Hi my name is Susan Mingle, I'm a clinical nurse educator with Med One Group, and I'm here today
to do a training session on the Alaris Point of Care unit and the syringe pump module that
you've recently acquired for use. I'd like to start out the demonstration with an overview of
what we call the Alaris PCU point-of-care unit sometimes referred to as the brain nurses like
to call it that because without this nothing else works. So now let's look at some of the
features of the point-of-care unit. The point of care unit's design much like an ATM machine,
you have a very large color screen you have arrow keys that surround the screen and these are going
to correspond to a prompt once we turn it on, and you'll notice there's an orange button that your
silence key and then below that your options key and then over here is system on which is how you
power up the device. Just below this you'll see your numeric keypad and notice that the decimal
is highlighted with a red circle. On the sides of the PCU, you're going to notice what we call
IUI connectors these are where the modules for the Alaris system attach and re-attach at a 45-degree
angle and on the back of the device is where the power cord is attached and this will power up
to four different devices with just the one power cord. There's also what we call our tamper resist
button this black button that you can press and it will lock out the panel so that you can prevent
patients or family members from programming the keypad when you're not in the room and also there
is an embedded ABGN card should you have wireless connectivity and the Alaris server already in
place in your organization. The battery is located beneath and it's an easy pop out for biomed and
to replace it they pop it right back in. As I previously mentioned, these are the IUI connectors
which give the connection for the Alaris modules and the point of care unit ability to communicate
with one another. So now we're going to attach the syringe pump module to the point-of-care unit via
the IUI connectors we previously discussed. So what you'll want to do is you want to take the
syringe pump module sort of tilted at a 45 degree angle so you're lining up this groove
with the actual IUI connector and then you want to seat it in there and you'll hear a click when
you have reached communication. Now each of the Alaris modules will have the same buttons
no matter which ones you choose to bring into your organization they'll have a channel select
button which is how you actually activate that module for use. You have a pause button should
you need to pause the infusion. You have a channel off button when you're ready to discontinue that
infusion and then you also have a restart button should you have paused something and
then you're ready to restart it. Next we're going to walk through the actual choosing of syringes,
loading the syringe pump, and then finally the demonstration of this drugs on the syringe module.
The Alaris syringe pump module accepts multiple vendors syringe sizes from 1 ml up to 60. BD,
Monoject, Terumo. The flow rates of the Alaris syringe pump module are as low as 0.001 for
your tiny premature babies, all the way up to 999 should you need that. Additionally,
the tubing for the Alaris syringe pump module is not proprietary, you can use any tubing that will
lure to the end of a syringe in any combination of what your hospital would want to use. So keep
that in mind that it does not have to be a dedicated syringe pump tubing from Alaris.
So now we're going to move forward with an instructor-led demonstration. I'm actually going
to be walking through scenarios and have a nurse do the actual programming much like you would do
in your own hospital skills lab setting. So we're going to have our nurse take a 10 ml syringe for
this scenario. Attach an extension set to the syringe, prime the syringe, and then we're going
to simulate loading and starting an infusion. So now we're going to walk through an infusion,
we're going to start off by powering on the device with the system on button. We'll wait
for the device to go through its diagnostics to confirm via the IUI connector that we have
connectivity between the PCU and the syringe pump. Now you'll see, one of the first screens that
you'll get is is this a new patient and remember those arrow keys that surround
the screen you choose yes. Then we are going to be using a NICU profile for this demonstration,
so you will say yes to the NICU profile. Patient ID we're going to just confirm and skip through
that that depends on if your hospital has that setup or not. So now it's just going to be in
a standstill mode until we're ready to tell it to do something and how we do that is by using
that rectangular blue bar at the bottom of the screen. It will say select the channel but first
of all before we select the channel, we're going to actually walk through how you load the syringe.
It's a three-step load you take the flanges of the syringe and you put them underneath this
gray area. Then second you pull out the plastic barrel clamp and you swing it around so that it
hugs the syringe itself, and then lastly the very top which is the plunger mechanism you turn it
and lower it down so that it grasps the top of the syringe. So that gives it the capability to press
down as the syringe pump is powered on. Now I'm going to ask the nurse to take
the plunger head off, and raise it back up to that very upright position. Now,
I'm going to show you a safety feature when you're programming this syringe pump if you don't have it
loaded accurately, it will not let you perform an infusion which is a great safety feature. So
I'll ask her to press channel select, and right away you get this bitmap and it's flashing that
she does not have the plunger engaged with the top of the syringe driver. So we're going to
go ahead and replace that and get it back down into that position and once that's confirmed she
presses confirm. Now she's able to move forward with the infusion. So now she'll confirm that
that is a BD 10 syringe because it's based on each manufacturer's internal diameter because
they're all different that's why you have to choose the manufacturer and press confirm.
Now we're going to walk through what we call Guardrails which is the name of the safety
software. We're going to do an IV fluid, so Guardrails IV fluid and in this scenario we'll
show you the name of the drug is on the left and shortcut keys are on the right. So you can speed
through the alphabet, so we're going to choose lipids. So she'll section through the alphabet
the K through O to get to lipids and pick L and then confirm yes that's what I wanted. We're
going to start with a rate of 0.1 per hour. Then notice that our volume to be infused says all,
you can have that in your configurations default to all or if she highlights volume to be infused
she could put in an amount that she wants. But for this instance we're going to go ahead and
say all because we want all the lipids to go in, so we're going to press start. You'll notice once
the start button is pressed, you have the green light at the top which means that that's a good
infusion everything's going positive. You have the rate just below and then scrolling across the
marquee you see the name of the IV fluid scrolling continuously across. So now we're going to have
to power this device off because we only have one for this scenario but let me show you how
you power it off without turning everything off. You press and hold power off till you hear chirp
then press any button on the keypad. That just at least wipes that infusion away and now we can
go show you how to do a Guardrails IV drug. So now we're going to press channel select again,
but now we're going to choose the top entry Guardrails drugs. Now here's when your shortcut
keys come into good use because we're going to do Midazolam so she needs to press K through
O. Then she can hit M but the drug is there so we can just press Midazolam on the left. Then
you have a choice again based on your hospitals Pharmacy guidelines what drugs will be in here
and parameters for this scenario we're going to use two kilos or greater. Then we're going to
choose the 5 milligrams in 25 mils and then all you do is say yes this is what I want. Then you
put in your patient's weight and we're gonna say our baby weighs 2.5 and it will remember
every other weight-based drug that weight should you have multiple infusions that are weight-based
it'll remember that each and every time. So press your next button to confirm and
then we're gonna do a dose so we highlight dose we're still going to leave the default to all.
Then we're gonna put in a dose of 10 mics and it will calculate the rate because it's a rate
dosed dose rate calculator. Then we're going to press Start. Again same green light which
means everything is good, the dose is listed below, and the name of the drug and the amount
of the drug is scrolling through the marquee. Now I'm going to demonstrate some of the safety
software that the Guardrails being a smart pump will protect you from making a decimal error,
too many zeros that type of programming error. So I'm going to ask Karen to channel select,
then I'm going to ask her to change her dose to 100. She missed she thought she hit 10 and somehow
she doubled key pressed and so this is what we call an example of a soft limit. It is above
the Guardrails limit that pharmacy set at 60, but it's giving her the opportunity say yes or no do I
want to do this and because she made a typo she's gonna say no I don't want to do that. Then she can
go back and put in the intended dose then I want to show you a hard limit. Let's say she puts in
she thought she put in 11.5 and she hit 115 by mistake, missed that decimal. Press Start this
is an example of what we call a hard stop that means that you cannot go above that limit you
must press reprogram and go back and put it put in something that's less than what pharmacy has set.
Let's go back to our 10 ten mic dos and press Start. So now I've simulated a near end of
infusion which is what will happen when your syringe is close to being empty. I did have to
change the drug and the rate so this could happen in a timely manner, so you see green and it's
still infusing but yellow means it's in a pause mode giving you time to go get your subsequent
syringe. So you can go ahead and press the silence button, then go get your subsequent syringe if you
don't bring your subsequent syringe back in time, then it will go to what we call a syringe empty.
Which just means that the infusion has finished it's not continuing to run anymore, so this is
why we give you this near end of infusion option to set in the configurations. So if you want the
heads up you definitely can program that in. So now we'll just let it go to a syringe empty,
so now after the syringes near end of infusion if it's not brought back in and one replaced it,
will ultimately go to what we call syringe empty and you see the red alarm light going. So you want
to silence that, bring in your new subsequent syringe, so you can take down the old one load,
your new one with your new 10 mLs and in this case we're going to use normal saline.
Okay, so we'll channel select we'll confirm that it's the BD 10 again and then you should
see to the left hand side of the PCU on the bottom button is a restore feature.
So if everything that you're programming is the same and the syringe is the same,
you hit restore and then you just press Start again. So a couple of things to keep
in mind on the syringe pump, it has options so we're going to walk you through a few of
those options. So you'll press the blue button that says options below your silence button,
and you'll see a couple of things here: display, patient ID, clinician ID, power all channels down,
and anesthesia mode. These are options on the brain, or the PCU so now if you exit out of there,
and hit channel select on your syringe now we can look at the syringe pump options.
So if you notice, that the pressure limit high, notice that so you have three choices low medium
and high to check pressure in the line. Low is 200 medium is 500 high is 800. So let's go back
to exit to go back to the main screen, and press Start and notice that everything is still running
even though we were looking at those options. If you'll notice, on the bottom of the syringe,
there's a place in there where you could place what we call our pressure sensing disk. This
is a tubing that is used for critical drugs on micro preemie babies such as dopamine, dobutamine,
and what this does is allow for real-time pressure in the line. So you actually can see what the
millimeters of mercury of pressure are in the line when you use that pressure sensing disk. So you'd
want to talk to your Med One rep about getting that tubing in if that's something that your
organization decides they would like to do. One additional feature I'd like to show you is if you,
need to interrupt or delay an infusion to say draw labs or something like that. If you'll press the
channel select and pressure delay options button on the left, you can actually delay your infusion
for hours or until a time during the day. So we're going to choose the delay for, because we're just
drawing some labs and we're going to put in ten minutes and then we're going to press call back
because we want to be called back when that ten minutes is up and we're going to choose before and
after. Because we want to be notified before and after and press confirm. So when that ten minutes
is up, we're going to receive an alarm that lets us know the ten minutes is up and then all we
need to do is go ahead and resume start because we've completed our lab draw. Lastly, we're going
to conclude our session with how do you turn the infusion off but before you do that you
want to make sure that you have charted all the infusions and the volume that has been infused.
So if you notice the bottom left button on the brain PCU, it says volume infused so this will
give you by pressing that this will give you all the infusions whether you had four channels
running, which is the max that you can have or just the one which we have done in this case and
it gives you that the total amount of drug that has infused the date and the time it was last
cleared. So if you're ready to chart, you go ahead and press write your numbers down, press the clear
all button, and then you can go back to your main screen. But our patient has now been ordered a
DC of this fluid, so we're going to go ahead and power down the module and since there's only one
module it will power down the whole system. So you press and hold channel off till you hear a little
beep, then you let go and now you've power down your syringe infusion.
This concludes our syringe pump demonstration we thank you so very much.