Shared on behalf of Adam Vinet, VP Patient Experience, Chief Nursing Executive, Regional VP Regional Cancer Centre and Jennifer Wintermans, VP, Quality and Corporate Affairs

---

We are issuing this notice to inform you about a change in practice when utilizing medications on the Baxter Novum IQ Large Volume Pump. This is in follow-up to the memos provided on August 1, 2023 and September 8, 2023. This change in practice is required due to an issue that has the potential for internal screws to loosen and interfere with the valves within the pump. This malfunction has the potential to lead over infusion of the intravenous solution.

As a precaution, we will be implementing the following action to address this potential malfunction with the Baxter Novum IQ Large Volume Pumps until they can be inspected, tagged and returned to the units.

1. Buretrols (volume control device) will be used for high risk infusions, particularly where close observation may not be possible. A list of high risk medications will be available on all units.
2. Utilize the smallest volume bag available when mixing and hanging medications, fluids, blood products especially for patients at high risk of fluid overload.
3. Avoid hanging 1000cc bags whenever possible.
4. Orders should not use to keep vein open (TKVO) rates and lock IV catheters as clinically appropriate.

We will remove the above additional safety precautions once units have had all pumps inspected and returned. You will receive further direction and communication on this process.

In addition, please continue to complete the following prior to initiating an intravenous infusion;

1. Confirm the pumping mechanism valves (two visible white valves when the pump door is open) are not stuck, ensure they move up and down.
2. While the pump is infusing monitor for any atypical sounds coming from the pump.*Please see the attached reference

If the pumping mechanism valves appear to be stuck and/or there is any atypical noise noted, bring the pump to your Patient Care Manager. Ensure the pump is labeled and a biomedical requisition is complete.

We understand that this workaround will require extra time and effort but it is necessary until we can ensure all pumps have been inspected. We appreciate your efforts and cooperation in these extra steps to ensure patient safety is maintained.

Baxter Corporation is onsite and working diligently with us to resolve the issue. Further communication will be provided as we work through this issue.