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IV medicines at home: Excelsior syringe pump (ESP)

Your child needs to take IV medicines at home. You will be taught what to do, what to watch for, and whom to call if you have questions or concerns.

Your child's IV medicine

Name of medicine

Dose

Give it every                   for          days.

Pump speed:

___ Normal ___ Slow ___ Extra slow

___ Normal saline flush solution or

___ Dextrose flush solution Amount to give: ml When to give it:

___ before and after giving the IV medicine

___:

Heparin flush solution

Amount to give:                ml

When to give it:

___ after giving the IV medicine and flushing with normal saline

___ every

Change the tubing every

What is an Excelsior Syringe Pump (ESP)?

The ESP is a small battery-powered medicine delivery pump. A medicine-filled syringe, with a long, thin tube is attached to the ESP. The thin tube is then attached to your child's IV and the medicine is slowly pushed into the IV.

Preventing infection

The nurse will show you how to keep your supplies sterile, so germs will not enter the IV catheter and cause an infection. An infection in the catheter could make your child sick, and could require removal of the IV catheter.

Cleanliness is a must! Each time you handle supplies or perform a procedure, do the following:

  1. Prepare a clean work area by cleaning a solid surface with a disinfectant cleanser, (Lysol® or another brand.
  2. Wash your hands well, using one of the following methods:
    • Use an alcohol-based hand sanitizer (Purell® or another brand) according to directions.
    • If alcohol-based hand sanitizer is not available, wash your hands for at least 15 seconds with antibacterial soap, rubbing all surfaces briskly, including between your fingers and under your fingernails. Use a paper towel or clean hand towel to dry your hands, and then use the towel to turn off the faucet.
  3. Each time, before you flush or attach tubing to the IV, put on non-sterile gloves and scrub the injection cap for 30 seconds with a fresh chlorhexidine wipe, using friction. Let it dry. Do not fan or blow on it.

Care of medicines

Store the medicine right after delivery:

___ refrigerator

___ room temperature

How do I give the medicine?

Getting ready

  1. Double-check the syringe to be sure:
    • the label has your child's name, and correct medicine name and strength.
    • the expiration date has not passed.

    Note: A medicine is good through the expiration date on the label. Throw it away sooner if there is a problem with it, sediment in it or if you question its cleanliness. If you throw away a dose, call the home care pharmacy to have it replaced.

  2. If refrigerated, warm the medicine-filled syringe to room temperature. Remove it from the refrigerator 6 hours before use or as directed by the pharmacist. Do not use a microwave oven, or bath water to warm. Put it in a clean area and keep it out of direct sunlight.

Setting up the medicine

  1. Prepare the work area.
  2. Wash your hands well.
  3. Gather supplies:
    • chlorhexidine wipes
    • normal saline or dextrose syringes (2)
    • heparin syringe (1)
    • non-sterile gloves
    ___ medicine-filled syringe or

    ___ if you will be mixing the medicine:
    • vial of dry medicine
    • vial of diluent (liquid to mix with the medicine)
    • alcohol wipes
    • syringe ( ml) with needle
    • sharps container for needles
  4. Check the labels of the normal saline or dextrose and heparin syringes, before giving them. Make sure they are the right medicines. Check expiration date.
  5. Pre-filled syringes have an air bubble in them. Before using, hold the syringe upright, pull slightly back on plunger and squirt the air bubble out. This includes normal saline, heparin and medication syringes.
  6. Every time you flush the IV with normal saline or heparin, use the "push-and- pause" method: push a little solution, then pause for 1 to 2 seconds, then push a little more, and pause, and so on. This method cleans the inside of the catheter. Your home care nurse will show you how to do it.

___ If you are instructed to mix your child's medicine:

(See the education sheet, "IV medicines: Preparing at home," if needed.)

Mixing the medicine

  1. Mix the medicine right before giving it.
  2. Put on non-sterile gloves and scrub the tops of the vials with a separate alcohol wipe for each for 30 seconds. Let them dry.
  3. Mix the powder in the vial according to the directions on the label. Be sure the powder is dissolved.
  4. Draw up your child's dose of medicine from the vial.
  5. Remove the needle from the syringe and place needle in the sharps container.

Priming the tubing

  1. Squirt the bubble out of the medicine syringe (see step 5 under "Setting up the medicine").
  2. For the very first dose, or if changing the syringe pump tubing:
    • remove tubing from package.
    • remove the flat, round tubing cap and twist the tubing securely onto the new medicine syringe.
    • remove the cap at the patient end of the tubing. Do not touch the tip once the cap is off. Push the syringe plunger until all the air is removed from the tubing. Put the cover back on the tubing.
  3. If re-using the IV tubing, remove it from the used medicine syringe and twist securely onto the new medicine syringe. Check for bubbles, and reprime if needed.

Setting up the ESP

  1. Pinch the two black levers and move the pusher arm to the top of the pump.
  2. Open the bottom clamp and place the medicine syringe into the clamp. Be sure the rim of the syringe barrel is in the slot at the top of the clamp.
  3. Move the pusher arm down until it touches the syringe plunger. Place the syringe plunger into the slot on the pusher arm.

Starting the infusion

  1. Put on non-sterile gloves and scrub the injection cap on the IV tubing with a chlorhexidine wipe for 30 seconds and let it dry.
  2. Unclamp the IV tubing and flush with normal saline, using the push-and-pause method. Remove the syringe.
  3. Scrub the injection cap with a new chlorhexidine wipe for 30 seconds and let it dry.
  4. Remove the cover from the end of the syringe tubing and twist into the injection cap. Save the cover if you will be reusing the tubing.
  5. Press the desired start button ("Normal", "Slow", or "Extra-Slow") to begin the infusion. A blinking green light shows that the pump is working at the selected speed.
  6. Put the ESP pump on a nearby surface. It does not have to be at a certain height above your child's body to work.

Stopping the infusion

  1. 1. At the end of the infusion, the red Attention light will flash. A beeper will also sound. Push the "Audible Alarm" button to stop the beep. Push the OFF button.
  2. Put on non-sterile gloves and disconnect the medicine syringe.
  3. Scrub the injection cap on the IV tubing with a new chlorhexidine wipe for 30 seconds and let it dry.
  4. Attach normal saline or dextrose syringe and flush solution using the push-and- pause method (see step 6 under "Setting up the medicine").
  5. Scrub the injection cap with a new chlorhexidine wipe for 30 seconds and let it dry.
  6. Attach heparin syringe and flush with using the push-and-pause method (see step 6 under "Setting up the medicine").
  7. Clamp the IV line.

Disposing used supplies

Put used syringes in the trash, unless they have a needle, or unless blood is in them.

Put syringes with needles, or with blood in them, into a sharps container. Do not overfill the sharps container. Your home care pharmacy will dispose of it.

Questions?

 

If you have any questions, please call your home care nurse or pharmacist. 

Problem solving

Note: Pressing the "Audible Alarm" button will silence an alarm.

Problem Possible cause What to do
Red Attention light is flashing. 
  • Infusion is complete.
  • Clamp is closed. 
  • Kink or bend in tubing. 
  • Syringe tubing is blocked. 
  • IV catheter is blocked. 
  • Follow instructions in the section, "Stopping the infusion."
  • Open all clamps. 
  • Massage tubing. 
  • Change hand or arm position. 
  • Call your home care nurse. 
Low Battery light is flashing.   
  • Replace all batteries with size C alkaline batteries. 

IV site is sore, painful, or leaking at injection site. 

Infusion is painful. 

 
  • Clamp the tubing. 
  • See the education sheet for your child's type of IV line. 

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This page is not specific to your child, but provides general information on the topic above. If you have any questions, please call your clinic. For more reading material about this and other health topics, please call or visit Children's Family Resource Center library, or visit www.childrensmn.org/educationmaterials.

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