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SARASOTA MEMORIAL HOSPITAL NURSING PROCEDURE PS1094 TITLE: LEVEL 1 RAPID INFUSER (H1200 FAST FLOW FLUID WARMER) (CRC25) ISSUED FOR: DATE: 4/15 REVIEWED: 4/16 PAGES: 1 of 3 RESPONSIBILITY: Nursing *Qualified Nurse-ECC, OR, PACU and Critical Care PURPOSE: To establish and define standards of use of Level 1 infuser for Rapid Fluid Infusion for Sarasota Memorial Hospital patients. DEFINITION (S): Qualified Nurses are nurses who have completed training and a competency evaluation on the Level 1 infuser. Competency includes alarm recognition and management and system set up and troubleshooting. CAUTION: 1. The nurse assigned to the Level 1 Infuser cannot assume any other responsibilities while in use. 2. Nurses may not administer medications via IVPB drip mode through this system. KNOWLEDGE BASE: 1. The Level 1 Fluid Warmer System may be used in the following nursing units: ECC, OR, PACU and Critical Care. 2. Blood and IV fluids may be administered per doctors’ orders and in conjunction with the Mass Transfusion Policy/ order set. 3. The rate at which blood and fluids can infuse is dependent upon the size/gauge of the patient’s IV access. 4. The Level 1 Infuser may also be used to “warm” fluids and not rapidly infuse fluids. Intravenous Fluid bag should be hung from IV pole above the Level 1 unit, not in the automated pressure chamber. The roller clamps can be used to adjust the flow. PROCEDURE: 1. Obtain Level 1 Infuser, disposable Level 1 IV set and intravenous solutions. 2. Set up disposable set in sequence with the numbers found on the hardware component: Once assembled turn power on. It may take up to 3 minutes to reach operating temperature. 3. A green “system operation” light should illuminate on the display panel. If “check disposables” light TITLE: LEVEL 1 RAPID INFUSER (H1200 FAST FLOW FLUID WARMER) (crc25) PAGE: 2 of 3 illuminates and intermittent alarm sounds, check disposable IV tubing installation at all sites. 4. To Prime IV Tubing Set: a. Close all clamps on disposable set b. Aseptically spike both infusion bags as ordered and hang on fluid warmer pole. Air should be “burped” out of IV solutions when possible to help prevent tubing errors. This should not be done with blood products. 2 bags of fluid/blood MUST be hanging at all times however, only 1 Bag of fluid/blood should be infusing at a time. c. Prime Disposable Set. Fill the drip chamber under 1 bag halfway. Open the clamp below the drip chamber. Open the clamp immediately below tubing Y and the clamp above the Air eliminator. When air eliminator/filter is filled with fluid, remove from holder and tap against pole until all air bubbles are vented out. Replace air filter in holder. Open clamps below air eliminator/ filter to prime remaining tubing. d. Don gloves and connect to patient catheter. e. Initiate infusion as per physicians order. REMEMBER: Only one bag will be infusing at a time. 5. To begin infusion, make sure IV solution bags are placed in each automated pressure chamber (unless warm fluid only to be given) There are hooks inside door of each chamber allowing for different sized bags to be placed. (ex. Blood products in smaller bags than 1 liter) 6. Open clamp to bag to be used and flip the level above the bag to + position moving to the left. This will inflate the pressure bag inside the chamber. *Make sure the other bag is clamped and the lever is to right (NO PRESSURE) 7. Changing Solution Bag: As first Solution bag empties, clamp off first bag that is finished and move lever to the right (negative) position to release pressure. Then open second bag clamp, and move lever to the left (positive) on the second bag to TITLE: LEVEL 1 RAPID INFUSER (H1200 FAST FLOW FLUID WARMER) (crc25) PAGE: 3 of 3 pressurize. Each liter of fluid when under pressure will take approximately 1 minute to complete so you must start changing the “empty” bag as soon as the other is started. 8. REFERENCES: Discontinuation of Rapid Fluid Infusion: a. Occurs when the fluid administration requirement is below 200 ml/hour as per physician order. b. Pressure should be removed from both bags, and bags should be clamped. Disconnect from the patient. 1. Level 1 Technologies Product Manual 2. Smith Industries Medical Systems Product Literature (supplier of tubing system) REVIEWING AUTHOR (S): Lori Danko, BSN, RN, CEN, Clinical Practice Specialist, ECC Benny Kruger, MSN, RN, CCRN, CNN, APN, Critical Care & Hemodialysis Risa Benoit, DNP, CNS-BC, CCRN-CSC, Advanced Practice Nurse, Perioperative Services