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Extending tubing to place intravenous smart pumps outside of patient rooms during COVID-19: an innovation that increases medication dead volume and risk to patients
  1. Jeannine W C Blake1,
  2. Karen K Giuliano1,
  3. Robert D Butterfield2,
  4. Tim Vanderveen3,
  5. Nathaniel M Sims4
  1. 1College of Nursing and Institute for Applied Life Sciences, University of Massachusetts Amherst, Amherst, Massachusetts, USA
  2. 2RDB Consulting, Poway, California, USA
  3. 3SafeMed Practices, Poway, California, USA
  4. 4Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
  1. Correspondence to Jeannine W C Blake, College of Nursing and Institute for Applied Life Sciences, University of Massachusetts Amherst, Amherst, MA 01003, USA; jwcblake1{at}


The COVID-19 pandemic has stretched hospitals to capacity with highly contagious patients. Acute care hospitals around the world have needed to develop ways to conserve dwindling supplies of personal protective equipment (PPE) while front-line clinicians struggle to reduce risk of exposure. By placing intravenous smart pumps (IVSP) outside patient rooms, nurses can more quickly attend to alarms, rate adjustments and bag changes with reduced personal risk and without the delay of donning necessary PPE to enter the room. The lengthy tubing required to place IVSP outside of patient rooms comes with important clinical implications which increase the risk to patient safety for the already error-prone intravenous medication administration process. This article focuses on the implications of increasing medication dead volume as intravenous tubing lengths increase. The use of extended intravenous tubing will lead to higher medication volumes held in the tubing which comes with significant safety implications related to unintended alterations in drug delivery. Safe intravenous medication administration is a collaborative responsibility across the team of nurses, pharmacists and ordering providers. This article discusses the importance and safety implications for each role when dead volume is increased due to IVSP placement outside of patient rooms during the COVID-19 pandemic.

  • biomedical engineering
  • COVID-19
  • critical care
  • nursing
  • pharmacology

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  • Contributors JWCB conceptualised the manuscript, wrote draft 1 of the manuscript and figures and table and coordinated all other author feedback and revision. KKG contributed significantly to drafting all aspects of the manuscript including content development and editing. RDB, TV and NMS contributed significantly to important intellectual content and revision of the manuscript in its entirety.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests As a consultant in medical product development, KKG has performed consulting services for numerous medical device companies. RDB has been employed by an infusion pump manufacturer and is currently a paid consultant for several infusion pump manufacturers. TV has consulted for several infusion pump manufacturers.

  • Provenance and peer review Not commissioned; externally peer reviewed.