The Plum pump is a sophisticated volumetric infusion device used extensively in healthcare settings to deliver precise amounts of intravenous fluids and medications. Priming the specialized Plum pump tubing, known as a PlumSet, is an obligatory step before any infusion begins. This process involves systematically removing all air from the tubing and the cassette mechanism by filling the entire system with the infusate fluid. Failure to adequately prime the set introduces the risk of air embolism, a serious complication where air bubbles enter the bloodstream. The correct technique ensures the integrity of the delivery system, promoting patient safety and guaranteeing the accurate volume of medication is administered.
Preparing the Infusion Set and Pump
Before fluid is introduced into the administration set, meticulous preparation is required to maintain sterility and ensure the pump system is ready for operation. The process begins with performing hand hygiene and gathering all necessary supplies, including the IV solution bag, the appropriate PlumSet, and the infusion pump itself. Inspecting the PlumSet for any defects, such as kinks, cracks, or compromised sterile packaging, is a mandatory step before proceeding.
The next action is to spike the IV bag with the piercing pin located at the top of the PlumSet, using a twisting motion to ensure a secure connection. The flow regulator, a white knob on the cassette, must be pushed in to the closed position to prevent uncontrolled fluid flow. Immediately after spiking, the drip chamber should be partially filled by gently squeezing it until the fluid reaches the designated score line, typically about half full. This partial fill prevents the passage of air into the line during the initial priming stages.
With the tubing prepared, the cassette portion of the PlumSet is then loaded into the pump’s channel. The cassette is designed to fit only one way, and it should be inserted securely into the pump mechanism until the cassette door is closed and locked into place. This physical setup readies the system for either manual or electronic priming.
Manual Gravity Priming of Tubing
Manual gravity priming is a technique used to flush the IV line with fluid without engaging the pump’s electronic features. To begin, the IV fluid container must be suspended high enough above the pump and the patient to allow gravity to generate sufficient pressure for flow. The cassette’s flow regulator, which was previously closed, is then slowly pulled out and twisted counter-clockwise to initiate a controlled drip.
As the fluid begins to flow, the tubing should be held in a vertical position, allowing the liquid to displace the air downward through the line. It is important to watch the fluid level as it fills the cassette’s internal chambers. To facilitate the removal of any large, trapped air pockets within the cassette or along the line, the tubing can be gently tapped or flicked.
The priming process continues until the fluid reaches the distal end of the tubing, expelling all air from the system. Once the fluid is observed exiting the distal connector, the flow regulator must be immediately pushed back in completely to shut off the flow. This action locks the line, preventing any accidental free flow of the medication, which is a necessary safety measure.
Using the Electronic Prime Function
The electronic prime function is the most common and efficient method for preparing the primary IV line, utilizing the pump’s motor to rapidly flush the system. After the cassette is securely loaded into the Plum pump, the device must be powered on to access the user interface. This function is typically accessed via a dedicated soft key or a menu option labeled “Prime” on the pump’s screen.
Before initiating the electronic prime, ensure the distal end of the tubing is disconnected from the patient and aimed into a designated waste receptacle. This prevents the unintentional infusion of air or the loss of medication. The electronic prime is then activated by pressing and holding the designated soft key or button.
The pump’s mechanism will automatically begin to run the fluid through the line at a high rate, effectively pushing the air out of the cassette and the entire length of the tubing. The user must continue to hold the prime button until a solid stream of fluid is observed exiting the distal end, confirming that all air has been expelled. Upon release of the button, the pump automatically performs a self-check to ensure the cassette and line are free of air before allowing the infusion to be programmed.
Checking for and Clearing Air Bubbles
After the line has been primed, a final, meticulous check for residual air bubbles is mandatory to ensure patient safety. The entire length of the administration set, from the drip chamber down to the distal connector, must be inspected visually against a light background. Particular attention should be paid to the cassette, the needle-free access ports, and any areas where the tubing may be bent or coiled, as air tends to collect in these locations.
If only small air bubbles are detected, they can often be removed without fully re-priming the line. The technique involves gently flicking the tubing with a finger near the bubble, encouraging the air to rise toward the cassette or the drip chamber where it can dissipate.
For a slightly larger or more stubborn bubble, the tubing can be clamped below the air pocket. A syringe can be attached to a nearby injection port to carefully aspirate the air out of the line.
Should a significant volume of air be observed, or if multiple small bubbles cannot be easily cleared, the safest course of action is to re-prime the set entirely. If the air is trapped within the cassette, the electronic prime function should be re-engaged while ensuring the distal line is disconnected. If the large air volume persists, the entire administration set should be discarded and replaced with a new one.