Introduction: Sedative boluses are among the most frequently delivered intermittent medications utilized in the care of patients in the cardiovascular ICU. Standard bolus doses are prepared using vials dispensed from automated dispensing cabinets, with volumes prepared and administered by bedside nurses. This requires RN’s to leave bedside and necessitates a line access for each dose administered. However, current-generation infusion pumps allow for administration of a pre-programmed bolus dose of sedation without interrupting ongoing infusions. It was postulated that pediatric patients requiring sedative medications after surgery for correction of congenital heart disease may benefit from this pump bolus administration.
Methods: A guideline was created allowing patients with ongoing sedative infusions to receive boluses of those sedatives via the infusion pump. Patients could only receive this pump-bolus if an intravenous lumen (central or peripheral) could be dedicated to sedative administration and if no drug-drug incompatibility was present. Eligible patients’ infusion pumps were programmed utilizing nursing double-check procedure for bolus administration. Data collection included the number of medications administered via the pump bolus setting, time to delivery of medications, associated medication cost savings, administration of reversal agents, and number of unplanned extubations. A pre- and post- implementation nurse satisfaction survey was also obtained.
Results: Sedative medications included fentanyl, hydromorphone, morphine, and midazolam. From July 2020 to May 2022, a total of 14,888 sedative doses were administered using syringe infusion pump bolus setting. This represented 30% of all sedative bolus doses administered in the cardiac ICU over this period. More, none of these doses required separate central line access. Over the reported period, the total number of unit-wide sedative doses administered to eligible patients decreased. However, the number of doses administered via pump bolus increased, suggesting increased utilization of this technique. No reversal agent (naloxone or flumazenil) was required, and no patient safety event related to pump bolus administration was reported. Approximately $100,000 was saved due to the elimination of single-use vials and their associated waste. Nursing survey data strongly supported continued use of this practice.
Conclusions: Use of dedicated lines to administer sedative boluses via a pump-bolus technique reduced time to delivery of medication, frequency of central line access, and medication costs and waste. Significant improvement in nursing satisfaction and patient safety was also captured. Broad adoption of this standard technique warrants further study.
