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PubMed1990

Cost and acceptability of three syringe-pump infusion systems.

The fiscal impact and acceptability of implementing a syringe-pump infusion system at a 900-bed university teaching hospital where the minibag system has been in use is reported. Researchers selected three models of syringe pumps for evaluation: the Bard Harvard Mini-Infuser 150XL, the Becton Dickinson 360 Infuser, and the Strato Stratofuse System. Each pump was evaluated for three weeks on a medical-surgical unit and a hematology-oncology unit. Drugs to be infused were chosen after a literature review to determine which drugs had been successfully infused via syringe pump; 22 formulary medications were selected. Syringes were prepared as singly packaged doses or as doses prepared in bulk and packaged frozen. Control of the syringe pumps and microbore tubing was assigned to the inpatient pharmacy staff. Nurses and pharmacy personnel were apprised of the study and taught how to use the syringe pumps. Time-and-motion studies were performed in the sterile products preparation area, and a cost analysis was done. Nurses preferred syringe pumps over the minibag system because the pumps reduced the nursing time needed to infuse a drug, administered less fluid, provided consistent infusion rates, had alarms, and were relatively easy to use. The time required to prepare syringes did not differ substantially among syringe-pump models. It was estimated that using any of the evaluated pumps in place of the minibag system would save $126,500 during the three-year period 1988-91, primarily because of differences in the cost of disposable items. The syringe-pump infusion system is an acceptable and cost-effective alternative to the minibag system.

Costs and Cost Analysis↗

PubMed1994

Tocolysis for recurrent preterm labor using a continuous subcutaneous infusion pump.

This study attempted to determine the best method of treatment for patients with recurrent preterm labor: administration of terbutaline via an automated, programmable, subcutaneous infusion pump or oral terbutaline. In this retrospective, controlled study, 32 patients diagnosed with recurrent preterm labor, as determined by persistent uterine contractions with cervical change, were treated with a programmable infusion pump adjusted to control uterine contraction frequency to < or = 4 contractions per hour. Patients in this group were matched for age, race, parity, gestational age and cervical dilation at diagnosis of recurrent preterm labor in subjects taking oral terbutaline. The patients receiving oral terbutaline were given an average of 6.5 mg every four to six hours to maintain uterine quiescence, while those in the pump group were given basal rates of terbutaline and in addition received four to six boluses per day (< 3 mg/d total dose) to achieve this outcome. Patients using the pump were more likely to reach term and less likely to fail tocolytic therapy than were those taking oral terbutaline. The terbutaline pump appeared to be more successful in prolonging pregnancies to term after the diagnosis of recurrent preterm labor than did oral terbutaline.

Administration, Oral↗

PubMed1990

[Practical use of infusion pumps].

The authors present a brief characteristic of infusion pumps on the drop principle and factors which influence the size of the drop. They also pay attention to the knowledge of drop size for nutritional needs and accurate dosage of drugs.

Infusion Pumps↗

PubMed2000

Infusion pumps: preventing future adverse events.

The Joint Commission offers this information for health care organizations to consider in their continuing efforts to reduce the risk of adverse events in the care of their patients, residents or individuals served. In the past two years, health care organizations have reported to JCAHO two sentinel events involving the use of infusion pumps. While it is difficult to reach meaningful conclusions from only two cases, these cases have raised a concern about patient safety involving the use of infusion pumps. In recent months there has been a great deal of discussion about potential problems with infusion pumps. Therefore, JCAHO provides the following expert comments and recommendations to alert health care organizations on how to prevent such adverse events from occurring.

Equipment Safety↗

PubMed2004

Laparoscopic placement of hepatic artery infusion pumps: technical considerations and early results.

BACKGROUND: Laparoscopic hepatic artery infusion pump (LHAIP) placement is a novel treatment option for patients with colorectal liver metastases. This study investigates technical difficulties with regard to variant hepatic arteries and the preliminary outcomes for patients treated with LHAIP placement. METHODS: Between March 1998 and January 2003, 38 patients with colorectal metastases confined to the liver, 35 (92%) of who had prior systemic chemotherapy that failed, were treated with LHAIP. RESULTS: Twelve patients (32%) had LHAIP placement only, and 26 (68%) had pump placement combined with laparoscopic radiofrequency ablation (LRFA; 24 patients) and/or liver resection (2 patients). Variant hepatic arterial (HA) anatomy was present in 18 patients (47%). The presence of a variant HA did not increase pump complications, operative time, or blood loss (P >/=.20) or decrease the functional time of pump use (P =.91) in comparison with normal anatomy. In all patients with a variant HA, laparoscopic ligation of the variant vessel and/or cannulation of nongastroduodenal artery resulted in complete hepatic perfusion. Three misperfusions identified intraoperatively with use of methylene blue injection were corrected by laparoscopic ligation (two) or postoperative angioembolization (one). Postoperative pump radionuclide flow studies confirmed isolated hepatic artery infusion in all cases. There was a 13% pump-related complication rate. During a median follow-up of 11 months (0.5 to 35.5 months), the actuarial rate of overall survival was 47% and the estimated median survival time was 17.5 months. CONCLUSIONS: LHAIP placement is technically feasible, and variant HA is not associated with increased pump complications or decreased pump functional time.

Aged↗

PubMed1992

Stability of fluorouracil, cytarabine, or doxorubicin hydrochloride in ethylene vinylacetate portable infusion-pump reservoirs.

The stability of fluorouracil, cytarabine, and doxorubicin hydrochloride in admixtures stored in portable infusion-pump reservoirs was investigated. Admixtures containing fluorouracil 50 or 10 mg/mL, cytarabine 25 or 1.25 mg/mL, or doxorubicin hydrochloride 1.25 or 0.5 mg/mL in 0.9% sodium chloride injection or 5% dextrose injection were placed in 80-mL ethylene vinylacetate drug reservoirs protected from light, and 1-mL quantities were withdrawn immediately after preparation and after storage for 1, 2, 3, 4, 7, 14, and 28 days at 4, 22, or 35 degrees C. For each condition, three samples from each admixture were tested for drug concentration by stability-indicating high-performance liquid chromatography. The admixtures were also monitored for precipitation, color change, and pH. Evaporative water loss from the containers was measured. Fluorouracil was stable at all temperatures for 28 days. Cytarabine was stable for 28 days at 4 and 22 degrees C and for 7 days at 35 degrees C. Doxorubicin hydrochloride was stable for 14 days at 4 and 22 degrees C and for 7 days at 35 degrees C. No color change or precipitation was observed, and pH values were stable. Loss of water through the reservoirs was substantial only at 35 degrees C for 28 days. When stored in ethylene vinylacetate portable infusion-pump reservoirs, fluorouracil, cytarabine, and doxorubicin hydrochloride were each stable for at least one week at temperatures up to 35 degrees C. Cytarabine and doxorubicin hydrochloride showed decreasing stability at longer storage times and higher temperatures.

Cytarabine↗

PubMed1998

Evaluation of the gemini infusion pump for the safe delivery of peripheral blood progenitor cells (stem cells).

The purpose of this in vitro study was to determine whether the Gemini PC-2TX infusion pump could safely deliver peripheral stem cells (PSC) for an autologous PSC transplant. For purposes of hypothesis testing, it was assumed that there would be no significant difference in CD34+ cell counts and colony-forming units-granulocyte, macrophage (CFU-GM) when the PSCs were administered by an IMED PC-2TX infusion pump as opposed to an intravenous push method. The American Red Cross collected 50-ml samples of PSCs from four donors by apheresis. These cells were tested for CD34+ using flow cytometry and for functional progenitor cells using a CFU-GM assay. The cells were cryopreserved after testing. For our study, samples were tested simultaneously at a single facility. Each sample was individually thawed and a baseline thaw sample collected; 10 ml of the donor specimen was pushed through a syringe into a specimen container (intravenous push sample). The remainder of the specimen was infused through the IMED Gemini PC-2TX pump into a specimen container (intravenous pump sample). All samples were assayed for CD34+ cell counts and CFU-GM. Data analyses were conducted using the t-test for paired samples, with values of P < 0.05 considered significant. Results failed to demonstrate a statistically significant difference between the CD34+ or CFU-GM results of the intravenous push and intravenous pump specimens. Additionally, we failed to find a statistically significant difference when we compared the intravenous push and the intravenous pump specimens with the baseline thaw sample. The results of this study support the hypothesis that the Gemini PC-2TX infusion pump can safely deliver PSCs for the purposes of stem cell transplantation.

Antigens, CD34↗

PubMed1993

[The treatment of liver metastases of colorectal tumors using intra-arterial fluorouracil via hepatic artery, administered with a completely implantable access system and a portable infusion pump].

Thirty-seven patients with liver metastases from colorectal cancer were treated with hepatic arterial infusion of 5-FU. Before therapy an arterial access device (Port-A-Cath) was implanted. Treatment was given on an outpatient basis with a portable infusion pump. 5-FU was administered as a continuous infusion at a dose of 1000 mg/sq.m. per day during 5 or 6 days. Cycles were repeated every three weeks. In 12 (37.5%) of the 32 evaluable patients a partial remission was achieved. Median duration of remission was 11 months and median duration of survival was 16 months. Side effects of chemotherapy were usually mild. In 11 patients thrombosis of the hepatic artery was observed, occurring after a median period of 5 months after implantation of the access device. Further study is required to improve the treatment results in this disease with its unfavourable prognosis.

Adult↗

PubMed1990

Pharmacokinetics of fentanyl administered by computer-controlled infusion pump.

Fentanyl was administered to 21 patients using a computer-controlled infusion pump (CCIP) based on a pharmacokinetic model. Eleven of the patients were dosed according to the pharmacokinetics described by McClain and Hug, and ten of the patients were dosed according to the pharmacokinetics described by Scott and Stanski. The authors measured the difference between the measured arterial fentanyl concentrations and the concentrations predicted by the CCIP for each pharmacokinetic parameter set. The median absolute performance error (MDAPE) in patients dosed according to McClain and Hug's parameters was 61%, and the MDAPE in patients dosed according to Scott and Stanski's parameters was 33%. The population pharmacokinetics in these 21 patients were analyzed using a pooled data technique. The pharmacokinetics of fentanyl in this population showed a smaller central compartment volume and a more rapid initial distribution half-life than previously estimated for fentanyl. The derived pharmacokinetic parameters described these patients well and also predicted the observed fentanyl concentrations from four previously published fentanyl studies with reasonable accuracy. Comparison of the parameters used by the authors with those of McClain and Hug demonstrated that dosing regimens designed from pharmacokinetic models can be fairly accurate at the times sampled in the original study but may not be accurate at time points not sampled in the original research. The authors concluded that although the pharmacokinetics of fentanyl administered by CCIP are the same as the pharmacokinetics of fentanyl administered by a bolus or constant rate infusion, a pharmacokinetic study using a CCIP may be particularly effective at characterizing the most rapid distribution pharmacokinetic parameters, and thus may provide parameters appropriate for subsequent use in a CCIP.

Adult↗

PubMed1992

Stability of ceftazidime (with arginine) and of cefuroxime sodium in infusion-pump reservoirs.

The stability of ceftazidime (with arginine) and cefuroxime sodium was studied after storage in infusion-pump reservoirs at freezing and refrigerated temperatures and subsequent simulated administration over 24 hours at near-body temperature. Polyvinyl chloride reservoirs and glass vials were filled with ceftazidime (with arginine) or cefuroxime sodium at various concentrations, diluted in sterile water. Three reservoirs each of ceftazidime 30 and 60 mg/mL and of cefuroxime 22.5, 30, 45, and 60 mg/mL were stored for various times and at various temperatures. Three glass vials each of ceftazidime or cefuroxime 30 and 60 mg/mL were stored for 30 days at -20 degrees C, followed by 4 days at 3 degrees C and 24 hours at 30 degrees C. Samples obtained periodically during storage and during simulated administration were analyzed with high-performance liquid chromatography. Both drugs maintained at least 90% of their initial concentration under all of the test conditions except simulated administration at 30 degrees C, during which degradation accelerated. In portable infusion-pump reservoirs, ceftazidime 30 and 60 mg/mL and cefuroxime 30 and 60 mg/mL were stable for 30 days at -20 degrees C followed by 4 days at 3 degrees C; ceftazidime 30 and 60 mg/mL was stable for 10 days at 3 degrees C; and cefuroxime 22.5 and 45 mg/mL was stable for 7 days at 3 degrees C. However, the drugs may need to be administered over less than 24 hours when the pump reservoir is worn on the patient's body.

Arginine↗

PubMed2001

Infusion pump performance with vertical displacement: effect of syringe pump and assembly type.

OBJECTIVE: To evaluate the effect of different infusion pump models on continuity of drug delivery during vertical displacement of syringe pumps. DESIGN: Zero-drug delivery time (ZDDT), retrograde aspiration volume, and infusion bolus were recorded using the same syringe in three different models of syringe pump after lowering and elevating the pump. Compliance of each infusion assembly was measured using the occlusion release technique at 38 mmHg. RESULTS: Lowering the pump by 50 cm at an infusion rate of 1 ml/h resulted in ZDDT values ranging from 2.78 +/- 0.29 to 5.99 +/- 1.09 min. Elevating the syringe pump to its original position caused infusion boluses between 44.1 +/- 3.2 and 77.1 +/- 5.1 microl. The results demonstrated that there are large differences between syringe pump models (F = 66.8, df = 2/33, p < 0.0001) and between pumps of the same model (F = 21.3, df = 1/34, p < 0.0001). A similar pattern was found in retrograde aspiration volume and infusion bolus. CONCLUSION: All tested pumps led to clinically relevant flow irregularities during vertical displacement of the syringe pump. Thus, vertical displacement of any syringe pump connected to an infusion line delivering highly potent drugs at low infusion rates should be avoided. The variability across syringe pumps indicates that syringe pump design remains an area of potential further improvement for reducing the risk of adverse patient events.

Analysis of Variance↗

PubMed1988

Testing computer-controlled infusion pumps by simulation.

The pharmacokinetic behavior of intravenous anesthetic drugs can be described by two- or three-compartment models. Rapid achievement and maintenance of steady plasma concentrations of these drugs requires a complicated delivery scheme, perhaps best controlled by a computer. The authors developed a method of simulating the performance of a computer-controlled infusion pump from the differential equations describing drug transfer between compartments. They also derived a mathematically simple and flexible approximate solution to these equations using Euler's numerical method. They incorporated this approximate solution into a computer-controlled infusion pump for intravenous drugs. They tested their pump by simulating the administration of fentanyl to a hypothetical patient whose fentanyl pharmacokinetics were described by a three-compartment model. The exact analytical solution served as the standard of comparison. The approximation technique, using a 15-s interval between model updates, had a maximum error of 0.35 ng.ml-1, and rapidly converged on the exact solution. The simulations revealed oscillations in the system. The authors suggest that such simulations be used to evaluate computer-controlled infusion pumps prior to clinical trials of these devices.

Anesthetics↗

PubMed1990

[Therapeutic effects by implantable infusion pump for hepatic malignant tumors].

Chemotherapy and chemoembolization using implantable infusion pump were performed in fifteen cases of hepatocellular carcinoma (HCC) and one case of cholangioma. The following results were obtained; (1) Complete response (CR) was obtained in two cases (12.5%) and partial response (PR) in three cases (18.8%) with HCC. (2) Tumor thrombus in the portal vein disappeared in two of four cases with HCC. (3) The followup period ranged from 54 to 768 days and administration from one to 33 times. These results suggest that good therapeutic effects and quality of life can be obtained by implantable drug delivery system.

Adult↗

PubMed2000

Reducing the risk of user error with infusion pumps.

Many of the adverse reports received by the Medical Devices Agency concern infusion pumps. Clinical governance aims to ensure that both employers and employees reduce the hazards related to device use. Full training is required to help staff avoid user errors.

Humans↗

PubMed1994

Patient-controlled analgesia using a miniature electrochemically driven infusion pump.

We describe a miniature electrochemically driven, wrist-worn infusion pump. Generation of gas by an electrolytic reaction compresses a reservoir containing medication and provides a predictable and controllable infusion rate. The pump was used for patient-controlled analgesia (PCA) in women who required analgesia after Caesarean section. It was accepted readily and was convenient for both patients and nursing staff. This portable system, using a novel motive force, has advantages of convenience over larger systems and has sophisticated features not present in existing small systems. It has potential as a routine PCA device and it may have uses in other situations requiring convenient infusion or intermittent injection in an ambulatory setting.

Analgesia, Obstetrical↗

PubMedDate not supplied

A universal air-bubble detector for infusion pumps.

A universal air-bubble detector has been developed for use with drip-controlled infusion pumps. Variations in the peak intensity of modulated infra-red radiation transmitted through the infusion line are used to detect the passage of an air gap or bubble. The device is unique in that bubbles in clear and opaque fluids are detected in most of the standard solution administration sets. The bubble detector is small and light and is an inexpensive way of upgrading an infusion pump to provide an air-in-line alarm facility.

Embolism, Air↗

PubMed1977

Pharmacy-based infusion pump program.

A pharmacy-based program for the procurement, allocation and maintenance of infusion pumps is presented. Policies and procedures for various facets of the program, job descriptions for personnel, and training programs for pharmacy and nursing personnel are discussed. A plan for quality assurance, including in-use accuracy testing, preventive maintenance, repairs, and complete record keeping and documentation is outlined. Various aspects of equipment selection, economic justification of equipment, and revenue generation potential are addressed. It is concluded that an infusion pump program can be operated successfully by the hospital pharmacy department.

Economics, Hospital↗

PubMed1995

Microbiologic and economic evaluation of multiday infusion pumps for control of cancer pain.

OBJECTIVE: To confirm established methods and assess bacteriologic and economic consequences for using external portable infusion pumps for the control of cancer pain in the home environment. METHODS: Sixteen patients with terminal cancer were treated subcutaneously or epidurally with continuous infusions of morphine using external multiday infusion pumps. Bacterial growth in the pumps and costs linked to use in a hospital or at home were assessed. Patients treats at home received 2 pumps weekly, marked A for first use and B for second use, patients treated in the hospital received 1 pump every fourth day. After use, the remaining solution in the reservoirs was examined for microbiologic contents. RESULTS: A total of 317 pumps was used and 211 pumps were cultured (66.6%). Growth was found in 16 (7.6%) (Staphylococcus albus in 13, Escherichia coli 2, and Candida albicans in 1 pump). There were no significant differences in contamination between pumps used in the hospital or A or B pumps used at home. No patient showed any signs of clinical infection associated with the infusions. The use multiday devices led to overall cost savings of $284,553 (2.1 million SKr) and a maximum cost savings potential of $379,404 (2.8 million SKr). CONCLUSIONS: The multiday pump system used and the methods established were found to be safe and bacteriologically satisfactory, as well as cost-effective for both hospital and home use.

Adult↗