Patient Name ____________________________________________________________
Date____________________________________________________________________
Instructor / Organization ___________________________________________________
Patient Signature _________________________________________________________
Performance Criteria – Invia® Liberty Pump (or other brand of pump being used)
Instructions for Use – Pump Operation
Completed
Identifies components of Invia® Liberty System (or whatever system you are using)
Powering the unit ON/OFF
Changing Canisters & Tubing
Disposal of Canisters and Tubing
Frequency of canister changes and documenting exudate volume
How to silence alarm
Use of clamps, function for open and closed
Troubleshooting alarms and warnings
1. Power failure
2. Dislodged tubing
3. Accidental disconnection
4. Battery Empty, #305
5. Failure to maintain charge
6. Canister Full, #306
7. Resource for Alarm references in Patient Quick Guide and Patient Instruction Handbook
8. When to immediately power off the pump
9. Leak in system. #301
10. System clogged, #302
Power docking station and use of power cord
Care and Safety Tips
Instructions to call ABC Medical for equipment service
How to disconnect the system to shower, bath and toilet.
Review physicians orders for length of time therapy is scheduled per day
Review physicians orders for dressing change frequency
Instructions for if there is a sudden increase of blood under the drape, in the tubes or canister
When to immediately turn off the pump
Review importance of infection control procedures such as good hand washing techniques when working with pump and
supplies
Monitor wound , periwound for trauma or damage, complications and/or signs of infection
Pump Cleaning and Disinfection techniques have been reviewed, keep open fluids away from pump
Disposal procedure for canisters, tubing and dressings
Verify disposable packages are not torn, damaged or opened prior to use
X____________________________________________________________________________________________________________
Patient understands that the Medela Invia Liberty Pump, docking station, power cord and case must be returned to ABC Medical.
Welcome!
Thank you for allowing ABC Medical to be of service. We would like to acquaint you with some helpful
information.
Emergencies
Should an emergency arise, please call 911.
STOP THERAPY IF SUDDEN, ACTIVE OR LARGE AMOUNTS OF BLEEDING OCCUR OR FRANK BLOOD IS
SEEN IN THE TUBING OR CANISTER. IN THIS CASE:
 Stop negative pressure, turn the pump off.
 Leave the dressing in place until the wound can be safely explored by the surgeon.
 Take measures to stop bleeding
 Provide immediate medical assistance.
Deliveries
We request that delivery of supplies be arranged 3 full days in advance during office hours. We have a special
service called the Customer Care Center that can help you schedule your needs well in advance. This service
should alleviate any concerns you may have about running out of supplies and will allow us to adequately schedule
your delivery.
Holidays
Deliveries around the major holidays, New Year’s Day, Memorial Day, July 4, Labor Day, Thanksgiving Day and
Christmas Day may be delayed.
Insurance
Medicare – We routinely accept assignments and bill Medicare for the patient.
Medicaid – Coverage varies by equipment needs and locations. Please contact the Customer Care Center at ABC
Medical for specific information.
Private Insurance – Depending on the specific insurance, ABC Medical will either accept
assignment or assist the patient in submitting claim documents.
Accredited by the Joint Commission of Healthcare Organizations (JCAHO) (or
whoever you are accredited by)