Keller, A. (Summer, 2017). Student Editorial: When the bottle emptied, the bell rang … An infusion pump alarm of the late 70’s. Online Journal of Nursing Informatics (OJNI), 21(2), Available at http://www.himss.org/ojni
Welcome to a review of the history and development of infusion control devices in this writer’s nursing career. As a new nurse it was almost unheard of that you needed an intravenous (IV) pump of some kind to control the rate of an IV solution infusing in a patient. Newborns or children under the age of one year were exceptions that did require some kind of mechanical control over and above the commonly used “screw clamp”. Thus the advent of infusion control devices that we as young nurses would learn to grow beside, began as simple, manually controlled apparatus - no bell would ring with these devices, they only “infused”.
The first infusion control device that this writer encountered was one that had different size tubing for a rotary peristaltic flow delivery that you could dial faster or slower depending on how the fluid volume was averaging for the needs of the patient. You chose a size A tubing for the slower infusion all the way up to size D, the largest bore tubing, depending on the rate ordered. We became skilled in this type of “guesstimate” and newborn patients thrived without fluid imbalances or fluid overloads based on a time-taped bottle to evaluate the volume delivered. That was the volumetric component of the day, a time tape marked ever so carefully with a felt tipped pen.
When the era of Total Parenteral Nutrition (TPN) was introduced, this nurse aspired to provide safe practices for all her patients who needed IV nutrition. The experienced physician who came to our hospital would expect experienced nurses to care for these short-gut patients that followed him as a forerunner in the development of TPN. We had to work hard to learn about the intricacies of TPN and the side effects for these patients. We even encouraged them to “drink” their cooking oil as ordered to prevent fatty acid deficiencies. That was a bit distasteful even to watch but it was part of early TPN therapy. The fat emulsions used today were not available in the US at that time. Imagine that, only the amino acids and sugar components with lots of vitamins, minerals and electrolytes added. We had to relate these solutions to a Thanksgiving dinner for our patients as they learned that the calories within gave them lots more than just being a nuisance to infuse every night. “Wow that pumpkin pie was sure good last night” and “tonight the steak and potatoes sounds like a treat” were common comments jokingly shared. There were no fancy infusion devices available for these patients and the newest trend for their “life-line” was a cuffed catheter inserted in their chest that ended in the superior vena cava. Our new nursing challenge was to provide Thanksgiving dinner within an open route to the heart.
Now the real challenge began. These patients needed to receive their infusions over about 12 hours every night from a bottle. Yes, a glass bottle of about two liters of beautiful yellow fluid. How would we safely administer this and still not subject the patient to a situation that could clot off their line when the infusion was completed?
In came the magic thinking of a certain physician who was creative in looking at delivery systems for his patients. He worked with technologists and nurses to create an infusion device that would, with the basic of basics, provide an alarm to alert patients that at the end of the infusion the “bell” would ring. By taking a simple balance system consisting of a simple rotary peristaltic pump attached to a pole, a device was created that would infuse a night’s worth of fluid from a 2 liter bottle into a patient. When the bottle emptied the lowering of the “lever” would ring a bell to alert the patient that the infusion was complete. When the bottle emptied, the bell would ring. Today many bells ring but thinking back when that bell rang it was an important moment and advancement in infusion pump technology. A Thanksgiving dinner had been infused!
Alene Keller, BSN, RN, CRNI is an Adjunct Associate Professor of Nursing at Lansing Community College, Lansing, MI. She has been an infusion nurse for over 35 years and she currently focuses her teaching to senior nursing students in the Associate Degree Nursing program. She graduated from University of Michigan School of Nursing and is currently completing her MSN in Nursing Education at Baker Online College.