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At least 19 recordsLinked to original sources
PubMed1988

Toxic shock syndrome from Staphylococcus aureus infection at insulin pump infusion sites. Report of two cases.

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.

Abscess↗
PubMedDate not supplied

Accuracy of intravenous infusion pumps in continuous renal replacement therapies.

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.

Equipment Design↗
PubMed1989

Decreased flow accuracy from volumetric infusion pumps.

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.

Calibration↗
PubMed1992

Algorithms to rapidly achieve and maintain stable drug concentrations at the site of drug effect with a computer-controlled infusion pump.

Computer-controlled infusion pumps incorporating an internal model of drug pharmacokinetics can rapidly achieve and maintain constant drug concentrations in the plasma. Although these pumps offer more accurate titration of intravenous drugs than is possible with simple boluses or constant rate infusions, the choice of the plasma as the target site is arbitrary. The plasma is not the site of drug effect for most drugs. This manuscript describes two algorithms for calculation of the infusion rates necessary for a computer-controlled infusion pump to rapidly achieve, and then maintain, the desired target concentration at the site of drug effect rather than in the plasma.

Animals↗
PubMed1978

Comparison of selected intravenous infusion pumps and rate regulators.

Selected intravenous infusion pumps and rate regulators were compared to determine the relative advantages and disadvantages and to formulate guidelines for purchase of these devices. Three basic types of devices were studied: infusion rate regulators, nonvolumetric (peristaltic) infusion pumps and volumetric infusion pumps. Simple syringe-type infusion pumps were not studied. After use and close study of the devices, both in the laboratory and in the clinical area, desirable features were identified. Ideally, the infusion device should operate over a wide rate range, use standard administration sets, be easy to assemble and service, have an internal battery of good power for several hours, have appropriate malfunction alarms, have an automatic keep-open device in alarm situations, be accurate under a variety of situations, and be easy for the nurse to understand and operate. All devices tested were accurate within the limits claimed by the manufacturer, although a couple of models have features which can cause gross volume errors. Overall evaluation resulted in preference of some devices over others. Cost of infusion devices and administration sets can vary widely, and this should be a factor in the final choice of intravenous infusion equipment.

Evaluation Studies as Topic↗
PubMed1992

Accuracy of drug infusion pumps under computer control.

Prototype systems implementing algorithms for automated drug infusions are typically constructed by coupling a microcomputer to a drug infusion pump through a serial communications interface. Infusion rates demanded of the infusion pump in many computed-controlled drug delivery applications are made to change at intervals much shorter than those encountered under routine clinical use. Because the ability of infusion pumps to maintain accurate flow rates during high frequency rate changes has not been documented, the purpose of this study was to validate the volumetric accuracy of three commercially available infusion pumps operating in a demanding computer-controlled application. In independent 2-h evaluations, the infusion rate demanded of each pump changed as often as every 5, 10, or 15 s using an algorithm for computer-controlled pharmacokinetic model-driven intravenous infusion. Accuracy of the infusion devices was determined gravimetrically. At all measurement times, each of the infusion pumps was accurate to within approximately +/- 5% of the expected volumetric output under each of the infusion rate intervals tested. Flow rate accuracy of +/- 5% is equal to the nominal expected accuracy of these infusion pumps in conventional clinical use.

Algorithms↗
PubMed1992

Plasma concentration clamping in the rat using a computer-controlled infusion pump.

We have developed a computer-controlled infusion pump to achieve rapidly and then maintain stable plasma thiopental concentrations in rats. Initially we derived the parameters of a triexponential pharmacokinetic model for thiopental, administered as a brief infusion to 10 rats, using nonlinear regression and standard pharmacokinetic equations. These parameters were incorporated into the pharmacokinetic model of a computer-controlled infusion pump. In a second group of animals this device was used to maintain three consecutive target thiopental concentrations ranging from 5 to 100 micrograms/ml in a stepwise fashion. Arterial blood gases were kept normal through controlled ventilation when necessary. The plasma thiopental concentrations in this second group of animals were generally higher than the target concentrations. The bias in pump performance (median prediction error) was +25%, and the inaccuracy (median absolute prediction error) was 26%. We fit the parameters of a three-compartment model to the plasma thiopental concentrations observed in the second group of animals. This produced a second set of thiopental pharmacokinetic parameters with the unique characteristic of having been derived from a computer controlled infusion study. These parameters were tested prospectively with a computer-controlled infusion pump in a third group of animals. This second set of thiopental pharmacokinetic parameters performed better, with a median prediction error of 0% and a median absolute prediction error of 15%. This study shows that it is possible to achieve rapidly and maintain steady plasma thiopental concentrations in the rat. Our results suggest that it is feasible to derive robust pharmacokinetic parameters from unusual drug dosing approaches, such as employed by a computer-controlled infusion pump.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1979

Limitations of a portable infusion pump in ambulatory patients receiving continuous infusions of anticancer drugs.

The delivery of continuous iv bleomycin and 5-fluorouracil to nine ambulatory cancer patients was studied using a novel disposable portable infusion pump, the Ar/Med Infusor. Although the chemotherapy was satisfactorily delivered, there were significant mechanical problems, including variable flow rates and substantial drug cartridge failure. Most therapy courses were finished within 10% of the projected termination time. Serious venous complications did not occur. While further exploration of various devices for outpatient continuous iv therapy is recommended, we believe that technical improvements are needed for the Ar/Med Infusor.

Ambulatory Care↗
PubMedDate not supplied

A computerized system to evaluate volumetric infusion pumps.

A computerized system was developed to examine the performance characteristics of infusion pumps. This system collects solution delivered by an infusion pump through an intravenous needle into a collection vessel. Using an inductor-type weight sensor and a semiconductor type of strain-gauge pressure sensor, the weight of the collection vessel and the pressure at the needle were monitored over a specific period (the sampling time), and changes in pressure, flow rate, and volume of fluid were calculated. This system was applied to five volumetric infusion pumps with different pumping mechanisms. Test conditions involved two different solutions, two sizes of needle gauge, and seven flow rates, for a total of 28 measurements per pump. Results showed considerable variation in the infusion pumps' performances based on differences in these indices. Use of an inductance weight sensor as a means to evaluate gravimetric performance appears to be an improvement over conventional methods, which use analytical balances for data generation. The results indicate that this system will be useful in evaluating the performances of commercially available infusion pumps as well as those in development.

Computer Graphics↗
PubMed1989

Stability of fluorouracil administered through four portable infusion pumps.

The stability of fluorouracil in four portable infusion pumps under simulated infusion conditions was studied. Three commercially available fluorouracil aqueous solutions (50 mg/mL) were used. Samples adjusted to six pH levels were examined for precipitate. Drug reservoirs of four different portable infusion pumps were filled with 70 mL of each fluorouracil injection. Under conditions simulating actual use, the reservoirs were attached to the pumps and the solutions were pumped at a rate of 10 mL/24 hours over a seven-day period at 25 degrees C and 37 degrees C. Samples at the distal end of the extension tubing were collected hourly for the first 10 hours and at 12-hour intervals thereafter. Visual observations and pH determinations were made immediately. Drug concentrations were determined by reverse-phase high-performance liquid chromatography. Diethylhexylphthalate (DEHP) concentrations (the result of leaching from the plastic tubing and container) were determined by gas chromatography. In the pH study, precipitate appeared immediately in all fluorouracil injections below pH 8.52; precipitate was observed after two to four hours at pH 8.60-8.68. Under simulated infusion conditions, no apparent changes in concentration or pH were detected with any of the brands of drugs or portable infusion devices. At 25 degrees C, a fine white precipitate was observed in the extension tubing of all devices with the Roche brand of fluorouracil 48 to 96 hours after the pumping cycle began. The amount of DEHP leached from the drug reservoirs over the seven-day period was less than 1 ppm at both temperatures. All tested brands of fluorouracil injection were found to be stable under simulated infusion conditions over a seven-day period at 37 degrees C.

Chemistry, Pharmaceutical↗
PubMed1990

In vitro and in vivo evaluation of platelet transfusions administered through an electromechanical infusion pump.

The authors evaluated two platelet infusion pump systems, the Abbott Lifecare 5000 and the Omniflow 4000, for evidence of in vitro platelet damage and in vivo platelet recovery. When compared with gravity infusion, there was no significant difference in levels of LDH discharge, beta-thromboglobulin release, cell counts, or morphology score after platelet concentrates were infused through these pumps. When the pumps were compared to gravity infusion in thrombocytopenic oncology patients, no differences were noted in platelet-corrected count increments at 1-4 hours or 12-24 hours post-transfusion. The authors conclude that these infusion systems do not significantly injure or activate platelets and that they are efficacious for transfusing platelet concentrates to thrombocytopenic patients. These infusion pumps may be of clinical benefit to pediatric or adult patients with a history of prior transfusion reactions, when precise control of the rate and volume of platelet transfusion is desired.

Blood Platelets↗
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↗
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↗
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↗
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↗