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PCP IFT with IV Pumps
Decision Support Tool

Purpose

With the new EMALB Scope Expansion for PCPs, there are more options for equipment, medications, and procedures.

Definitions

a) 6 Rs of medication administration: Patient, Time, Dose, Drug, Route, Documentation.

b) Basic infusions:

  • Saline without the Dose Rate Calculator (DRC)
  • Infusion over time
  • Medication infusion with the DRC (heparin)

c) Library infusions: Using the library is preferred practice and mandatory when the drug being used is programmed. PCPs will use the PCP library for some in-scope medications and generic fluid administration. The CCP/IFT library will be used for out-of-scope medications being delivered.

c) High Alert medications: Medications that come with the potential for increased harm and require additional care. High Alert medications that may be given by PCPs include opioids, heparin, and epinephrine.

d) VTBI: Volume To Be Infused. Sets the limit for how much the pump will deliver. When setting the VTBI the time of infusion will be displayed at the bottom of the screen. NOTE: the VTBI will vary for different dose rates as it only specifies the volume and not the amount of drug.

Scope

With the expansion of PCP scope of practice, they are now able to administer out-of-scope medications under the orders of a physician, equipping them to manage many of these transfers without an escort. A training program and IV pumps are being provided to PCP crews in the two stations in the Fraser Valley on a trial basis to test the feasibility of PCP crews performing low-acuity transfers requiring out-of-scope care.

PCPs will be caring for patients who are expected to be stable during transport and require one or more of the following interventions:

  • Cardiac Monitoring
  • Single IV medication infusion
  • Vascular Constriction Band
  • PRN medication administration required during transport

The PCP crews will be able to administer out-of-scope medications either using the IV pump or PRN by any route under the orders of an EPOS physician or transport advisor.

Procedure

Determining if the IFT is appropriate for a PCP crew

The IEMD who books the transfer will notify the CCP-A or ITT-A when the transfer is booked. The CCP-A will review the event and contact the sending facility to get details of the patient clinical condition and the treatment plan and will assess the risk of clinical deterioration. They will document findings in CAD and determine if a PCP crew is appropriate for the transfer. If a PCP crew is assigned to the event they will contact the CCP-A/ITT-A and discuss the treatment plan together prior to arriving at the sending facility.

If the treatment plan involves an out-of-scope medication, the PCP crew will need to consult with EPOS before leaving the sending facility.

PS Involvement

  • The crew calls you when they should have called the CCP-A: They’re supposed to call the CCP-A on the way to their call. If they call you instead, please transfer them over to the CCP-A.
  • The crew needs to discuss administering an out-of-scope medication: Please connect them to EPOS.
  • The CCP-A has previously determined that the transfer is PCP appropriate, but when the crew arrives they feel it isn’t appropriate for them to manage: If the event falls under this PCP-IFT procedure and has already been vetted by the CCP-A or ITT-A, please connect the crew to them. If the consultation is related to an IFT that is not a part of this trial, please continue to manage these consults as you normally would.
  • The crew is having trouble with a pump: Help them troubleshoot their problem, there’s no need to transfer the call! I requested that the PS desk be provided with an extra IV pump so that we can better assist crews who are having trouble. Please take some time to practice with the pump while you’re at the desk so you’re prepared to support crews who might need help troubleshooting a device that is new to them.
  • The crew has a question about a medication or intervention during a transfer: Some of these you should transfer to the CCP-A or EPOS, but some of these we can manage ourselves. You can help the crew with clinical decision making within the confines of the EPOS orders they have already received. If you have concerns, feel free to escalate to EPOS, but also don’t hesitate to support crews when you are able to do so.
  • The crew has a question about administering a medication that is within PCP scope: You don’t necessarily need to involve EPOS and the CCP-A in that discussion. Continue to manage these consultations as normal.
  • Dispatch may call you regarding prioritization of IFTs vs Prehospital events: Nothing changes for us if an IFT is a part of this trial. Continue to manage these requests as you normally would.

Infusion Pumps

Pumps are now being adopted for all PCP resources in the province to support both prehospital care and interfacility transfers.

Specifications

BCEHS is utilizing the B. Braun Infusomat® Space® Large Volume Pump.

  • Priming volume is 26 mL
  • 15 gtts set (compared with our regular 10 or 60 sets) – 15 drops = 1 milliliter

Components

  • Normal spike/drip chamber
  • White slide clamp
  • 3 Luer-lock ports
  • Pump insert tubing and guide
  • Green pump safety clip
  • Roller clamp

The pump attaches to the bracket by sliding lining up the grooves on the pump with the guides on the bracket and clicks when secure. The bracket is attached in the ambulance by hand-tightening the bracket to a fixed bar. The pump should not be secured to the IV pole on the stretcher during transport.

General Notes

  • You can program your pump prior to loading the pump set (helpful to prepare everything ahead of time)
  • A new bag of medication must be provided by a facility on an IFT as our pump sets are different than regular hospital sets
  • Understand standby mode (hold power when a pump set is loaded)

Common Alarms

Downstream Occlusion

Causes:

  • Kinked tubing
  • Interstitial IV
  • Bent arm (especially if AC)
  • Roller clamp
  • Thrombus
  • You’re sitting on it

Solutions:

  • Address cause of kinked line
  • Flush the IV
  • Be aware of bolus
  • Restart IV
  • Move

Upstream Occlusion

Causes:

  • Clamp closed between pump and IV bag
  • Closed vent port on drip chamber with rigid container
  • Kinked upstream tubing

Solutions:

  • Open clamp
  • Open vent port
  • Un-kink tubing

Air Bubble

Causes:

  • Air introduced during priming
  • Changing bags
  • Accessing Luer-lock ports
  • Inverted bag

Solutions:

  • Address cause of air entrainment
  • Follow screen prompts to prime the line
  • Detach from patient to avoid injecting air
  • Use syringe to remove air in the line at the middle port

SAFETY ALERT

  • The occlusion alarms and need for higher pressure can indicate a problem with the IV or IO or infusion system (Interstitial IV, Dislodged IO). Troubleshoot and check your IV/infusion before adjusting the pressure.

Providing a Bolus

Push the BOL button > Select the bolus dose unit you want to use

Usually, we want to bolus: - A quantity of drug (i.e., mg) - A volume of fluid (i.e., ml)

Push the or OK button to select ml. You can now enter the amount in ml you wish to bolus. Units are shown on the bottom right. The confirmation screen shows what you selected as a check to make sure it’s what you intended.

Pressing BOL again will deliver the bolus.

Secondary Infusions

To deliver a secondary infusion a Secondary Medication Set is used.

Simple equipment:

  • Spike
  • Drip chamber
  • Tubing (93 cm long)
  • Roller clamp
  • Luer-lock end
  • Blue hanger

The secondary set is used to spike the medication to be delivered over a set time. The secondary set is attached to the most proximal port of the main B. Braun drip set. This is the first port after the drip chamber and before the set enters the IV pump.

The secondary infusion that you are delivering must hang higher than the original infusion. Use the blue hanger that comes with the secondary set. It must be fully extended. The bag that is highest will be drawn into the pump and the patient.

Vascular Compression Devices

Deflation

1) Use the syringe provided with the band. Ensure the syringe is in the 2 mL deflation position.

2) Remove 2 mL of air from the inflation balloon every 15 minutes via air port. Document time and volume of air removed; remove syringe from the band inflator.

3) Re-assess site for bleeding and hematoma after each deflation. If bleeding restarts, reinflate to hemostasis and wait 30 mins.

Repeat steps 1 to 3 until all the air is removed from the band

After Air Removal from VCD

Leave the band on the patient’s wrist. Continue to observe for the following while in transit:

  • Assess site for hematoma or bleeding
  • Capillary refill (< 3 seconds)
  • Coolness and/or colour change
  • O2 saturation of affected thumb
  • Pain, numbness and tingling
  • Continue the scheduled site checks every 15 min

References

Guidelines/Procedures/Forms

B. Braun Infusomat® Space® Pump Manual

Review Schedule

Adopted Next Review Scheduled Owner Reviewer
Jul 2026 Jul 2027 Clinical Hub Mnager BCEHS OHS Team