Interdisciplinary
Lexington Medical Center
SUBJECT:
EFFECTIVE:
SERVICES:
Intravenous Infusion: Alaris Infusion System
10/2011
Nursing, Pharmacy, Biomedical Engineering
Purpose:
To define and describe the features & uses of the Alaris Infusion System with
Guardrails®.
Policy:
Intravenous medications, solutions, and blood products that are to be administered on an
infusion pump to control delivery shall be placed in the Alaris Infusion System.
Intravenous medications or solutions not requiring an infusion pump may be
administered by gravity at the discretion of the RN. Staff must utilize the appropriate
profile and the Guardrails® Drugs and IV fluids library to enhance the safe delivery of
intravenous medications.
I. Definition of Terms:
A. BRAIN – This is the part of the Alaris Infusion System that contains drug data sets and pump
configurations. The BRAIN controls all the solutions and medications delivered through the pump
Channels. The BRAIN cannot deliver any medication without a pump Channel. Each BRAIN has
the ability to control four pump Channels.
B. Pump Channel – This is the module that attaches to the BRAIN for delivery of intravenous fluids
or medications.
C. Pump Configurations- These are sets of data determined for each profile that controls the overall
operation such as maximum rate, air in line sensitivity, pressure and alarms of the BRAIN and
pump Channels. Configurations are established unique to each profile.
D. Profile- These are programs that represent a specific patient population that uses similar infusion
types and requires similar safety parameters. Each profile contains drugs and instrument
configurations that are appropriate for that patient population.
E. Guardrails: This is a software program within the BRAIN that consist of list of fluids, drugs,
dosing limits, bolus doses, concentration limits, duration limits, rate limits, therapies,
configurations and clinical advisories that are used to deliver medications safely via the Alaris
pumps and Channels.
F. Drug Data Set Library-These are profile specific list of drug names, concentrations, dosing limits
and dose parameters available during normal operation. May also include clinical advisories and
therapies and represents best practice and is monitored via the Guardrails software.
G. Soft limit- This is a programmed limit that can be overridden. It allows the operator of the infusion
system to adjust the rate or dose of drug delivery above and below the limit. When a soft limit is
reached, the operator will be asked to review and approve the infusion rate to assure that an error
has not been made before overriding the Guardrails limit. A visual prompt will continuously scroll
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across the pumping module indicating that the infusion is being delivered above (
) or below
(L L L) the Guardrails® limit when a soft limit is overridden.
H. Hard limit-This is a programmed limit that can not be overridden. It does not allow the operator of
the infusion system to adjust the rate or dose of drug delivery above or below the limit.
I. Basic Infusion Mode – This is a program used to deliver non standard concentrations IV
infusions/medications that are not in the Guardrails library. It is very rare for an infusion to be
delivered by basic infusion.
J. Continuous Quality Improvement (CQI) log- This is a program in the Brain. This software records
whenever the Guardrails System is used, subsequent programming occurred and when non
standard concentrations are entered into the Alaris System. This information is used for trend
tracking and quality monitoring.
Special Emphasis: It is against this policy to use basic infusion mode when the drug or fluid is
in a Guardrails library.
II. Procedure:
A. Equipment
 Brain and pump Channel (s)
 Intravenous tubing (as appropriate)
 Intravenous medication, solution, or blood product, as ordered by physician/health care
provider.
B. Procedure
1. Assemble all needed equipment and prime tubing.(Hyperlink: Recommended Priming
Procedure)
2. Turn on the BRAIN and pump module to begin programming.
3. Select one of the following :
a. Guardrails Drugs
b. Guardrails IV Fluids
c. Basic Infusion
4. When setting up the point of care unit, the department number should be entered when patient
ID is requested by the pump. This needs to occur when the infusion/medication is initiated.
5. Select the appropriate profile, only one profile can be used at a time. The following profiles
are available for use:
a. Medical Surgical Profile
b. Critical Care Profile
c. Intermediate Profile
d. Oncology Profile
e. Pediatric Profile (Pediatric profiles based on weight rather than age or physical area)
 < 20 KGs
 20 –39 KGs
 40 KGs or greater
f. Obstetric Profile
g. Special Care Nursery Profile
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6. The receiving nurse is responsible for checking and changing (if needed) the profile to meet
the level of care provided on that unit. When changing a profile, the BRAIN must be
powered down and re-booted, and then the new profile is selected. The nurse needs to select
“no” when asked by the pump if this is a new patient. Selecting “no” when changing profiles
will ensure the preservation of the history in the pump.
7. Select the appropriate medication using the pharmacy label as guide.
8. Acknowledge any clinical advisory by selecting “confirm”. The clinical advisory is only
visible when this infusion is initiated and should be communicated as part of the handoff
reporting between clinicians.
9. The Guardrails feature must be used for any medication or IV solution found within the Drug
Library. Basic Infusion mode is only available for medications or solutions not listed in the
library of the clinical profile. No safety software exists in this mode. If a soft limit alert
occurs, verify the rate/dosage before proceeding. The nurse may use double check with
another RN or Pharmacist when appropriate.
10. Drug and IV solutions programmed with the bolus feature within Guardrails, may be bolused
from the bag. All drug and IV solutions programmed with the bolus feature within Guardrails
must be from the same solution.
11. When initiating a secondary infusion, the maintenance infusion must be hung with the
hanger fully extended for accurate delivery of medication. (Hyperlink: Recommended head
height differential)
12. The Alaris pump has a “lock” feature to keep the infusion rate from being adjusted by
someone other than the nurse. After the infusion/medication is initiated, the nurse can press
the soft black button on the back of the BRAIN module for 2-3 seconds until a beep is heard.
This locks the key display. To disable this feature, the nurse once again needs to press the
soft black button on the back of the BRAIN for 2-3 seconds; a beep will sound indicating the
key display is unlocked.
Special Emphasis: The Guardrails feature must be used for any medication or IV solution found
within the Drug Library. Upon patient transfer, the receiving nurse is responsible to check and /or
change the profile to meet the level of care provided on that unit. To change the profile, the
BRAIN must be powered down and rebooted. When asked if this is a new patient, respond “no”.
Doing so will ensure all volumes will be maintained in the system. The Alaris system must not be
used near magnetic resonance imagining (MRI).
III. Documentation
1. Medications/IV solutions will be documented using the approved documentation system for
each area.
IV. Cleaning of BRAIN (Patient Care Unit and Pump Module)
1. The infusion pump and pump Channels are cleaned in between each patient and when visibly
soiled.
2. Cleaning process
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a. Disconnect BRAIN and pump Channel(s) from patient.( Hyperlink: Module attachment
& Removal)
b. Separate BRAIN from pump Channels
c. Remove dried material, such as blood or fluid, from BRAIN and pump Channels by using
a washcloth dampened with tap water. Do not immerse the BRAIN or pump Channel in
water.
d. Wipe inside and outside of units with a hospital approved disinfectant wipe and allow to
air dry.
e. Open pump module door and gently wipe interior with a hospital approved disinfectant
wipe and allow to air dry before closing.
V. Drug Library Review and Updates
1. Oversight of the Alaris infusion system will be conducted by the mulitidisicplinary Alaris
Pump IV Data Management Committee. They will meet on a monthly basis for drug library
updates, supply evaluations, and CQI analysis. This committee consists of representatives
from the following disciplines:
a. Pharmacy
b. Nursing
c. Center for Best Practice ( Outcomes, Risk Management and Clinical Education)
d. Bio Medical Engineering
e. Information Technology (ad hoc)
f. Infection Control
g. Materials Management (ad hoc)
h. Anesthesia
2. The IV Data Management Committee will address specific drug library needs and finalize
requested changes to the drug library. All changes to the drug library will be approved by the
committee and be consistent with other LMC policies governing medication administration.
3. Drug library recommended changes will be made using the Alaris Guardrails Data Set
Change/ Reporting form found on LexLoop. .
4. Each request will be classified as either “Urgent” (< 96 hours) or “Routine” (30-90days).
5. The Data Set Change request form will be submitted via email to either the DL Alaris Team –
Urgent or DL Alaris Team – Routine. Individuals submitting changes need to ensure they
have the approval of their department director or Vice President prior to submitting the
change request form.
6. All updates or changes to the data sets or changes regarding the Alaris System will be
communicated through Clinical Education (Center for Best Practice). Monthly (or as needed)
communication in the form of a flyer titled Alaris Update will be sent to department
managers for posting and dissemination. The flyers will also be posted on the Alaris
homepage located on LexLoop.
VI. Equipment Management:
1. All pump BRAIN’s and Channels will be maintained and verified by Biomedical
Engineering. Biomedical Engineering will complete preventative maintenance
annually.
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2. Biomedical Engineering will maintain some BRAIN and IV pump Channels to be used when a
pump is taken out of service.
3. When initiating an infusion with the Alaris system, if the preventative maintenance check is
past due, a reminder message will scroll across the BRAIN display stating the BRAIN or
Channel is scheduled for annual preventative maintenance. If this occurs, the nurse should
retrieve another pump, take the pump or pump module out of service and call Biomedical
engineering so they can retrieve the pump. If this occurs during an emergency or if another
pump or pump module is not available, the nurse can press the confirm button on the BRAIN
display and continue to program the infusion. The pump should be taken out of service as soon
as possible and the nurse should contact Biomedical engineering so they can provide a
replacement BRAIN or pump Channel.
Reference: Alaris Systems – Care Fusion - Directions for Use Manual for PC Unit Model #8015
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