Secondary Infusion Underdelivery: Risks and Rewards of Common Workarounds

Secondary medication delivery using large-volume smart pumps offers important workflow and safety benefits. However, the widely used linear peristaltic large-volume smart pumps rely on sufficient head-height differential for accurate secondary infusion, leading to underdelivery risks. This article outlines common clinician workarounds used to mitigate these risks, including delivering secondary medications via primary mode, programming excess volume to be infused, clamping primary lines, and using short-set primary delivery. Although intended to ensure full medication delivery, these strategies introduce safety risks, increase alert burden, and heighten cognitive load. In contrast, cassette-based large-volume smart pumps use valve-controlled fluid delivery, eliminating the need for head-height differential and reducing the potential for human error. This review evaluates the risks and rewards of these workarounds and offers guidance to support informed decision-making while advocating for long-term technology solutions that improve safety, reduce clinician burden, and align with best practices in infusion therapy.