From: Michele Durda
To: Pharmacy Clinical Specialist
Cc: Chris Pamperin, Berkley Sykes
Sent: Monday, April 30, 2018 4:21:01 PM
Subject: Alaris Infusion Pumps - Stepped Infusions
Attachment: amiodarone Infusion Protocol (Alaris Pump)
Adult IVIG Infusion Instructions

While the Alaris pumps are much better and easier to use overall than the Plum Pumps, the loss of the multi-step feature is causing some angst.

This is particularly problematic for amiodarone and IVIG.

Amiodarone :
Our BD consultant recommending turning amiodarone into 3 separate orders 1. Use the 150 mg/100 mL pre-mix bags for the bolus (set up as an IVPB) 2. Use the 360 mg/200 mL pre-mix bags for the 6 hour initial infusion (set up as an IVPB) 3. Set up the maintenance infusion as a continuous infusion

This sounds like a great option - except both of the pre-mix bags are on indefinite backorder.
Therefore, we will have to continue to administer all 3 steps from the 450 mg/250 mL bag.
The nurses are running into problems because the pump will not let them set up the infusion for a duration of 6 hours (have to enter VTBI, which they must calculate). In addition, if a bolus is given from the bag, there is not enough left in the bag to administer the full 200 mL of the initial infusion. They then have to calculate the remaining VTBI to infuse from the second bag.

I have attached an attempt at providing them some instructions to deal with this problem. Please let me know your thoughts. For those of you that haven't worked with the pump, I have a pump in my office that you can work with.

IVIG :
The pump does not give you the option of programming in mL/kg/hr. IVIG is currently set up as an intermittent infusion (I've been told this is the best way for interoperability). The pump will only let the initial rate for an intermittent infusion to be set as the VTBI and Duration. Rate changes require the Rate and VTBI to be set. The grayed out components cannot be programmed in the pump. Looking for feedback.

Thanks,
Michele
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Michele Durda, Pharm.D.
Medication Safety/Drug Utilization Pharmacist Huntsville Hospital