Intravenous Pump Research Articles

Review of pharmacokinetic models for target controlled infusions in anesthesia

Intravenous injection of anesthetic drugs dates back to the 17 th Century when opium and chloral hydrate have been injected intravenously. It was not until the 1930s intravenous anesthesia became popular with the invention of barbiturates.Early intravenous anesthetic agents such as barbiturates were ideal for induction of anesthesia, but not suitable for maintenance of anesthesia. Most of these drugs accumulated significantly with increasing durations of infusion and also resulted in cardiorespiratory depression. The invention of propofol and shorter acting opioid analgesics such as remifentanil and alfentanil have revolutionized intravenous anesthesia. The rapid onset and offset of these drugs lends itself to being suitable agents for maintenance of anesthesia over prolonged periods of time. 1,2 Detailed understanding of the pharmacokinetics of propofol and remifentanil, combined with technological advances in intravenous pumps capable of accurate delivery of drugs have resulted in great development of the field of total intravenous anesthesia and target controlled infusions. I would like to discuss, in this article, the pharmacokinetics and pharmacokinetic models behind these intravenous infusion pumps.

Design and validation of a diaphragm pump for pediatric CRRT during ECMO

Children requiring artificial heart-lung support through extracorporeal membrane oxygenation (ECMO) are at increased risk of developing acute kidney injury (AKI). Continuous renal replacement therapy (CRRT) is the preferred method of treatment in pediatric AKI patients. CRRT devices are noted to provide inaccurate fluid balance (FB) when operated under low flow rates seen in children. We present the design and validation of a novel pump concept to provide accurate pediatric CRRT during ECMO. A diaphragm pump was prototyped with a working stroke volume (SV) of 7 mL. Fluid transport occurs by periodic expansion and contraction of a flexible membrane due to pressure fluctuations of hydraulic fluid contained below its surface. Comparison of intravenous (IV) pumps to the diaphragm pump was conducted in vitro across the range of pressures observed during CRRT in ECMO. The pump was integrated into a CRRT circuit parallel with ECMO and FB accuracy was evaluated. The pump design improved efficiency of fluid transport, with flow rate errors as low as 1-5 ml/hr as compared to IV pumps (15-50 ml/hr). The SV of IV pumps increased with source pressure in a nearly linear manner compared to the minimal variation produced by the diaphragm pump. Inclusion of the diaphragm pump in a conventional CRRT circuit with ECMO improved the FB accuracy. A novel diaphragm pump concept has been presented for providing CRRT during ECMO in the pediatric population. Improvement of the pump accuracy compared to currently used CRRT pumps was demonstrated via in vitro testing.

Using smart pumps to understand and evaluate clinician practice patterns to ensure patient safety.

Safety software installed on intravenous (IV) infusion pumps has been shown to positively impact the quality of patient care through avoidance of medication errors. The data derived from the use of smart pumps are often overlooked, although these data provide helpful insight into the delivery of quality patient care. The objectives of this report are to describe the value of implementing IV infusion safety software and analyzing the data and reports generated by this system. Based on experience at the Carolinas HealthCare System (CHS), executive score cards provide an aggregate view of compliance rate, number of alerts, overrides, and edits. The report of serious errors averted (ie, critical catches) supplies the location, date, and time of the critical catch, thereby enabling management to pinpoint the end-user for educational purposes. By examining the number of critical catches, a return on investment may be calculated. Assuming 3,328 of these events each year, an estimated cost avoidance would be $29,120,000 per year for CHS. Other reports allow benchmarking between institutions. A review of the data about medication safety across CHS has helped garner support for a medication safety officer position with the goal of ultimately creating a safer environment for the patient.

The Essentials of Medical Device Inventory Tracking

As the cost and complexity of medical equipment increase, healthcare technology management (HTM) professionals find themselves more and more in need of tools to track inventory maintenance and location, particularly for commonly used portable devices. However, the computerized maintenance management systems widely used in hospitals are not designed to help locate moveable devices, and many healthcare facilities do not make use of tracking technology that has been available for many years. This article reviews some of the central issues in medical inventory management and the more common challenges HTM professionals face. Several examples of successful tracking system implementation also are discussed.

Critical Care Transportation by Paramedics: A Cross-sectional Survey

ObjectiveThe purpose of this study was to gather data from paramedics practicing in the critical care transport setting to guide development of the education, training, and clinical practices for certification as a critical care paramedic. MethodsA paper survey of 1991 randomly selected nationally registered (NREMT) paramedics was conducted. Nine paramedics with residences in small US Pacific Island territories were not included in the survey. ResultsWe received 610 responses (30.6%). Respondents that stated that they provided critical care transport services reported using pediatric skills and equipment the most and intracranial pressure monitoring the least. Paramedics served as the primary provider for pediatric patients (72.5%), 12-lead electrocardiogram (66.3%), intravenous infusion pump (76.7%), mechanical ventilator (66.9%), central line management (63.1%), and chest tube management (63.3%). Paramedics served in a team member capacity most often with neonatal isolette (71.8%), intra-aortic balloon pump (79.2%), and ICP monitoring (64.9%). The majority provided ground critical care transport (249) compared to 44 rotor-wing and 6 fixed-wing. Sixteen respondents reported serving as primary providers on combinations of ground, rotor-, and fixed-wing services. ConclusionsParamedics reported being the primary provider on the critical care transport team and performing skills while using equipment and administering medications that exceeded their education and training as paramedic and, at times, without the benefit of any additional education or training. National appreciation of this reality should spur development of standardized education, licensing or certification, and continuing education to prepare paramedics for their role as critical care medical providers.

Outcomes of Discharge after Elective Laparoscopic Colorectal Surgery with Transversus Abdominis Plane Blocks and Enhanced Recovery Pathway

Enhanced recovery pathways (ERP) have been well shown to permit early recovery and discharge. The addition of a transversus abdominis plane (TAP) block to a standard pathway may improve these outcomes. We evaluated the addition of a TAP block to an established ERP. One hundred consecutive patients underwent elective laparoscopic colectomy by a single surgeon. A laparoscopic-guided TAP block was administered at the end of the procedure. Patients followed an established ERP that included overnight intravenous patient-controlled analgesia pump, diet and oral analgesia on postoperative day 1, and standardized discharge criteria. The mean age was 60.5 years (range 15 to 92 years), 62 patients were female, and mean body mass index was 28.4 kg/m(2) (range 18 to 46 kg/m(2)). Median hospital stay was 2 days and mean length of stay was 2.9 days. Patients were grouped and analyzed by the day of discharge. Sixty-two percent of patients were discharged within 48 hours (27 on day 1; 35 on day 2). There was no mortality. Only 1 patient discharged within 48 hours of surgery developed a complication. Two patients were readmitted, both of whom were discharged more than 48 hours after surgery. Transversus abdominis plane blocks with an ERP contribute to a short length of stay after laparoscopic colectomy, without increasing complication or readmission rates.

Using Higher Doses to Compensate for Tubing Residuals in Extended-Infusion Piperacillin-Tazobactam

To mathematically assess drug losses due to infusion line residuals and evaluate methods to compensate for drug loss due to residual volumes in intravenous pump tubing. Literature was accessed through Ovid MEDLINE (1996-February 2013), using combinations of the search terms tubing residuals, residual volume, residual medication, intravenous infusions, intravenous injections, piperacillin, piperacillin-tazobactam, β-lactams, equipment design, infusion pumps, extended infusion, extended administration, and prolonged infusion. In addition, select reference citations from publications identified were reviewed. All articles that involved extended-infusion piperacillin-tazobactam implementation strategies were included in the review. Infusion pump characteristics and tubing residuals can affect extended-infusion piperacillin-tazobactam dosing strategies. Two studies addressing tubing residuals were identified. Both studies recommended increasing infusion volumes to compensate for tubing residuals. One study also recommended decreasing infusion-line dead space by using alternative infusion pump systems. Study calculations suggest that higher doses of piperacillin-tazobactam may be used to account for medication left in tubing residuals if alternative infusion pump systems cannot be obtained, and increased infusion volumes are not an option. Extended-infusion piperacillin-tazobactam has been used as a method of maximizing pharmacodynamic target attainment. Use of higher doses of piperacillin-tazobactam may be a reasonable method to compensate for drug loss due to residual volumes in large-bore intravenous pump tubing.

Retrograde Chemoinfusion of the Upper Tract: Standardizing the Delivery of Topical Adjuvant Therapy

Upper tract urothelial carcinoma has a high recurrence rate after endoscopic treatment. Immediate postoperative topical chemotherapy may reduce recurrences, as in bladder cancer. A reliable delivery method to the upper tract does not exist. We propose a new infusion pump technology for the delivery of topical chemotherapeutic agents to the upper tract. With the patient under general anesthesia, contrast is infused into the upper collecting system using a standard infusion pump. An optimal infusion rate is determined based on fluoroscopic filling of the upper collecting system and transduced intrapelvic pressures. Using this rate, the infusion is repeated postoperatively with the chemotherapeutic agent. We report one case of successful execution to demonstrate proof of concept. We are the first to describe retrograde upper tract chemotherapeutic irrigation with an intravenous pump. This technique may facilitate and standardize the delivery of intracavitary chemotherapy. Further investigation to determine whether it translates into improved safety and/or efficacy is warranted.

Quality-improvement analytics for intravenous infusion pumps

The implementation of a smart-pump continuous quality-improvement (CQI) program across a large health system is described, with an emphasis on key metrics for outcomes analyses and program refinement. Three years ago, the University of Pittsburgh Medical Center health system launched a CQI initiative to help ensure the safe use of 6000 smart pumps in its 14 inpatient facilities. A centralized team led by pharmacists is responsible for the retrieval and interpretation of smart-pump data, which is continuously transmitted to a main server. CQI findings are regularly posted on the health system's interdisciplinary intranet. Monitored metrics include rates of compliance with preprogrammed infusion limits, the top 20 drugs involved in alerts, drugs associated with alert-override rates of ≥90%, numbers of alerts by infusion type, nurse responses to alerts, and alert rate per drug library update. Based on the collected CQI data and site-specific requests, four systemwide updates of the smart-pump drug library were performed during the first 18 months of the program, reducing "nuisance alerts" by about 10% per update cycle and enabling targeted interventions to reduce rapid-infusion errors, other adverse drug events (ADEs), and pump-programming workarounds. Over one 12-month period, bedside alerts prompted nurses to reprogram or cancel continuous infusions an average of 400 times per month, potentially averting i.v. medication ADEs. A smart-pump CQI program is an effective tool for enhancing the safety of i.v. medication administration. The ongoing refinement of the drug library through the development and implementation of key interventions promotes the growth and sustainability of the smart-pump initiative systemwide.

Organizational and Technological Correlates of Nurses’ Trust in a Smart Intravenous Pump

The aim of this study was to understand technology and system characteristics that contribute to nurses' ratings of trust in a smart intravenous pump. Nurses' trust in new technologies can influence how technologies are used. Trust in technology is defined as a person's belief that a technology will not fail them. Potential outcomes of trust in technology are appropriate trust, overtrust, distrust, and mistrust. Trust in technology is also related to several use-specific outcomes, including appropriate use and inappropriate use such as overreliance, disuse or rejection, or misuse. Understanding trust in relation to outcomes can contribute to designs that facilitate appropriate trust in new technologies. A survey was completed by 391 nurses a year after the implementation of a new smart intravenous pump. The survey assessed trust in the intravenous pump and other elements of the sociotechnical system, individual characteristics, technology characteristics, and organizational characteristics. Results show that perceptions of usefulness, safety, ease of use, and usability are related to ratings of trust in smart intravenous pumps. Other work systemfactors such as perception of work environment, age, experience, quality of work, and perception of work performance are also related to ratings of trust. Nurses' trust in smart intravenous pumps is influenced by both characteristics of the technology and the sociotechnical system. Findings from this research have implications for the design of future smart intravenous pumps and health systems. Recommendations for appropriately trustworthy smart intravenous pumps are discussed. Findings also have implications for how trust in health technologies can be measured and conceptualized in complex sociotechnical systems.

The ON-Q pain management system in elective gynecology oncologic surgery: Management of postoperative surgical site pain compared to intravenous patient-controlled analgesia

ObjectiveThe goal of this study was to compare postoperative surgical site pain in gynecologic cancer patients who underwent elective extended lower midline laparotomy and managed their pain with either the ON-Q pain management system (surgical incision site pain relief system, ON-Q pump) or an intravenous patient-controlled analgesia pump (IV PCA).MethodsTwenty gynecologic cancer patients who underwent elective extended lower midline laparotomy were divided into two groups. One group received a 72-hour continuous wound perfusion of the local anesthetic ropivacaine (0.5%, study group) into the supraperitoneal layer of the abdominal incision through the ON-Q pump. The other group received intravenous infusion pump of patient-controlled analgesia (fentanyl citrate 20 mg/mL · kg+ondansetron hydrochloride 16 mg/8 mL+normal saline). Postoperative pain was assessed immediately and at 6, 24, 48, 72, and 96 hours after surgery using the visual analogue scale.ResultsPostoperative surgical site pain scores at 24, 48, and 72 hours after surgery were lower in the ON-Q group than the IV PCA group. Pain scores at 24 hours and 48 hours after surgery were significantly different between the two groups (P=0.023, P<0.001). Overall painkiller administration was higher in the ON-Q group but this difference was not statistically significant (5.1 vs. 4.3, P=0.481).ConclusionThis study revealed that the ON-Q pain management system is a more effective approach than IV PCA for acute postoperative surgical site pain relief after extended lower midline laparotomy in gynecologic cancer patients.

Equipment Used for Safe Mobilization of the ICU Patient

Mobilizing critically ill patients in the intensive care unit requires careful planning and attention to detail. The risks involved in mobilizing these patients include dislodging equipment, injury to the patient, injury to the caregivers, and physiologic decompensation of the patient. To carry out the activity safely, the therapist and the nurse must identify risks and have contingency plans in place for; physically supporting the patient should they become unstable during the activity, for returning the patient to bed quickly if needed; and for providing increased oxygen/ventilator support if needed. If the activity involves leaving the bedside area, there must be a method to transport monitors, oxygen, and intravenous pumps. There are simple pieces of equipment, already available in the intensive care unit, which can be used to accomplish the mobility goals safely in all patient populations. This article explores how standard hospital equipment can be used to improve patient activity and performance and minimize risk.

Temperature Variations around Medication Cassette and Carry Bag in Routine Use of Epoprostenol Administration in Healthy Volunteers

BackgroundAccording to several treatment guidelines, epoprostenol is an important treatment option for pulmonary arterial hypertension. However, the pharmacokinetic characteristics and poor stability of epoprostenol at room temperature make its administration challenging. We therefore studied temperature fluctuations between the drug administration cassette and atmosphere to promote the safe use of epoprostenol.Methods and FindingsFive healthy volunteers carried a portable intravenous infusion pump attached to a medication cassette containing saline in a bag during their ordinary activities over 16 days during which the mean atmospheric temperature was 29.6±1.5°C. The temperature around the medication cassette was not less than 25°C on any occasion, and the mean period over 24 h during which the temperature around the cassette exceeded 35°C and 40°C was 96.9±156.4 min and 24.4±77.3 min, respectively. Significant correlations were observed between the temperatures outside the bag and around the cassette, as well as between temperatures around the cassette and of the saline solution in the cassette (r = 0.9258 and 0.8276, respectively). There were no differences in the temperatures outside the bag or around the cassette with respect to the bag material.ConclusionsTemperatures around a medication cassette and outside the bag containing the medication increase with sunlight exposure. The temperature around cassettes used for administering epoprostenol must therefore be kept low for as long as possible during hot summer conditions to maintain the drug stability.

Enhancing Nursing Education with Remote Access Laboratories

Abstractâ??Given the vast coverage area and dispersed population centres in which nursing professionals practice in Australia, Remote Access Laboratory (RAL) based learning activities would seem to be an ideal match. However while they are commonplace in engineering faculties; in other disciplines such activities are not widely used. This may well be due to the intricacies of these practicals not being as straightforward and readily reproducible as typical physics or science experiments. &#x0D; In our chosen case, the safe practice of intravenous pump driver operations and related clinical reasoning skills are important components for the training of both registered nurses and nursing students. The aim of this research project is to develop and trial remote access technologies that enable nursing students to test their knowledge, skills, and clinical reasoning with intravenous infusion pump drivers. This has been possible by extending the concept of RAL from a physical and tangible experiment, to more conceptual experimentation in any form conducted remotely. In such a context clinical reasoning becomes possible. &#x0D; This paper discusses a prototype system that has been built with collaborative input from the Faculty of Engineering and Surveying and the Department of Nursing and Midwifery. An initial evaluation with a group of nursing students has been completed to assess if such activities can assist with the training of student nurses. Previous work has identified the need to scaffold learning activities that rely on RAL technology; the key conclusion in this paper is that in the context of nursing this has to be taken a step further. RAL activities here require contextualisation to become an effective learning tool.

Exploration of duration of intravenous analgesia pump after gynecological surgery

Objective To evaluate the influence of the duration of patient-controlled intravenous analgesia (PCIA)on pain and gastrointestinal function after gynecological abdominal surgery.Methods Patients who received gynecological abdominal surgery were divided into 3 groups according to using time of PCIA for 24 hours,48 hours,72 hours.There were 30 cases in each group.Pain intensity,gastrointestinal peristalsis time,anal exhaust time,getting out-of-bed time,voluntary micturition time,nausea and vomiting were compared among three groups after stopping PCIA.Results There were no significant differences in VAS score among three groups at each time point.There were no significant differences in voluntary micturition time among three groups.The anal exhaust time,getting out-of-bed time in 24-hour group were earlier than those of the other two groups,the differences were significant; The nausea and vomiting in 24-hour group were lower than the other two groups,the difference was significant.Conclusions The application of PCIA can effectively relieve acute pain 24 hours after surgery,but the effect was not obvious on pain induced by activities after 24 hours.But the side effects induced by analgesia pump(anesthetic)still work,such as vomiting,long duration of discharge,activity inconvenience.So PCIA should be stopped at right time in order to reduce complications and facilitate for recovery of patients after the surgery. Key words: Gynecological abdominal surgery; Pain control; Duration; Adverse reaction

Intraoperative placement of transnasal small intestinal feeding tube during the surgery in 5 cases with high position intestinal obstruction and postoperative feeding

To explore the value of employing the small intestinal feeding tube in treating high position intestinal obstruction of newborn infant. Five newborn infants (3 males and 2 females; 1 premature infant and 4 fully-mature infants; 2 had membranous atresia of duodenum, 1 had annular pancreas, and 2 had proximal small intestine atresia; 1 infant had malrotation). The duodenal membrane-like atresia and the blind-end of small intestine were removed and intestinal anastomosis was performed, which was combined with intestinal malrotation removal. Before the intestinal anastomosis surgery, the anesthetist inserted via nose a 6Fr small intestinal ED tube, made by CREATE MEDIC CO LTD of Japan[ the State Food and Drug Administration-instrument (Im.) 2007-NO.2661620]. Twenty-four hours after surgery, abdominal X-ray plain film was taken and patients were fed with syrup; 48 hours later, formula milk was pumped or lactose-free milk amino acids were given by intravenous injection pump through the feeding tube. The amount of milk and fluids was gradually increased to normal amount according to the condition. In initial 3 days the intravenous nutrition was given and one week after operation, the infants were fed through mouth in addition to pumping milk through the tube and stopped infusion. Ten to 22 days after operation, the tube was removed and the infant patients were discharged. All the five infants showed that the feeding through the nutrition tube was accomplished and the time of venous nutrition was reduced and fistula operation was avoided. None of the infants on question was off the tube and no jaundice exacerbation was found and the liver function was also found normal. At the very beginning, the tube was occasionally blocked by milk vale in one infant and after 0.9% sodium chloride solution flushing patency restored. After that, the feeding tube was washed once with warm water after feeding. In one infant vomiting occurred due to enough oral milk. The photograph of upper gastrointestine did not show anastomomotic stricture or fistula, or intestinal obstruction. After pulling out the tube, the symptoms disappeared and then the patient was discharged. One child was found to have diarrhea with no lactose nutrition liquid and given compound lactic bacteria preparations for oral administration, the symptom disappeared. In the 5 cases, the shortest hospital stay was 10 days and the longest was 22 days, the average stay was 16 days. Three to 5 days after operation the weight restored to birth weight, the weight had increased, when discharged, to an average of 5.5 g (kg·d). The small intestinal feeding tube was very effective for the postoperative nutrition maintenance of high position intestinal obstruction in newborn infants.

Lithium Battery Fires: Implications for Air Medical Transport

Lithium-ion batteries provide more power and longer life to electronic medical devices, with the benefits of reduced size and weight. It is no wonder medical device manufacturers are designing these batteries into their products. Lithium batteries are found in cell phones, electronic tablets, computers, and portable medical devices such as ventilators, intravenous pumps, pacemakers, incubators, and ventricular assist devices. Yet, if improperly handled, lithium batteries can pose a serious fire threat to air medical transport personnel. Specifically, this article discusses how lithium-ion batteries work, the fire danger associated with them, preventive measures to reduce the likelihood of a lithium battery fire, and emergency procedures that should be performed in that event.

Subcutaneous implantation of a new intravenous pump system for prostacyclin treatment in patients with pulmonary arterial hypertension

BackgroundIntravenous prostacyclin treatment is a well recognized option in patients suffering from pulmonary arterial hypertension (PAH), and remains the gold standard of treatment. However, intravenous prostacyclin treatment involves several limitations, because the available battery-driven pump systems carry the risk of line infections, catheter-related embolisms, thrombosis, and delivery system malfunctions. Case ReportWe report for the first time, to the best of our knowledge, on the safe transition procedure from subcutaneous to intravenous treprostinil in a 74-year-old woman suffering from severe PAH (New York Heart Association functional class III), using a new implantable, gas-driven, intravenous pump device (LenusPro, Tricumed/OMT, Frittlingen, Germany). ConclusionsThis implantable pump system may overcome the well-known limitations and risks of commonly used delivery systems, and thus may provide a new option for continuous intravenous prostacyclin treatment in patients with PAH.

Effect of propofol on stress response and immune balance in patients with severe trauma hemorrhage after fluid resuscitation

Objective To explore the stress response and immune balance in patients with severe trauma hemorrhage after fluid resuscitation and to clarify the clinical effect of Propofol administered with continuous intravenous infusion pump on it.Methods With prospective,randomized and control analysis,54 patients treated with fluid resuscitation following severe trauma hemorrhage admitted from October 1st,2008 to December 1st,2009 were studied.Another 20 healthy volunteers were enrolled as control group (C group). Patients were randomly divided into:conventional treatment group (R group,n =27 ) and conventional therapy combined with propofol treatment ( P group,n =27) as per gender,age,ISS score,estimated blood loss four factors and the principle of minimum distribution imbalance index.HR,MAP,the levels of stress hormones [ norepinephrine (NE),cortisol (Cor) ],immune function ( T lymphocyte subsets Th1/Th2) and other biomarkers were observed.Mortality within 28 d between R group and P group was compared.ANOVA was used for the comparison of biomarkers,and independent samples t test was employed to compare variables between the two groups. Results Plasma cortisol (Cor),norepinephrine (NE),alanine aminotransferase (ALT),creatinine ( Cr),blood glucose,and Th1 and Th2 lymphocytes in patients were significantly higher than those in healthy volunteers of group C (P ＜0.01 ),and Th1/Th2 was significantly lower than those in healthy volunteers of C group (P =0.001 ).The ALT (48 h),Glu (6 h),NE (24 h and 48 h) and Cor (6 h and 24 h) of patients in P group were lower than those in R group ( P ＜0.05 ),and Th1 and Th2 were lower than those in R group at different intervals ( Th1:24h P =0.028,48 hP=0.002 ; Th2:6 h P=0.033,24 h P=0.007,48 h P=0.009),and Th1/Th2 ratio (48 h) was significantly higher in P group than that in R group (P =0.028),but there was no significant difference in mortality within 28d between the two groups. Conclusions Strong stress response,immune suppression and organ dysfunction can occur in the early stages of severe trauma hemorrhage after fluid resuscitation.Propofol can inhibit excessive stress response,modulate the immune balance and protect the important organs in those exsanguination patients from severe trauma. Key words: Trauma hemorrhage; Fluid resuscitation; Propofol; Stress response; Immune balance; T lymphocyte subsets; Norepinephrine; Cortisol

Making drug delivery in the ICU safer: the implementation of advanced computerised intravenous infusion pumps

Drug administration errors account for approximately 78% of all medical errors occurring in ICUs [1,2]. The aim of this project was to introduce advanced computerised infusion pumps with in-built drug safety software, so-called smart pumps, in the ICU to facilitate safer drug administration.