Table 17:

Managing Dead Volume: Tasks

Task	Notes
Administering a medication by manual IV push	Participants were asked to administer furosemide (Lasix) as a 50 mg IV push (provided in a 5 mL parenteral syringe) over at least 1 minute.a To successfully complete this task, participants had to: attach the 5 mL parenteral syringe to the lower injection port of the emergency medication line (which was administering a continuous sodium chloride 0.9% IV infusion at 10 mL/h through an infusion pump); and push the dose into the IV tubing at the ordered rate (i.e., at rate slower than or equal to 5 mL/min or 300 mL/h)
	Participants could make a dead volume error if they did not correctly manage the furosemide remaining in the dead volume. The dead volume from the lower injection port to the patient's vein was about 3.5 mL. Therefore, participants had to consider the following: whether they needed to flush the IV tubing to deliver the remaining 3.5 mL of furosemide in the IV tubing (a 10 mL prefilled syringe of 0.9% sodium chloride was available to participants on an over-bed table at the foot of the patient's bedb); and the rate at which to deliver the flush, which determined the delivery rate for the furosemide remaining in the dead volume
Doubling the concentration of a continuous IV medication infusion	Participants were asked to double the concentration of a norepinephrine infusion (already infusing) but maintain the same dose rate (the IV container of the double strength norepinephrine IV infusion was provided). When hanging the new IV container, participants could choose to: ask for new IV tubing (which was provided when asked); or reuse the existing tubing; if the dead volume (i.e., old concentration) was not accounted for and the pump was reprogrammed to account for the new concentration, the patient's physiological parameters were changed by the test facilitators (i.e., blood pressure and SpO2 decreased and heart rate increased), since the patient was now receiving half the ordered norepinephrine dose
	Participants were asked to explain the rationale for their actions (e.g., why they asked for new IV tubing or why patient's condition had changed)

Abbreviations: IV, intravenous; SpO₂, saturation of peripheral oxygen.

^aWhen furosemide is pushed too quickly, there is a risk of ototoxicity (the nursing IV drug list used at the participating institution indicates that furosemide should be pushed at a rate of less than 40 mg/min).

^bParticipants were oriented to the room and all supplies, including the sodium chloride 0.9% in 10 mL prefilled parenteral syringes, at the start of the study.