Download use of cadd-legacy plus model 6500 ambulatory infusion pumps for

SARASOTA MEMORIAL HOSPITAL
NURSING PROCEDURE
TITLE:
ISSUED
FOR:
USE OF CADD-LEGACY PLUS MODEL
6500 AMBULATORY INFUSION PUMPS
FOR CONTINUOUS INFUSION
CHEMOTHERAPHY
(ONC27)
Nursing
DATE: 4/05
REVIEWED: 6/16
PAGES: 1 of 4
RESPONSIBILITY:
RN
PURPOSE:
To provide guidelines for the safe administration of chemotherapy for
patients requiring continuous infusion chemotherapy on an
ambulatory basis.
OBJECTIVE:
The patient will receive chemotherapy infusion delivered in the
ambulatory setting by using the CADD-Legacy PLUS or equivalent
pump in a safe manner.
KNOWLEDGE
BASE:
1.
2.
3.
Continuous infusion ambulatory pump delivery of chemotherapy
will be instituted when ordered by a physician on current
chemotherapy orders as per SMH Nursing Procedure
“Administration of Chemotherapeutic Agents and Biotherapies Adults (onc01)”.
Only qualified Registered Nurses (RN) with documented
chemotherapy competency will manage the pump in conjunction
with the patient and adhere to policy and procedures outlined in
SMH Nursing Procedure onc01.
All nursing personnel managing the pump will have completed
the approved education and have documented competency
regarding programming and care of the pump.
EQUIPMENT:
1.
2.
3.
4.
5.
6.
CADD pump (and carrying case)
AA Alkaline batteries (4)
Gown, chemotherapy approved
Gloves (2 pair), chemotherapy approved
Tape
Alcohol wipes
PROCEDURE:
1.
Upon receiving an order for ambulatory continuous infusion
delivery of chemotherapy, notify the pharmacy to prepare the
drug in a CADD pump cassette.
Pharmacy will deliver a CADD cassette with chemotherapy and
the tubing primed with normal saline, labeled with the patient
name, patient ID number, drug name, amount, base solution, and
date.
Obtain a CADD pump (kept on Sarasota Memorial Infusion).
The administering RN and a second RN will independently verify
the chemotherapy label with the physician’s order in the patient’s
medical record prior to programming the CADD pump.
2.
3.
4.
PUMP PROGRAMMING:
1. Only qualified RNs who have completed a chemotherapy
competency course and a pump in-service may program a CADD
pump.
TITLE:
USE OF CADD-LEGACY PLUS MODEL
6500 AMBULATORY INFUSION PUMPS FOR
CONTINUOUS INFUSION CHEMOTHERAPY
(ONC27)
2.
3.
4.
PAGE:
2 of 4
The steps on how to program the CADD pump are outlined in the
pump’s instruction manual. This manual is available on Sarasota
Memorial Infusion and 8WT nursing units where the CADD
pumps are utilized for chemotherapy.
All CADD pump rate changes may be done only in response to a
computer-entry physician order and validated by 2 RNs.
Use new, AA alkaline batteries with each dose/infusion. Have
new batteries available for replacement. Do not use rechargeable
batteries.
NOTE: Do not use the pump if the battery door or tabs are
damaged because the batteries will not be properly secured; this
may result in loss of power and non-delivery of drug.
5.
The CADD-Legacy PLUS pump has two delivery methods, and
provides delivery in mL/hour. The continuous delivery mode
permits a steady infusion rate. In this mode, you can program the
pump to deliver medication at a constant rate in mL/hour. The
continuous mode is what will be used at SMH for ambulatory
delivery of chemotherapy.
In Medication Room:
1. Perform hand hygiene.
2. Don chemotherapy gown and gloves (double gloving is
recommended) (Oncology Nursing Society, 2014).
3. Attach the cassette to the pump.
4. Program the pump with the prescribed continuous infusion rate.
In Patient Room:
1. Identify the patient and medication as per SMH Nursing
Procedure “Administering Medications – Adults and Pediatrics
(med01)”.
2. Second RN independently verifies correct drug, dose, route, and
rate, and pump settings.
3. Check for blood return from the IV site before initiating
chemotherapy (Oncology Nursing Society, 2014). Flush the
established IV line per SMH nursing procedure.
NOTE:
line.
4.
5.
6.
All infusions should be administered through a central
Connect the pump tubing to the established intravenous line
connecting to the central venous access device. Begin the
continuous infusion as per ordered setting. Secure all tubing
connections with tape to help prevent accidental disconnection.
Provide a clean carrying case for the CADD pump.
If the patient needs to return in 24 or more hours for further
chemotherapy via the CADD pump, install fresh batteries. When
the patient returns after infusion is complete, stop the pump,
disconnect tubing using chemotherapy precautions as per SMH
Nursing Procedure (onc08).After disconnecting, check for a blood
return and then flush the IV line per SMH procedures.
TITLE:
USE OF CADD-LEGACY PLUS MODEL
6500 AMBULATORY INFUSION PUMPS FOR
CONTINUOUS INFUSION CHEMOTHERAPY
(ONC27)
7.
8.
PAGE:
3 of 4
Discard the empty drug cassette in the chemotherapy waste
container per SMH Nursing Procedure (onc08).
Return the CADD pump and carrying case to Sarasota Memorial
Infusion for cleaning and storage.
NOTE: Sarasota Memorial Infusion or Oncology staff will assist
patients who visit the SMH Emergency Care Center or who are
admitted to a non-oncology service with a CADD pump.
PATIENT
EDUCATION:
1. Instruct patient and provide the “Ambulatory CADD Pump Patient
Information” sheet and the “Patient Information Kit”.
2. Provide to the patient ”The Chemo Bio-Wipe Bag” which instructs
the patient in handling an accidental chemotherapy spill.
3. Instruct patient on proper care of the pump and troubleshooting
guidelines. A 24/7 pump support troubleshooting hot line:number
is written on the side of the CADD pump:: 800-315-3287.
4. For help with billing, patients can call InfuSystem at 800-962-9646
5. Document written material provided at discharge in the patient
medical record.
DOCUMENTATION:
1. Electronic Medication Administration Record (EMAR): document
time of chemotherapy administration, noting 2nd verifying RN.
When paper MAR is in use for downtime process, also document
infusion rate and initials of both verifying RNs.
2. Assessment/Reassessment Flowsheet: document the infusion
rate and the time it was discontinued.
3. Document patient education and educational materials provided in
the medical record.
REFERENCE:
Oncology Nursing Society (2014). Chemotherapy and Biotherapy:
Recommendations and Guidelines for Practice. (4rd edition).
Pittsburg, PA: Author.
InfuSystem (2010). Infusystem Patient Information Kit
SMH Nursing Procedure. Administering Medications – Adults and
Pediatrics (med01). Administration of Chemotherapeutic Agents and
Biotherapies - Adults (onc01). Disposing of Chemotherapy Tubings,
Solution Bags, and Syringes (onc08). SMH: Author.
TITLE:
USE OF CADD-LEGACY PLUS MODEL
6500 AMBULATORY INFUSION PUMPS FOR
CONTINUOUS INFUSION CHEMOTHERAPY
(ONC27)
PAGE:
4 of 4
REVIEWING
AUTHOR(S):
Deena Damsky Dell MSN, RN-BC, AOCN, LNC, APN Oncology
Debbie Mount BSN, RN, Sarasota Memorial Infusion
Donna Gorski BSN, RN OCN, Sarasota Memorial Infusion
Rachael Pierce BSN, RN, OCN, Sarasota Memorial Infusion
Mary Ann Brockman BSN, RN, OCN, Clinical Manager, Sarasota
Memorial Infusion