If you do not have an IV pump on your truck, stop reading here...
Problems with the current PDP Model
1.Large margin for dosing errors 2.Wasting a CC, drawing up a CC, and giving a CC with a 10 CC syringe. We know that pediatric dosing with a 10cc syringe (1:10,000) is not recommended and we should really only be drawing up what we plan on giving. Check out this article in JAMA. 3.Failure to bridge to an infusion. The problems with just starting an infusion 1.Some will argue that they can mix a PDP faster than they can set up a drip and program the pump. 2.Lag time through the extension set. With most extension sets having a 1-2 ML priming volume, a Levophed drip at 5 mcg a minute with a standard 16mcg/ml concentration would not even touch the patient for about 4 minutes... yikes. A central line would obviously take even longer! Solution
1. The clinician using a 5cc syringe draws up and inserts 4 mg of Levophed into a 250 bag. 2. The bag now has a concentration of 16 mcg/ml 3. The same syringe that was used to insert the 4 mg of Levophed is used to withdraw 3 CC’s out of the bag. This leaves a concentration of 16mcg/ml. 4. The clinician then will insert 1 ml into the patients IV extension set. This will prime the extension set. Using a 5cc syringe allows larger graduation marks and easier assurance of ML’s pushed. 5. The bag will then be spiked and programmed at the desired starting dose.
*Special thanks to Kevin Rixmann (Flight Nurse) for helping me with this project.