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Elastomeric infusion systems

Clinical safety note 
There are physical and operational differences between different brands of elastomeric infusors. Always refer to the operator's manual for a complete list of all warnings and precautions associated with these devices. Flow rates of these devices can be affected by variables such as heat, cold, presence of fever and hypertension. See ISMP safety alert regarding an incident involving the rapid infusion of high dose fluorouracil.

Only health care professionals who have attained competency, as per institutional guidelines, in non-electronic infusion device management and related competencies, e.g. safe administration, handling and waste management of cytotoxics, and central venous access device care, should perform these procedures.

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This document provides information on the management of non-electronic infusion devices (elastomeric infusors). These devices are used to administer protracted infusions of medications via central venous access devices.

This document should be read in conjunction with:

Description

An elastomeric infusor is a lightweight, single use, disposable device which is used to administer intravenous drugs continuously e.g. antibiotics, analgesia or cytotoxics. The infusor consists of a rigid transparent round or cylindrical container which encapsulates a balloon reservoir that is capable of being inflated to a predetermined volume and the drug delivered over a set period of time.


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Clinical safety notes

Each device has a flow restrictor which regulates the flow of the drug. The flow restrictor is activated by body heat and should be in contact with the patient's skin as per manufacturer's instructions. The casing of the infusor has a measurement scale which allows for the monitoring of the balloon reservoir. The balloon takes approximately 4 hours to start decreasing in size and should be checked regularly (e.g. every 8 hours).

Flow rates can be affected by:

  • exposure to high temperatures including direct sunlight (causing rate to increase)
  • exposure to cold temperatures (causing rate to decrease)
  • viscosity of fluid (5% dextrose is the recommended diluent)
  • hypertension
  • gauge, length, diameter, and location of the central venous catheter used
  • incorrect positioning and fixing of the flow rate sensor to the patient's skin
  • the balloon reservoir being positioned above or below the luer lock connector height.

Image of flow rate restrictor and pump position (PICC line)

Image of balloon deflation

© www.baxterhealthcare.com.au

For further information see the manufacturers recommendations.rr
Central venous access and the use of luer lock connectors with a split valve septum are recommended when administering drugs via an infusor.
Read more about the clinical procedure for elastomeric infusion management systems.

Troubleshooting

Report all incidents that involve the incorrect delivery of drug to a medical officer and pharmacist immediately. Document in the patients notes and complete an incident form.

Problem Cause Action
Failure to infuse 1. Line clamped. 1. Unclamp line.
2. Line kinked. 2. Unkink line.
3. Flow sensor not in contact with patient's skin. 3. Attach flow sensor to patient's skin.
4. CVAD blocked. 4. Check patency of CVAD by withdrawing blood and flushing. If the line flushes freely and there are no obstructions the infusor may be faulty. If the line does not flush refer to a senior nurse or medical officer for review.
5. Faulty infusor. 5. Change the infusor.
6. Filter has come into contact with soap or fatty solutions. 6. Change the infusor. Educate the patient to avoid the filter coming into contact with soap or fatty solutions.

Rapid infusion -completed before due date/time

Safety alert

 7. Patient exposed to a heat source such as a heater or the patient is febrile. 7. Identify cause. Educate patient to avoid heat sources. If the patient is febrile the patient must be reviewed by a medical officer before continuing with treatment.
8. Infusor incorrectly positioned above luer lock connection. 8. Always position infusor at luer lock connection level.
9. Infusor positioned within or close to radiation field. 9. Always position infusor away from radiation field.
Under infusion - not completed on due date/time 10. Infusor exposed to cold temperatures. 10. Educate patient to avoid cold temperature.
11. Infusor incorrectly positioned below luer lock connection. 11. Always position infusor at luer lock connection level.
12. Flow rate sensor not in contact with patients skin. 12. Attach flow rate sensor to patient's skin.
13. The patient has high blood pressure. 13. Monitor patient's blood pressure and refer to medical officer before continuing with treatment.
Rupture and/or leakage 14. Accidental line breakage or disconnection 14. Clamp line proximal to the line rupture/leakage. Manage as per Spill management
15. Alcohol preparations has come into contact with the filter. 15. Clamp line proximal to the leakage. Manage as per Spill management

Patient and carers should be educated:

  • to safely manage their elastomeric infusor by:
    • keeping the infusor at a suitable height
    • inspecting infusor for and reporting leaks
    • checking for correct placement of the sensor
    • checking the balloon is deflating every mealtime and before bed
    • avoiding extremes in temperature
    • keeping the infusor out of direct sunlight
    • not submerging the infusor in water.
  • about safe handling and spill management
  • to immediately report symptoms such as pain, burning, stinging, pruritus around the CVAD site
  • about what to do in the event of extravasation and/or leakage of drug
  • about what to do if the infusor completes earlier than expected.

Patients and carers should be supplied with Patient information and given details of appropriate 24 hour medical and nursing contact to which patients can direct queries.

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Bibliography

Bak, K., E. Gutierrez, E. Lockhart, et al. 2013. "Use of continuous infusion pumps during radiation treatment." J Oncol Pract 9(2):107-111.

INTRODUCTION: Despite increasing chemoradiotherapy treatment, there is a paucity of information regarding the effects of radiation exposure on ambulatory infusion pumps used to deliver chemotherapy or other essential medications. The aim of this overview is to present the available evidence on this subject, heighten awareness within the clinical community, provide considerations for minimizing possible negative effects on patient care, and encourage the monitoring of infusion devices after exposure to radiation or electromagnetic interference. METHODS: Published literature was systematically searched using MEDLINE and EMBASE; gray literature was searched using Google and an environmental scan of relevant Web sites. A multidisciplinary working group reviewed the compiled evidence, and a draft of the document was sent to health professionals from various disciplines for an external review. RESULTS: Four reports and three manufacturer device alerts were identified that suggest a risk of pump malfunction as a result of radiation exposure. The estimated cumulative dose at which pump failure has been reported ranges from 28.5 to 42 Gy; however, additional clinical investigations should be undertaken. Pump relocation, pump shielding, and assessment of the pump after radiation exposure are most commonly suggested to minimize pump malfunction related to radiation exposure. A list of additional considerations is offered for those developing institution specific policies and procedures based on the available evidence and expert consensus. CONCLUSION: The varied and unpredictable results of radiation exposure on infusion devices suggest that additional testing should be carried out to determine the limits of dose exposure and to raise awareness around this patient safety issue.

Camp-Sorrell, D. & Matey, L. (eds). 2017 "Access device standards of practice". Oncology Nursing Society. Pittsburgh.

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Version 4

Date Summary of changes
30/10/2019 Resource reviewed by nursing reference committee electronically. Images of flow restrictor, pump position and balloon deflation added. Link to safety alert updated. Minor updates to troubleshooting. Next review 2 years.

Version 3

Date Summary of changes
18/07/2009 Approved on eviQ.
18/7/2009 Transferred to eviQ.
22/07/2011 Reviewed and updated. Format changed. Document separated into resource, clinical procedure, trouble shooting.
06/09/2012 Reviewed. No change. Review date change.
05/02/2015 Updated. Troubleshooting table incorporated.
18/03/2015 Changed title to Supporting Document.
23/03/2016 Reviewed. Nil changes to content. Review in 2 years.
31/05/2017 Transferred to new eviQ website. Version number changed to V.3

This document reflects what is currently regarded as safe practice. While every effort has been made to ensure the accuracy of the content at the time of publication, the Cancer Institute NSW does not accept any liability, with respect to loss, damage, injury or expense arising from any such errors or omission in the contents of this work. Any reference throughout the document to specific pharmaceuticals and/or medical products as examples does not imply endorsement of any of these products. While eviQ endeavours to link to reliable sources that provide accurate information, eviQ and the Cancer Institute NSW do not endorse or accept responsibility for the accuracy, currency, reliability or correctness of the content of linked external information source. Use is subject to eviQ’s disclaimer available at www.eviQ.org.au

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20 Apr 2024