GemStar Infusion Pump: Part 1

MD Anderson Cancer Center
Date: May 2013

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>> Hello. When you go home from the hospital or clinic you will use the GemStar infusion pump.

This pump works on a battery. It can be worn in a pouch around your waist or as a backpack. This is an easy way to receive your treatment when you are home.

In this video you will learn about the pump and how to use it to complete an infusion that was started at the hospital.

First, let's go over the main parts of the pump.

The display screen shows the important information about your infusion. There are many buttons on the front of the pump, but you need to know only a few. These include the button to silence the alarm, the stop and start buttons, the on/off button and the buttons that say enter or yes.

On the bottom of the pump is the battery compartment, and on the side is the cassette. The cassette is what holds the tubing in place.

Now that you know the parts of the pump, let's talk about how you can tell if your pump is working correctly.

Before you leave the hospital the nurse will have already programmed the pump and started the medicine, but you will manage the pump until the medicine is done.

First, you will see the rate that the pump is delivering the infusion. On the pump's screen this is displayed as the number of milliliters per hour.

There are other things to check as the infusion continues. Two or three times per day check that the screen is showing the right infusion rate, the arrows are moving across the bottom of the screen, the IV bag is getting smaller and the number, which indicates the amount infused, is getting larger.

If your pump is not working correctly, call the Ambulatory Treatment Center or ATC for help.

It is important to understand the type of infusion you are receiving, either continuous or intermittent.

A continuous infusion controls the flow at a steady rate until the entire bag is empty. The pump screen will display this rate.

An intermittent infusion controls the flow for set time periods such as every 12 hours. If you are receiving an intermittent infusion, your pump will show "giving dose one", "giving dose two", et cetera.

Between dose one and two you will see "KVO" on the screen. This means keep vein open, where a very small amount is infusing to keep the line open.
In between doses the pump screen should show "next dose at" and provide a time.

While using the pump, the alarm may go off. This lets you know there is a problem. The screen will tell you what is wrong. Most common problems include low batteries, air in the line, distal occlusion, proximal occlusion, check cassette and container empty.

Let's review in detail what these messages mean.

The low batteries message means you have about 60 minutes of battery life left. If you do not change the batteries you will then get the change batteries message. This means the batteries are too low to run the pump and they need to be changed.

The pump uses two disposable AA batteries. Changing the batteries is simple.

First, press silence to stop the alarm.

Then turn off the pump by pressing the stop button.

The battery compartment door is on the bottom of the pump. Flip up the gray flap of the battery door and turn it to the left to remove the battery door. Remove the old batteries and replace them with two new AA batteries. The positive end of the battery goes into the compartment first. Replace the battery door and turn it to the right until it fastens under the slot. Flip the gray flap of the battery door down to lock it in place.

To restart the pump, press the on/off button.

The screen will show "using batteries". Press yes, enter to tell the pump that batteries are the only power source.

The air in line message means there is air in the IV tubing. Press silence to make the alarm stop beeping.

Look at the tubing and find the air bubble.

Find the tube's filter. The bubble will be either before the filter or after the filter, between the filter and you.

For a bubble above the filter press stop, then press start.

Repeat pressing stop and start until you see that the air bubble has been pushed past the bottom part of the pump.

The air filter will catch the air bubble.

For a bubble below the filter, stop the pump and call the Ambulatory Treatment Center for further instructions.

The distal occlusion message tells you that the flow has been stopped for some reason between the pump and you. Usually the cause is a kink in the tube. If you find the tubing kinked, press silence to make the alarm stop beeping. Then press stop.

Check the tubing below the pump. If there is a kink or blockage, free the tubing and press start. If your CVC line is clamped, open the clamp and press start.

The proximal occlusion message means that the flow has stopped between the IV bag and the pump. Press silence to make the alarm stop beeping. Then press stop. Check to see if the IV bag is empty. If it is, clamp the line ^M00:06:46 and press the on/off button.

If the IV bag is not empty, check the tubing above the pump for a possible kink. Free the tubing and press start.

The check cassette message means that the cassette is not installed properly. It may be loose or have fallen out. Press silence to make the alarm stop beeping. Then press stop.

If the cassette is loose or has fallen out, align the tubing to the silver ball and press firmly until you hear it clicks.

Make sure all four cassette latches are clearly visible after the cassette is installed. Press start.

The empty container message means the IV bag is empty and the infusion is complete. Press silence to make the alarm stop beeping. Then press stop.

Hold the on/off button for two seconds to turn the pump off. Clamp all clamps including the infusion line. Call or go to the Ambulatory Treatment Center for help disconnecting or refilling the pump.

If you are disconnecting your own line, follow instructions you were given during class. If you have been instructed on changing the IV bag yourself, follow the instructions in part two of this video. If not, return to the Ambulatory Treatment Center as soon as possible.

If you ever see medicine leaking from the tubing or the IV bag, immediately stop the infusion. Press stop and then the on/off button to turn off the pump. Then clamp the line.
Please refer to the Safe Handling of Chemotherapy handout for further instructions on what to do about the spill. If the infusion is running all night, you could accidentally cause a leak by pulling the line or getting up without remembering you are connected to the IV. Just be very careful.

The information provided in this video is available in the patient information handouts about the GemStar infusion pump. If you do not have these, ask your nurse for a copy.
Remember, if you have any questions or concerns please talk with your nurse.