I don't supply a lot of these anymore but now have a patient on q 4hr PCN 4mu and which is going well. I've had problems in the past with KVO's less than 1ml per hour and so I don't go below this. I also add in volume for priming and the KVO and don't count this in the daily dose.
I'd like to know other providers approach and results. Has anyone gone without KVO's on Groshong type catheters (I'm thinking about 24 hr or longer Vanco bags) or had success with lower rates i.e. 0.1ml/hr. Do you count the KVO volume for the total daily dose?
Submitted by: Ken Fagerman, R.Ph., Outpatient Pharmacist Supervisor, St. Joseph’s VNA Homecare
Response Summary
There were 3 Listserv responses to Ken’s question.
Nancy Kramer, Director, Nursing Services; Coram, Inc. replied: We frequently use a KVO of 0.5 ml per hour so its impact on total drug dose/delivery is negligible. The key to avoiding catheter occlusions at this rate is to use a back-check valve on the tubing. Without a back-check valve, blood can move into the catheter when the pump is not actively cycling (and that's most of the time when the infusion is only 0.5ml/hr). Some pump manufacturers automatically supply the back-check valve with each set (Hospira GemStar). Some, like the CME BodyGuard pump, have the back-check valve built into each set, so it's not an option to use/not use. Others, such as B. Braun Curlin, offer sets with or without back-check valves included in the package.
We try to use a back-check valve whenever the rate of infusion is at 10ml/hr or less for any prolonged period of time. There are no studies that I'm aware of that drive that recommendation and the only pump manufacturer who made any formal recommendation about back-check valves was Sabratek with the original Sabratek 6060 (they advised a back-check valve be used with any infusion less than 20ml/hr).
Jean Macias, Pharmacy Manager, Home Medical Services Infusion Pharmacy stated: When we get orders for patients who have been on q 4hhrs in the hospital, usually it is changed to continuous once they go home.
Joseph Jesuele Jr., RPh, General Manager, Home Solutions responded with: Initially we had used 0.2ml KVO rate but ran into problems with high pressure alarms (CADD Prizm) We now use a 0.4ml KVO rate on our intermittent infusions without problems
Rock-Pond Analysis
Continuous Intermittent Infusions in the home setting occur but not frequently. As Nancy Kramer alluded to, utilizing a back-check valve whenever the rate of infusion is at 10ml/hr or less is an optimal practice. Fortunately these sets are available for most Infusion Pumps.
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