Sapphire Pump Clinician General User Training Slides
Contents
1. Regents of the University of Michigan 5 7 2015 Dy HOMEMED UNIVERSITY OF MICHIGAN HEALTH SYSTEM QCore Sapphire Pump Clinician Training Program April 2015 Goals for training Goals e Review pump functionality sets and accessories e Understand key process steps for e Starting an infusion e Stopping an infusion e Changing a container e Re programming the pump e Troubleshooting alarms Expectations e Stay together e Stay on task e One conversation at a time e Write questions on a comment card Regents of the University of Michigan 5 7 2015 Pump Anatomy Cassette Chamber Also PCA Bolus gue Cord port Power Communicatson Connector Reference Sapphire Rev 11 0 Technical Manual Sapphire Features Modes e Continuous Intermittent Multi Step PCA TPN Epidural turned off Only programs in the selected mode at the time of Medium Lock level activation will be accessible to the patient Regents of the University of Michigan 5 7 2015 Sapphire Features Cont On Screen troubleshooting o Guides users through resolving alarms Occlusion auto re start o An occlusion alarm will occur if a detected occlusion isn t resolved within 40 seconds Infusion near end o Alarm will sound 10 minutes before the end of therapy to alert patient to gather disconnect supplies o Requires patient to acknowledge alarm by pressing OK infusion continues through alarm HomeMed specific configuration2. bolus history administered vs attempts is available in Bolus History Menu User able to pause and quit a bolus with Medium Lock level e Quitting bolus allows user to resume basal rate infusion Bolus history shows that partial bolus volume given 16 Regents of the University of Michigan PCA Display PCA Screen Shot 5 7 2015 C Rate Continuous Rate does not display during bolus admin VTBI Volume of Bag to be infused Lock out time time remaining until next bolus available Time left Time left of bag infusion Bolus mL patient bolus from touch screen e requires pump to be unlocked Bolus History displays pump settings and bolus info PCA Bolus Administration gt When a bolus is available Patient administered bolus can be given in 2 ways e Pump Touchscreen Administered bolus requires patient to unlock Patient Lock with Medium Level Code PCA Bolus Cord does not require pump to be unlocked 17 Regents of the University of Michigan TPN Mode Review e KVO rate is preset at 3 mL h e Max Taper 3 hours up and 3 hours down e Cannot edit infusion program with High level passcode while the pump is infusing Pump displays Plateau rate during program review e Plateau Max Infusion Rate Calculation based upon the formula for an area of a trapezoid HomeMed TPN spreadsheet updated to reflect this Faye Dares Pema BA imaa Ped Platecu Period infusion Per
3. infusions at Commonly used for high intermittent pre set intervals frequency antibiotic dosing e g nafcillin Multi Step Delivers the infusion in a set KVO 3mL hr of 1 to 25 steps Possible uses for IVIG or continuous programs 1 step requiring KVO Delivers a basal pre set rate either alone or in addition to PCA boluses Delivers an infusion at a Can also be used for constant rate with optional continuous infusion therapies tapering at the beginning where KVO allowable in and end of the infusion addition to TPN program Start Up Screen Components Indicator Bar Power Status Mode Main Screen New Infusion Repeat Infusion PreSet Programs Toolbar reset Programs Prime e Options Requires High Passcode Delivery Mode selection Pump Configurations Alarms General Settings Regional settings Test system e View Regents of the University of Michigan Pump Status Indicators gt Status LEDs l Alarm Red LED Alarm is occurring Charge Yellow LED flashing Battery is charging Yellow LED steady on Pump is connected to main power and battery is fully charged Run Green LED Pump is running Tubing Sets Tubing set components o Cassette o Anti free flow valve AFFV gt Shipped OPEN for gravity priming not advised Automatically in CLOSED position after removal from pump o Filter if available Filter should be below the vascular access site Y Site o CLA
4. pump 4 in Figure 4 3 Pull out the cassette and close the safety door Figure 4 3 HomeMed Notes e Recommended to remove tubing before turning pump OFF e The AFFV is automatically CLOSED upon cassette removal Reference Sapphire Rev 11 0 User Manual Power Off Turning the Pump Off Pressing the On Off hard key for 5 consecutive seconds turns the pump off Alternatively press the On Off hard key and then from the Attention screen press Off After operating the pump with lt 1mL h flow rate you will be prompted to remove the administration cassette before turning off the pump Reason When powering down the pump fingers self adjust and may deliver small amount of medication at greater than 1 mL h rate Reference Sapphire Rev 11 0 User Manual 20 Regents of the University of Michigan 5 7 2015 Cleaning the pump in the home Pump Can be wiped with a damp cloth mild detergent or 70 Isopropyl Alcohol IPA allowable LCD Screen o A mild detergent or 70 IPA may be used o Wipe thoroughly with a soft clean dry cloth o Do not use ketone or aromatic solvents on screen Internal white panel under pump door Should be kept free from dirt and foreign objects o If necessary use mild detergent or 70 IPA on a cotton tipped applicator around the pump fingers Sensor Fingers o Clean the finger tips with a slightly damp cloth or sponge only Bubble Detector Self Cl
5. VE Y site for needle free connections NOT available with current 1 2 micron filter microbore tubing o Bifurcated extension set will be required for patients with Y site medication admin 5 7 2015 Regents of the University of Michigan Starting a New Infusion in the Home Inspect tubing and medication dose Spike bag Insert Tubing Power Pump On Confirm Battery Use Select 1 resume program Review Program Prime set press and HOLD purge key Connect to patient Select Change Press 1 for new container Press Start Gemstar Steps OLD Insert Tubing Seat saddle on MACIE nspect tubing and medication dose Power Pump On Open Door Insert cassette Close Door Spike Bag Select PreSet Programs Select Program name Confirm program Prime set single push of button Connect to patient Press Start gt M p D a PA a Spy JA i G a j Sapphire Steps NEW Power on before inserting tubing to allow pump fingers to self adjust without administering drug to patient Engage Metal Secured Cassette Locks 5 7 2015 Regents of the University of Michigan 5 7 2015 Prime Tubing Select to Prime Safety Check Countdown while Message priming Press Finish Prime or hard STOP key to stop early Prime Tubing manually gt To prime the administration set manually 1 Open all the clamps on the administration set 2 To allow free flow open the AFFV by pushing it in and down towards th
6. anges appropriately 14 Regents of the University of Michigan 5 7 2015 Multi Step Mode Review gt VTBI total amount of fluid to be infused in a given step Rate speed at which the fluid is infused in a given step gt Time the period of time over which the fluid is infused Allowable to program in VTBI Rate or VTBI Time Fa Rate Multi step Flow Profile Reference Sapphire Rev 11 0 User Manual Step g Steph Time PCA Mode Review General VTBI Volume of bag to be infused Total volume priming volume Continuous Rate Basal Rate Demand Bolus Patient bolus dose volume Bolus Lockout Time between end of one bolus and start of next Bolus Limit Bolus per fixed time period o and 4 hour limit ranges available with PreSet program 4h hour only with New Infusion from Main Screen o Max Allowable based upon time between boluses lockout and bolus administration time at rate of 125 mL h 15 Regents of the University of Michigan 5 7 2015 PCA Mode Review General cont HomeMed Not recommending Loading Dose use because most patients are transferring from an inpatient PCA to home PCA PCA Flow Profile Rate Time K Reference Sapphire Rev 11 0 User Manual PCA Mode Review Bolus Options Automatically in Patient Lock while running No alerts display on the pump when a bolus request is denied during the lockout period Review of
7. e center of the O Core administration cassette 1 in Figure 4 4 Fill the entire administration set with fluid so that the fluid displaces all air in the administration set To block free flow close the AFFV by pushing it up and away from the center of the cassette 2 in Figure 4 4 ey ary Tian pes Figure 4 4 Opening and Closing the AFFV Closed AFFV Opened AFFV Closed AFFV Reference Sapphire Rev 11 0 User Manual Regents of the University of Michigan 5 7 2015 Start Using PreSet Program Press PreSet Select From Patient Review and Confirm Start Infusion Programs to Select Specific List Program Compare to Drug Label HomeMed will not be using New Infusion OR Repeat Last Infusion options for programming the pump These options do not allow programs to be named and have different configuration limitations Run Screen l Indicator bar PreSet Program Name Action Wheel Delivery Mode Battery Indicator Main display infusion status Toolbar all buttons visible but access could be restricted based upon authorization level 10 Regents of the University of Michigan 5 7 2015 Toolbar Options from Run Screen Toolbar all buttons visible but access could be restricted by authorization level 400 gt Bolus Clinician 4 o Requires High lock level ori o Not recommended in Gr b the field m Configuration limited to 1 mL h bolus so any programmed bolus will only adminis
8. eaning with loading removal of tubing May clean with cotton tipped applicator Use a mild detergent or 70 IPA and wipe thoroughly with a soft clean cloth Reference Sapphire Rev 11 0 Tech Manual Troubleshooting Alert Type MESSAGE Description gt A condition of medium severity that should be and Action attended to as soon as possible Required gt Auditory alarms sound and screen displays reason and recommended action Infusion continues to operate during alert unless infusion complete Available action keys on touchpad e Mute silences alarm for 2 minutes e Ok confirms message and returns to previous screen Examples Low battery Door opened Infusion near end Infusion complete Pump inactive 21 Regents of the University of Michigan 5 7 2015 Troubleshooting Description and Action Required Examples Level 1 Level 2 Level 3 gt Pump Shuts gt Infusion stops gt Infusion stops Down and cannot be but may be resumed resumed v Battery Mechanical error Vv Air in line Depleted Pump fault Cassette v Internal Error Battery misplaced Reminder Occlusion Upstream Downstream Flow Error Insufficient Battery Troubleshooting Common Issues Issue Pump is NOT Charging Problem Solution gt Probable Causes e The charge has become disconnected from the mini cradle or the power supply e The charger is not working v Confirm all power connections are in place v Connect the charger to a different po
9. en tan be accessed by pressing the Views Edit function key and than irom the VieweEdit seren selecting Bolus history Reference Sapphire Rev 11 0 User Manual 5 7 2015 18 Regents of the University of Michigan 5 7 2015 Changing a Container Press Stop Press Stop or Pause On tubing change day Press Quit Quit prime tubing by Press PreSet Program HOLDing purge key Select Name of Program Connect to patient Review against drug label Press Change Press Ok Press 1 for new On tubing change day container prime tubing by selecting Confirm Program Prime Press Start Press Start Gemstar Steps OLD Sapphire Steps NEW Do NOT select repeat last infusion Changing Modes v v yv yv yv Yv Y WF VF YF HH Press Stop or Pause Press Quit Quit Press Options Enter High Authorization code Select Mode Press PreSet Program Select the desired program name Review against drug label Press Ok On tubing change day prime tubing by selecting Prime Press Start to infuse Discouraged in the home Requires patient to use High lock level passcode 19 Regents of the University of Michigan 5 7 2015 Remove tubing from pump To remove the Q Core administration cassette Close all clamps on the administration set Disconnect the patient from the administration set gt 1 2 3 Open the safety door Opening the Safety Door on page 52 4 Loosen the cassette by raising the metal lock that secures it to the
10. ilities _ o Pump operation with EPB at 125 mL h 15 20 hours EBP is connected properly if the external battery icon shows on the pump right corner LED at the bottom of the EBP is illuminated o Replace batteries when light flashes Detach the EBP when regular power supply restored and wall charging available Strap included for IV pole hanging Reference QCore Sapphire EBP Package Insert Pump Authorization Levels Authorization Features Available in Level Lock Levels Low donot planto Stop and resume the pump use regularly Power on and off Administer Patient bolus 9990 Use the view menu Medium All of above and Start an infusion Use Preset program feature Code 8880 Use Restart last program feature Prime View bolus rate PCA Unlock Patient Lock Status High All of above and Start Infusions using NEW infusion feature View Edit parameters Issued by Access Configuration menu HomeMed Create Edit Preset programs Use All PCA options Change the infusion mode w passcode entry Administer Clinician bolus w passcode entry Technician Access to pump testing and configuration for equipment staff e Patients will only receive the Medium lock level code Regents of the University of Michigan 5 7 2015 Sapphire Infusion Modes Mode Description Notes Continuous Delivers and infusion as a No KVO available in HomeMed s constant programmed rate configuration Intermittent Delivers
11. iod i JM axr Rate FTBI Example VTEI 2000mL Taperup 1 hr Taperdown 1 hr Infusion period 9 hr 7 hours 9 hours 2000 5 Mar Rate calculation change Mow Rese 250 mLfor Reference Sapphire Rev 11 0 User Manual Viewing Event Logs Viewing the Events Log The Events log screen enables you to view a record of all events audited by the system You can view a list of all events or only the events that occurred on a specific day To view events that occurred on A tpecifice day From the Options menu select View On the View screen select Events log On the Events log screen select By date Using the keypad enter values for the day 2 digits the month 2 digits and the year 2 digits When U S format is set the order is month day and year ti To navigate directly to component of the date 6 9 day press the component On the toolbar press OK A list of events i displayed i If no events occurred on the selected day a Blank screen is displayed gt To view all events From the Options menu select View On the View screen select Events log On the Events log screen select All events A list of events is displayed Viewing Bolus History This screen which appears only in the PCA and PCEA infusion modes provides a summary of all bolus related events that occured during a specified time frame o When a PCA or Epidural infusion it running the Bolus hittary Scre
12. priming volume gt Time period of time over which the fluid is infused KVO rate is preset at 0 mL h HomeMed setting o KVO not available in Cont Mode to prevent over under dosing of High Risk Medications infusing at low rates gt Bolus e Available in High Lock Level e Warning to Clinicians Do not enter a bolus e Configured to 1 mL h max Safety Step to prevent Significant alteration of intended dose rate e Patient cannot use this key with Medium level passcode 13 Regents of the University of Michigan 5 7 2015 Intermittent Mode Review VTBI Volume of bag to be infused Total volume priming volume Dose the amount of each dose Dose Rate continuous rate at which the dose is delivered Interval Duration time from the start of one dose to the start of the next dose Dose KVO KVO The rate of fluids delivered between doses to prevent line occlusion 0 20 mL h allowable Lin Intermittent Flow Profile Reference Sapphire Rev 11 0 User Manual Intermittent Mode Review Cont Intermittent Screen Display gt VI Total is the volume that has been infused over the total VTBI in the bag Time to dose Time remaining until the end of the current interval Dose left KVO o When Paused the time to the next dose is paused and not displayed Time left Time remaining until the end of the entire infusion Infusions always start with the dose bolus Patients should take note of dose times and time bag ch
13. setting changes to configuration will not be saved after powering off the pump Sapphire Features Conta Priming o No longer need to hold to prime Auto configured priming volume of 8 mL KVO Settings o Continuous 0 mL h o PCA O mL h o TPN 3 mL h o MultiStep 3 mL h Backlight o Set to partial screen will dim after 30 seconds o Touch screen to turn backlight back on HomeMed specific configuration setting changes to configuration will not be saved after powering off the pump Slide 6 J CT2 Not adding air detection setting here Tharp Jamie 3 25 2015 Regents of the University of Michigan 5 7 2015 Sapphire Pump and Accessories AC Power Cord standard accessory Bolus Cord External Battery Pack e Requires 6 AA batteries e Emergency use only Optional Accessories Sapphire Battery Info Internal Rechargeable Sapphire Battery Life by Rate Battery Charge time 4h 100 aaraa aine Time of Operation hh mm 2 5 h 80 Charge light flashes while sere la iho a charging solid light when men sen ene charged ALL Patients should be coached to plug in at night like their cell phone External battery pack available for emergency preparedness for high need patients 00 vI N ui Reference Sapphire Rev 11 0 User Manual Regents of the University of Michigan 5 7 2015 Sapphire External Battery Pack EBP External Pack Charge pet Capab
14. ter at mL h Run Screen Tool Bar a Toolbar Options from Run Screen Cont View Edit o Clear Volume Infused not needed with PreSet program previous VI auto cleared o View System Infusion values alarm volume occlusion authorization level delivery mode air detector information date time software version serial number 11 Regents of the University of Michigan 5 7 2015 Toolbar Options from Run Screen Cont Lock Lock Screen No Code Required gt prevents inadvertent touch changes o Patient lockout Medium Code Required ideal for securing screen infusion while wearing in a carry case or around children Pause gt to temporarily interrupt infusion o 5 minute call back o May also pause using the hard STOP key below the touchscreen Pause Infusion Messages Warnings Lock Level Restriction Infusion Stop Alert Prevented Clinician Bolus Durin i Infusion Active Confirmation Required Teaching moment for patients Alert means they won t be able to start where this infusion is leaving off new program will think it is equal to a new dose 12 Regents of the University of Michigan 5 7 2015 General Use Information Optimum bag height above the pump is 20 inches 50 cm Educate patients to charge the pump each night Continuous Mode Review Rate speed at which the fluid is infused gt VTBI Volume to be infused does not include
15. wer supply outlet and reconnect it to the pump v Ifthe Charge is not functioning properly replace it 22 Regents of the University of Michigan 5 7 2015 Troubleshooting Common Issues Issue Recurring Air in Line Problem gt Probable Causes e Treatment is near end e Therapy prone to foaming or effervescence e Air detection settings are too sensitive Solution v Minimize shaking prior to administration and allow adequate time for product to warm to room temperature v Close clamps remove administration cassette from pump and prime the set manually Replace set if manual prime unsuccessful v Clean Bubble Detector v Air detection settings can only be modified by HomeMed Troubleshooting Common Issues Issue Recurring Occlusion Problem gt Probable Causes e Occlusion issue has not been properly resolved Solution v Close clamps remove administration cassette from pump disconnect from patient and prime the set manually v Replace the administration set v Change the infusion site v Assess catheter for thrombus and treat appropriately 23 Regents of the University of Michigan Questions Contact HomeMed at 800 862 2731 to speak with an onsite clinician 5 7 2015 24
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