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PubMed1997

General-purpose infusion pumps.

In this Guide, we provide a variety of information intended to help healthcare facilities make informed infusion pump purchasing decisions. Specifically, we present an overview of general-purpose infusion pump technology and then guide facilities through the process of defining their needs and identifying the pump capabilities and features that will help them meet those needs. We also describe the factors to consider when performing a cost analysis to help the facility determine which unit will be the most cost-effective choice. Finally, we include a comprehensive listing of infusion pump suppliers and their products, covering 70 infusion pump models sold throughout the world. After clarifying their needs, facilities can review this listing to identify models that are worthy of further consideration. For more detailed information on choosing the most appropriate model, readers can refer to our Evaluation of general-purpose infusion pumps in this issue. In that article, we test and rate 17 pump models from 6 suppliers.

Catalogs, Commercial as Topic↗

PubMed1996

[Clinical evaluation of a new programmable syringe infusion pump].

A new programmable syringe infusion pump, Auto Syringe Model AS 40 A, was evaluated for infusion of muscle relaxants, vasodilators and opioids in 4 surgical patients. Every drug mentioned above was easily adjusted according to surgical requirement in these patients. Auto Syringe Model AS40A is light and compact. Its major advantages lie in the mechanisms for delivery of a bolus dose and automated delivery of intermittent doses, automatic rate calculation, and the applicability to various sizes of syringes. Auto Syringe Model AS40A was found to be very useful for intravenous infusion of drugs.

Adult↗

PubMed1985

Modification of the catheterization procedure for the totally implantable infusion pump.

The totally implantable infusion pump is a new and expensive device. Once this pump is unpacked and is in contact with a patient, it is impossible to have it resterilized. For this reason, we suggest the use of a separate catheter for catheterization. Once the catheter is successfully placed in the appropriate artery, then the pump can be unpacked and attached to this catheter. If catheterization proves impossible, the pump is still sterile and can be used for the next patient.

Catheterization↗

PubMed1991

Influence of infusion pumps on the pharmacologic response to nitroprusside.

OBJECTIVE: To compare the relationship between variability in nitroprusside delivery from five infusion pumps and the resulting variability in mean arterial pressure (MAP). DESIGN: Randomized, crossover study design. SETTING: A pediatric ICU in a university hospital. PATIENTS: Informed parental consent was obtained for six patients who were hemodynamically stable and receiving a continuous nitroprusside infusion for a clinical application. Subjects ranged in age from 11 months to 9 yr. INTERVENTIONS: All of the subjects were administered nitroprusside using selected infusion pumps, which included Abbott (Micro), 3M/AVI (210), IMED (965), IVAC (565), and Kendall McGaw (MicroRate). MEASUREMENTS AND MAIN RESULTS: After an initial equilibration interval for each device, MAP was measured and recorded at 10-sec intervals for greater than or equal to 90-min intervals using a computerized data collection technique. Variation in nitroprusside administration (flow continuity) for each infusion pump was determined in vitro using a computerized gravimetric technique. Variation in both MAP and flow continuity was mathematically expressed as the coefficient of variance (CV) of the measured values for each of the respective infusion pumps. For the Abbott, IMED, 3M/AVI, IVAC, and Kendall McGaw, infusion pumps, mean +/- SD continuity CV values were 85 +/- 31%, 39 +/- 26%, 19 +/- 8%, 17 +/- 3%, and 12 +/- 3%, respectively, and MAP CV values were 18 +/- 21%, 15 +/- 11%, 8 +/- 2%, and 16 +/- 10%, respectively. CONCLUSIONS: An apparent direct relationship between MAP variability and flow continuity was observed. We speculate that variation in effect of potent short-acting drugs may, in part, be due to infusion pump operation.

Blood Pressure↗

PubMed1997

Selection of intravenous infusion pumps.

Three broad types of intravenous infusion pump are available--gravity driven, electronic and mechanical devices. The type suitable for a unit will depend on the patient group. Nurses are generally responsible for administering intravenous infusions and should therefore be involved in the purchasing process.

Humans↗

PubMed1990

Reassessment of external insulin infusion pumps.

Continuous subcutaneous insulin infusion (CSII) therapy using external infusion pumps provides an alternative to multiple daily injections (MDI) for insulin-dependent diabetics who require intensive insulin therapy. CSII allows for the delivery of regular insulin continuously at preset basal rates and at bolus doses, which can be varied in response to insulin needs of the patient. Intensive insulin therapy by CSII or MDI was administered to diabetics to improve control of their blood glucose levels and to assess its effects on the development of complications such as retinopathy and nephropathy. CSII appeared to be as effective as MDI in attaining near-normoglycemia and improving metabolic control in patients with insulin-dependent diabetes mellitus who required intensive insulin therapy. It was not clear, however, whether the improved control of the blood glucose levels resulted in the prevention or progression of the diabetic complications. The risks of having adverse effects, such as diabetic ketoacidosis or hypoglycemia, were higher with CSII as compared with MDI; both methods having higher risks of these complications in comparison to conventional insulin therapy. CSII may be beneficial for patients requiring intensive insulin therapy who may need greater lifestyle flexibility with regard to meal timing, work, and recreational scheduling.

Humans↗

PubMed1988

Patient-controlled analgesic infusion pumps.

We evaluated seven PCA infusion pumps from seven manufacturers. The condition for acceptable use of six of the units was that they not be used at low volumes that could result in overinfusion from the stored volume when an occlusion is cleared. Our ratings and ranking were based primarily on safety, security, and overall ease of use. All pumps met most accuracy, electrical safety, and performance criteria. Two of the pumps were suitable for ambulatory use but were not recommended for general hospital or home care bedside use. One of the pumps was totally disposable and nonelectronic.

Evaluation Studies as Topic↗

PubMed1985

Long-term follow-up of diabetic patients using insulin infusion pumps. Considerations for future clinical application.

Current debate about the use of insulin infusion pumps in the treatment of diabetes mellitus is partly attributable to a lack of available data about the long-term course of patients who use pumps. We evaluated the course of our first 20 patients treated with insulin infusion pumps. Two or more years after the inception of therapy, only half of these patients were still using the insulin infusion pump. Psychosocial stresses, which affected glycemic control, were identified retrospectively in a majority of patients, but were not appreciated when pump therapy was initiated, despite our best attempts to do so. Mean hemoglobin A1 levels decreased significantly for the entire group and for the subgroup that did not discontinue pump therapy. These results suggest that insulin pump programs must have the resources to provide appropriate support for all candidates, including unsuitable candidates, who present for treatment with insulin infusion pumps.

Adult↗

PubMed2003

Consequences of syringe size sensor malfunction in a modern infusion pump.

Prompted by an actual case of potentially life-threatening infusion pump malfunction, we investigated the effects of wire breakage(s) within the syringe size sensor circuit in a Graseby 3400 infusion pump. The circuit wires within the sensor were systematically broken. The syringe sizes recognised by the sabotaged circuit and the actual sizes of syringes inserted into the pump were compared. Thirty-eight per cent of the possible wire breakages resulted in a smaller syringe size being recognized, causing the infusion rate to be too fast, and 38% of the possiblewire breakage resulted in a larger syringe size being recognized, causing the infusion rate to be too slow. The volume delivered for each different size of Terumo syringe as a function of distance travelled by the plunger was measured. The errors ranged from 0.4 to 2.6 times that of the expected rate. Only 1.3% of the possible wire breakage(s) were recognised as errors by the pump. The infusion rates were not affected in 22.5% of the cases. Wire breakage within the syringe size sensor in infusion pumps is yet another potential source of infusion error, with important safety implications.

Equipment Failure↗

PubMedDate not supplied

Portable infusion pumps used for continuous regional analgesia: delivery rate accuracy and consistency.

BACKGROUND AND OBJECTIVES: Multiple benefits of postoperative perineural local anesthetic infusion have been shown including potent analgesia, decreased opioid requirements, and improved rehabilitation. Consequently, portable infusion pumps have been used with increasing frequency to provide perineural infusion for medically unsupervised ambulatory patients. We believe that the infusion rate accuracy and reliability of these pumps infusing potentially toxic doses of medication should be investigated independently. Therefore, we studied the flow-rate accuracy and consistency of various portable infusion pumps that have not been examined previously. METHODS: Using a computer/mass balance combination to record infusion rates, 6 pumps (3 electronic and 3 non electronic) were tested. Several factors that may influence pump performance were varied: temperature (ambient/skin), battery (replacement/addition), and catheter exchange (wound/perineural). RESULTS: Infusion rate accuracy differed significantly among the pumps, exhibiting flow rates within +/-15% of their expected rate for 55% to 99% of their infusion duration. Furthermore, the profiles (infusion rate over time) of the various pumps differed significantly depending on the pump power source. Although elastomeric pump infusion rate increased with an increase in temperature, battery life was a limiting factor for one of the electronic pumps. Substituting wound catheters with commonly used perineural catheters did not significantly alter infusion profile. CONCLUSIONS: Factors such as infusion rate accuracy and consistency, infusion profile, temperature sensitivity, and battery life affect the dose of medication administered by various portable pumps used for continuous regional analgesia. Health care providers should take these factors into consideration when choosing and using a portable infusion pump for local anesthetic administration.

Analgesia↗

PubMed1999

An in vitro evaluation of flow from multihole epidural catheters during continuous infusion with four different infusion pumps.

We have observed in vitro the distribution of flow from 10 identical multihole epidural catheters during continuous infusion with four different infusion pumps. The pumps chosen were the B Braun Perfusor Secura FT syringe driver and three volumetric infusion pumps utilising different pumping mechanisms (Dekra 3000 BL, Graseby 500 and CADD-Prizm). These pumps infused 0.9% saline through each catheter at 5 ml.h-1, 15 ml.h-1, 50 ml.h-1 and 99 ml.h-1 for 3 min. The number of holes through which flow occurred and the catheter hole where flow predominated during each test were recorded. The pressure waveform generated during each infusion was displayed and the peak pressure recorded. In 38 of the 160 tests (24%) the largest proportion of flow was seen at the hole closest to the catheter tip. The CADD pump generated multihole flow during significantly more tests (p < 0.0001) than the other pumps and produced significantly higher driving pressures (p < 0.001) at all infusion rates compared with the Graseby and Perfusor pumps. The CADD was the only pump to produce flow from all three holes of the catheter at 5 ml.h-1.

Anesthesia, Epidural↗

PubMed2000

Interscalene brachial plexus block with a continuous catheter insertion system and a disposable infusion pump.

Continuous interscalene brachial plexus blockade traditionally requires a hospital stay for local anesthetic infusion, and achieving consistent catheter insertion may be difficult. Incorporating long-acting pain relief from a continuous peripheral nerve block, with a reliable method of catheter insertion, and a self-contained infusion system would be a valuable asset for short-stay care. We compared the efficacy of single injection interscalene brachial plexus blockade to a continuous peripheral nerve block, with an insulated Tuohy system and a disposable infusion pump. Forty adult patients scheduled for open rotator cuff repair were entered in this randomized, double-blinded, placebo-controlled study. Patients received an interscalene brachial plexus blockade and a continuous peripheral nerve catheter as their primary anesthetic and then, were assigned to receive one of two different postoperative infusions: either 0.2% ropivacaine at 10 mL/h via a disposable infusion pump or normal saline at 10 mL/h via a disposable infusion pump (n = 18-20 per group). Visual analog pain scores and postoperative morphine consumption were measured for 24 h. The ropivacaine group showed less pain than the placebo group (P: = 0.0001) between 12 and 24 h after the initial injection of local anesthetic. In addition, initial interscalene blockade was successful in all patients and all redosed catheters were functional after 24 h with the continuous catheter insertion system. We conclude that it is possible to achieve a high rate of successful catheter placement and analgesia by using the continuous catheter insertion system and a disposable infusion pump in the ambulatory setting. This method of analgesia may offer improved pain relief after outpatient rotator cuff repair.

Adolescent↗

PubMed1988

Patient-controlled analgesic infusion pumps.

We evaluated 7 PCA infusion pumps from 7 manufacturers. The condition for acceptable use of 6 of the units is that they not be used at low volumes that could result in overinfusion from the stored volume when an occlusion is cleared. Our ratings and ranking are based primarily on safety, security, and overall ease of use. All pumps meet most accuracy, electrical safety, and performance criteria. Two of the pumps are suitable for ambulatory use but are not recommended for general hospital or home care bedside use. One of the pumps is totally disposable and nonelectronic. Purchasing decisions should also take into consideration the cost of disposables, application, and medication security.

Disposable Equipment↗

PubMed2003

Changes in red blood cell integrity related to infusion pumps: a comparison of three different pump mechanisms.

OBJECTIVE: To study the effects of three different infusion pumps on red blood cell (RBC) integrity. SETTING: Laboratory. INTERVENTIONS: Transfusion of packed RBCs using three different pumps (syringe pump, conventional peristaltic pump, and a new volumetric pump with shuttle mechanism). Flow rate was set at 20 mL/hr and duration was 2.5 hrs, simulating a neonatal transfusion. Experiments were repeated in each pump with eight different units of packed RBCs. MEASUREMENTS AND MAIN RESULTS: Plasma hemoglobin, potassium, lactate dehydrogenase, bilirubin, and osmotic fragility were assessed before and after transfusion. There was a significant degree of hemolysis in the RBC bags before transfusion (mean +/- sd for plasma hemoglobin, 5.9 +/- 3.0 g/L; potassium, 40.0 +/- 11.8 mmol/L; lactate dehydrogenase, 64 +/- 38 units/L; total bilirubin,: 1.5 +/- 0.8 microM/L). Overall increase between samples before and after transfusion was 12% for plasma hemoglobin (p =.01, paired Student's t -test), 2% for potassium (p =.03), 20% for lactate dehydrogenase (p =.0001), and 47% for total bilirubin (p =.04). Plasma hemoglobin and lactate dehydrogenase changes were significantly influenced by the type of infusion pump (p =.006 and.01, multiple regression analysis). Regarding these two variables, the new volumetric pump was less hemolytic than the other two pumps. The degree of the transfusion-related RBC changes was also significantly and independently influenced by the storage time of the blood bags with plasma hemoglobin, bilirubin, and osmotic fragility changing less in old bags. CONCLUSIONS: The new pump's shuttle mechanism seems to be less injurious to RBCs compared with a conventional syringe and a peristaltic infusion pump. However, the clinical significance must be related to the hemolytic changes in the RBC units before they are transfused, which are a major source of the overall hemolytic load.

Bilirubin↗

PubMed2004

Evaluation of infusion pump performance in a magnetic resonance environment.

BACKGROUND AND OBJECTIVE: For use in a magnetic resonance (MR) scanning room infusion pumps must be MR safe and compatible. This study tested two commonly used infusion pumps (Alaris P6000 and Alaris Asena-GH) to determine if they met these criteria. METHODS: The pumps underwent testing within the scanning room of a 3 T MR scanner. Pump infusion rates were tested at up to 100 Gauss magnetic field strength, with and without radio frequency signals present. The effect of the pumps on image quality was assessed. The occlusion pressure alarm of the pumps was tested at up to 100 Gauss. The projectile risk was assessed by measuring the force exerted upon the pumps at the entrance to the scanner. RESULTS: The maximum mean flow rate errors at 100 Gauss were 2.18% for the Alaris P6000 and 1.42% for the Alaris Asena-GH, both within our accepted limits. Radio frequency signals had no effect on flow rate. The pumps produced no discernable artefacts on the acquired images. The maximum mean occlusion pressure error was 204 mmHg higher for the Alaris P6000 pump and 99 mmHg lower for the Alaris Asena-GH (P-values < 0.001) at 100 Gauss compared to testing outside the scanner. Both pumps were subject to significant attractive force at the entrance to the scanner. CONCLUSIONS: Whilst the pumps cannot strictly be termed MR safe or compatible at 100 Gauss we have demonstrated that flow rates are unchanged and that, for the Alaris Asena-GH, the effect on the occlusion pressure alarm is unlikely to have patient safety implications.

Equipment Design↗

PubMed1996

Comparison of recovery of propofol and methohexital sedation using an infusion pump.

Two sedative anesthetic agents administered by an infusion pump were compared during third molar surgery. Forty American Society of Anesthesiologists (ASA) class I or II volunteers were randomly allocated to two groups. All subjects received supplemental oxygen via a nasal hood, fentanyl (0.0007 mg/kg intravenous [i.v.] bolus), and midazolam (1 mg/2 min) titrated to effect. Patients then received either 0.3 mg/kg of methohexital or 0.5 mg/kg of propofol via an infusion pump. Upon completion of the bolus, a continuous infusion of 0.05 mg/kg/min methohexital or 0.066 mg/kg/min propofol was administered throughout the procedure. Hemo-dynamic and respiratory parameters and psychomotor performance were compared for the two groups and no significant differences were found. The continuous infusion method maintained a steady level of sedation. Patients receiving propofol had a smoother sedation as judged by the surgeon and anesthetist.

Adult↗

PubMedDate not supplied

Continuous venovenous renal replacement therapy using a conventional infusion pump.

To evaluate continuous venovenous hemofiltration and hemodiafiltration with a conventional infusion pump in a pediatric sized animal model. Fourteen Maryland pigs weighing 8 to 13 kg were used. A conventional infusion pump (IVAC 571), with a flow of 900 ml/h and a pediatric hemofilter of 0.22 m2 were used. Ringer's solution was used for both the dialysate and the replacement fluid. Each experiment included 1 hour of hemofiltration and 1 hour of hemodiafiltration. Heart rate, arterial blood pressure, pH, Na, K, Cl, and hematocrit were measured every 30 minutes. Mean ultrafiltrate flow was 249.7 +/- 100.3 ml/hr, 240.5 +/- 109.5 ml/hr with hemofiltration and 271 +/- 101.1 ml/hr with hemodiafiltration, the differences not being significant. No significant changes were seen in heart rate, blood pressure, hematocrit, electrolytes, or pH. Pressure in the circuit rose from 107.7 +/- 70.3 mm Hg at the beginning of the experiment to 234.2 +/- 118.1 mm Hg after 2 hours (p < 0.05). The technique was well tolerated by all the pigs. Continuous venovenous hemofiltration and hemodiafiltration with a conventional infusion pump is a possible alternative to conventional methods of extrarenal replacement therapy in neonates and infants.

Animals↗

PubMed1979

[Possible effects of infusion pumps on the registration of cardiotocograms (author's transl)].

Artifacts in cardiotachographic tracings caused by infusion pumps have been recorded and are presented. Registration of the artifacts occurs in ultrasonic or abdominal EKG-tracings when the fetal signals are weak or absent. The cause of these misregistrations which can lead to faulty interpretations are an interference of the infusion pump through the general circuit. Interference from the infusion pump is registered when grounding is insufficient or when the infusion pump is in close proximity to the abdominal electrode. In the abdominal EKG technique the instruments have to be in closer proximity than in the ultrasonic technique.

Adolescent↗