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Infusion pumps are used to deliver drugs and other substances to patients at a pre-set rate. Infusion pumps are classified according to their application, whether ambulatory, patient controlled, anaesthesia or general purpose units.
Two young diabetic females using insulin infusion pump therapy became ill with toxic shock syndrome secondary to Staphylococcus aureus infection at the insulin infusion pump site. Physicians need to be aware of this potential complication in diabetic patients using insulin infusion pump therapy so proper management can be initiated early. Infections at insulin infusion sites are common. Patients need to be instructed in the importance of preventing infections at the pump infusion site and proper management of any abscesses that should develop. Controlled studies evaluating proper management of insulin infusion pump sites to prevent infections are needed.
Infusion pump analyzers are test devices that aid in determining the performance of infusion pumps. These devices perform simple flow tests, and in some instances volume and occlusion pressure tests as well, that otherwise would be performed using burettes or other calibrated glassware, balances, timers, and pressure meters or gauges. We evaluated five models from four different suppliers, focusing primarily on performance and human factors design. Three units were rated Acceptable, and two were rated Acceptable--Not Recommended because of performance limitations and, for one of the units, poor human factors. This Evaluation includes an overview of infusion pump analyzer technology and a Selection Guide detailing the factors that facilities should consider when purchasing an infusion pump analyzer. In addition, a supplementary article discusses recertification systems, which are designed for testing home-use pumps before use on each new patient. Another supplementary article deals with trumpet curves, a capability that may have limited value for most users.
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OBJECT: The objectives of this multicenter study were to monitor the performance of a 10-ml pump infusing intrathecal baclofen to treat 100 children with cerebral spasticity, to monitor complications associated with the pump, and to correlate pump-related complications with body habitus. METHODS: Age at implantation of the pump ranged from 1.4 to 16.8 years (mean 8.1 years). The effects of ITB on spasticity in the upper and lower extremities were evaluated using the Ashworth Scale. Data were collected regarding implant site, infection, complication, and body mass index (BMI). Ashworth Scale scores decreased significantly in the upper and lower extremities at 6 and 12 months after pump implantation (p < 0.001). There were four serious system-related complications, all specific to catheters. There were 32 serious procedure-related complications in 21 patients: 11 complications were infections that occurred in nine patients. Four of nine pump-induced infections were treated with pump removal and antibiotic therapy; five infections were treated successfully with antibiotic therapy alone, without pump removal. In children younger than 8 years of age there was a significantly higher incidence of serious procedure-related adverse events than in older children. There was no significant correlation between BMI and the incidence of pump pocket-related complications or infections. CONCLUSIONS: The 10-ml pump can be used therapeutically in small children, particularly those weighing less than 40 lbs, with greater ease and less wound tension, than the conventional 18-ml pump. The incidence of complications associated with the 10-ml pump in younger children appears to be similar to that previously reported with the 18-ml pump in larger-sized children.
Intraarterial infusion chemotherapy has several theoretical advantage over conventional therapy for the treatment of unresectable malignancies. However, the catheter problems and patient restriction to the hospital associated with its use have resulted in infrequent application and a notable lack of progress in this field of oncology. This paper describes the use of a totally implantable, percutaneously refillable infusion pump in 5 patients with primary or metastatic carcinoma of the liver. The infusion cannulae were placed into the hepatic arteries under direct vision at laparotomy, and the pumps were placed in subcutaneous pockets. Four patients received infusions of 5-fluorodeoxyuridine at rates of 0.2-0.5 mg/kg/day for periods of three to 29 weeks; the pump in the fifth patient was defective and was removed. The implanted pumps were well tolerated in these subjects, who received chemotherapy as outpatients; the only adverse effects noted were related to FUDR toxicity. This implantable infusion pump appears to be a practical means of delivering long-term intraarterial infusion chemotherapy to outpatients.
The approach taken by a pharmacy department of a 310-bed community hospital to evaluate and implement a syringe infusion pump system is described. The cost of the minibag system used by the hospital was compared with the cost of the syringe system. A trial of the system involving three medications was implemented in two patient-care areas. After a six-week period, nurses favored expansion of the new system. After a detailed cost comparison was presented to hospital administration, hospitalwide conversion to the new system was approved. Groups of drugs were gradually added to the dispensing list. At the end of a five-month period, 80% of secondary intravenous medications were administered via the new system. Advice is offered to other hospitals considering the system. A smooth transition to a syringe infusion system was the result of the well-planned approach.
Intensive therapy includes continuous delivery of drugs with infusion pump. This article describes an infusion rate computing programme using a Macintosh micro-computer and the HyperCard 2 software. The latter permits the classification of data onto cards collected in stacks. The card that is displayed when the programme is launched shows fifteen buttons assigned to various drugs. Click upon a button opens the corresponding card which displays the presentation of the drug and suggests a dilution. The next step associates input of patient's weight into the appropriate field and a click on the main button. A display then indicates for various standard dosages, the corresponding rate of infusion in mL.h-1 and the daily consumption of the drug. In order to avoid casual or voluntary changes of the setting, soft securities have been inserted in the programme.
Intraarterial infusion chemotherapy has not been widely accepted for the treatment of head and neck cancer due to the high rate of complications it involves. To avoid these complications, a totally implantable infusion pump has been developed to achieve continuous low-level drug delivery for long periods of time. The pump is implanted in a subcutaneous pocket and connected to a permanent, indwelling, arterial catheter. It can be repeatedly refilled with chemotherapeutic agents by hypodermic needle injection through the skin and through a self-sealing septum located at the entry to the pump. Refilling the pump recharges an inexhaustible power source for the next delivery cycle. Preliminary results suggest that long term intraarterial infusion chemotherapy for the treatment of head and neck cancer is practical for outpatients.
Regional infusion of chemotherapeutic agents in the treatment of liver cancer can greatly increase tumor exposure to certain drugs. Exposure is 100 times greater with floxuridine, 6 times greater with mitomycin C, and 6 times greater with BCNU. The Model 400 Infusaid implantable, refillable drug infusion pump overcomes much of the discomfort and inconvenience associated with previously employed extracorporeal systems. Our experience with our first 50 patients has been presented herein. Forty-one patients had metastatic colorectal cancer, 3 primary cancers, and 6 other metastatic cancers. Eleven pumps and 11 catheters were implanted at laparotomy. Thirty-nine patients had their pumps integrated to angiographically placed catheters. In over 260 patient months there were no pump malfunctions and only one infection. There were no vascular complications in the patients with angiographically placed catheters. Chemotherapeutic programs included floxuridine, floxuridine and radiotherapy, or floxuridine with mitomycin C and BCNU. In 18 patients with evaluable metastatic colorectal cancer who received hepatic arterial combination chemotherapy, there were therapeutic responses in 13 and disease stabilization in 4. The pumps were well tolerated by patients. They offer a reasonable approach to long-term ambulatory regional hepatic chemotherapy.
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Most extracorporeal continuous renal replacement therapies (CRRT) require inflow pumping of either dialysate, filtrate replacement solution, or both. Outflow of spent dialysate and ultrafiltrate can be accomplished by gravity drainage or pump. Intravenous infusion pumps have been commonly used for these purposes, although little is known about the accuracy of these pumps. To evaluate accuracy of two different types of intravenous infusion pumps used in CRRT, we studied flow rates at nine different pressure variations in three piston type and three linear peristaltic pumps. The results showed that error of either pump was not different for flow rates of 4 and 16 ml/min. Both types of pumps were affected by fluid circuit pressures, although pressure conditions under which error was low were different for each pump type. The linear peristaltic pumps were most accurate under conditions of low pump inlet pressure, whereas piston pumps were most accurate under conditions of low pump pressure gradient (outlet minus inlet) of 0 or -100 mmHg. The magnitude of error outside these conditions was substantial, reaching 12.5% for the linear peristaltic pump when inlet pressure was -100 mmHg and outlet pressure was 100 mmHg. Error may be minimized in the clinical setting by choosing the pump type best suited for the pressure conditions expected for the renal replacement modality in use.
INTRODUCTION: Blood cells pumped by technical systems are exposed to non-physiological mechanical stress. Haemolysis or subhaemolytic damage may occur. Interaction between cells and the artificial material as well as the shear stress are the main reasons for this traumatisation. Up to now in vitro evaluation is the method of choice as no profound theory of mechanical cell damage has existed yet and, furthermore, haemolytic effects exhibit al large biological variability. METHODS: This study deals with the mechanically induced haemolysis due to blood pumping by infusion pumps (type INCA; Fresenius AG) in dependence on device related as well as blood preserve related (donor, storage time) factors. RBC count, MCV, MCHC, hematocrit, total and extracellular haemoglobin were obtained before and after pumping the blood sample. RESULTS: At a pump rate of 1000 ml/h, 0.06% of RBC (storage duration of 1-3 days) and 0.3% (storage duration of 34-36 days) were destroyed, respectively. Furthermore, it was shown that only gravity induced perfusion of the Intra-Air-system and the tubing system without any pumping lead to a minor, but significant elevation of extracellular haemoglobin concentration. In contrast, a volume flow rate of 2000 ml/h or the 10 times repeated pump process (1000 ml/h) increases haemolysis by only 27% or 520% respectively. CONCLUSION: It was concluded that any extrapolation from given experimental conditions to other ones must be performed with great caution due to the complex nature of the haemolysis process. Infusion pumps of the INCA-type stress RBC only slightly and may therefore be used for controlled blood transfusion.
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Results of using an implantable osmotic pump, a preset disposable infusion pump, or a reusable programmable infusion pump for postoperative administration of buprenorphine or morphine in dogs undergoing abdominal surgery are described. Ten dogs underwent abdominal surgery for implantation of vascular access ports. Dogs were given buprenorphine s.c. by use of an implantable osmotic pump (4 dogs), morphine s.c. by use of a preset infusion pump (4), or buprenorphine intra-arterially by use of a programmable infusion pump (2). Dogs were monitored, and serum buprenorphine or morphine concentration was measured for 72 hours after surgery; pumps were removed 48 hours after surgery. Severity of pain was determined by assigning a pain score. The preset infusion pump and the programmable infusion pump resulted in comparable pain relief and sustained serum analgesic concentrations throughout the recovery period. However, the cost of the pumps and other associated factors may limit their use to dogs undergoing invasive surgical procedures expected to result in substantial postoperative pain. The level of analgesia obtained with the implantable osmotic pumps was inconsistent.
Accurate flow from infusion pumps should be maintained when exposed to a variety of clinical conditions. The intent of this study was to evaluate in vitro flow rate accuracy of three infusion pumps subjected to the influences of variable back-pressure, solution viscosity, and infusion rates. A factorial study design was selected to determine the influence of three flow rates (5, 10, and 20 ml/h), three back-pressures (100, 200, and 300 mm Hg), and two solution viscosities (5%, 25% dextrose in water) on flow rate accuracy from three infusion pumps (Abbott 4P, IVAC 560, and Travenol 6200) using a standard gravimetric technique. Mean +/- SD accuracy values were -9.4 +/- 6.4% (range -29.1 to -0.7), 0.5 +/- 2.2% (range -4.2 to 6.3), and -0.5 +/- 4.7% (range -8.5 to 9.9) of the desired rate for the Abbott, IVAC, and Travenol devices, respectively. Back-pressure was the only factor to influence significantly flow accuracy for the Abbott device (r = .81). All factors significantly influenced accuracy for the Travenol device (r = .55). No factor influenced accuracy for the IVAC infusion pump. Both the IVAC 560 and Travenol 6200 have acceptable flow accuracy values within the range of study factors examined. The Abbott 4P had significant decreases in flow accuracy in response to increasing back-pressure.