = 1 hr 30 min). CLEAR and BACKSPACE fix typing.
- The prompt alternates Press START to begin / Press BOLUS to prime. To prime: press BOLUS, then press and hold BOLUS until fluid reaches the end of the tubing (priming volume shows), then EXIT.
- Press START. When an intermittent or volume/time infusion finishes, the pump beeps: STOP, then flush the line if ordered. It warns when about 5 minutes are left (press SILENCE) and alarms when the syringe is empty.
- Titrate a drip with CHG DOSE → new dose → ENTER → START.
Soft limits vs. hard limits
Soft limit: the dose is unusual for this care area. Stop, re-read the order, recheck your math and the patient's weight. Override only if the order is correct and verified. Overrides are recorded.
Hard limit: the dose is unsafe for this care area. The pump will not run it. Re-enter or hold and call the provider or pharmacist.
Basic Infusion (on the single-channel pump: not in library, Basic Mode) skips all limits. Never use it to get around an alert, and never for high-alert medications.
Vasopressors: mcg/min or mcg/kg/min?
Norepinephrine, epinephrine and phenylephrine each have two library entries for the same bag: the plain entry doses in mcg/min, the weight-based entry in mcg/kg/min. Read the units in the order and pick the matching entry. 0.1 mcg/kg/min is not 0.1 mcg/min: picking the wrong one is an 80-fold error for an 80 kg patient.
On the dual-line cassette pump there is one drug name: choose the dose units (mcg/min or mcg/kg/min) on the Dose Calculation screen and enter the weight.
Dose calculation formulas
concentration (per mL) = drug amount in bag ÷ bag volume (mL)
mL/h = dose per hr ÷ concentration
units/kg/hr : mL/h = (dose × kg) ÷ (units/mL)
Heparin 15 units/kg/hr × 70 kg = 1,050 units/hr ÷ 100 units/mL = 10.5 mL/h
mcg/min : mL/h = (dose × 60) ÷ (mcg/mL)
Norepinephrine 8 mg/250 mL = 32 mcg/mL; 6 mcg/min × 60 = 360 ÷ 32 = 11.3 mL/h
mcg/kg/min : mL/h = (dose × kg × 60) ÷ (mcg/mL)
Norepinephrine (weight-based) 0.1 mcg/kg/min × 80 kg × 60 = 480 ÷ 32 = 15 mL/h
milliunits/min: Oxytocin 30 units/500 mL = 60 mU/mL; 6 mU/min × 60 = 360 ÷ 60 = 6 mL/h
volume/time : mL/h = mL ÷ hours (250 mL over 90 min = 250 ÷ 1.5 = 166.7 mL/h)
mL/h = dose per hr ÷ concentration
units/kg/hr : mL/h = (dose × kg) ÷ (units/mL)
Heparin 15 units/kg/hr × 70 kg = 1,050 units/hr ÷ 100 units/mL = 10.5 mL/h
mcg/min : mL/h = (dose × 60) ÷ (mcg/mL)
Norepinephrine 8 mg/250 mL = 32 mcg/mL; 6 mcg/min × 60 = 360 ÷ 32 = 11.3 mL/h
mcg/kg/min : mL/h = (dose × kg × 60) ÷ (mcg/mL)
Norepinephrine (weight-based) 0.1 mcg/kg/min × 80 kg × 60 = 480 ÷ 32 = 15 mL/h
milliunits/min: Oxytocin 30 units/500 mL = 60 mU/mL; 6 mU/min × 60 = 360 ÷ 60 = 6 mL/h
volume/time : mL/h = mL ÷ hours (250 mL over 90 min = 250 ÷ 1.5 = 166.7 mL/h)
Alarm troubleshooting
| Alarm | Likely cause | What to do |
|---|---|---|
| Patient side occlusion | Kinked tubing, closed slide clamp, bent arm, infiltrated IV | Silence. Look at the site and the line from the pump to the patient. Straighten, unclamp, assess for infiltration. Press RESTART. |
| Fluid side occlusion | Roller clamp closed above the pump, spike not open, empty bag | Open the roller clamp, check the spike and bag. Press RESTART. |
| Air in line | Tubing not fully primed, bag ran dry, bubbles from a new bag | Pause, open the door, remove the air by priming or using a port below the air, reload the set. Press RESTART. |
| Infusion complete / KVO | VTBI reached | Hang a new bag if ordered, CHANNEL SELECT, enter a new VTBI, press START. Or turn the channel off and flush/lock the line. |
| Channel paused too long | Channel paused over 2 minutes | Resume with RESTART, or turn the channel off if the infusion is stopped. |
Safety habits that prevent pump errors
- Always use the drug library. Match the concentration to the bag label.
- Titrate by dose, not by rate, so the library checks the new dose.
- Independent double check for high-alert drips (heparin, insulin, vasopressors, opioids, oxytocin, magnesium).
- Set VTBI to the ordered volume, especially for boluses and pediatrics, not automatically to the bag size.
- Trace every line from bag to pump to patient at start, at handoff, and whenever a new line is added.
- Check the pump against the MAR at the start of every shift and after every change.