Use Of Infusion Pumps Research Articles

Rhabdomyolysis Following Shoulder Arthroscopy

Abstract Fluid extravasation is not uncommon after shoulder arthroscopy. We report a case of massive fluid extravasation that resulted in rhabdomyolysis and renal shutdown following routine shoulder arthroscopic surgery. Compartment pressures in the deltoid, supraspinatus, and infraspinatus were normal. Magnetic resonance imaging of the shoulder revealed extensive subcutaneous edema and high-signal changes in the entire deltoid muscle. The patient made an uneventful recovery with adequate supportive treatment and renal dialysis. Repeat imaging studies 3 months later revealed complete restoration to normal of the deltoid muscle. In addition to extensive fluid extravasation in this patient, the use of nonsteroidal anti-inflammatory medication, the development of a transient allergic reaction to a prescribed antibiotic, and the inclusion of epinephrine in the infusion fluid may have collectively contributed to rhabdomyolysis. We recommend that the use of infusion pumps should be limited to the shortest time possible, and that gravity inflow should be used as much as possible. Inflow should preferably occur through the arthroscope itself, rather than through a separate portal cannula, which may dislodge, inadvertently causing infusion of high-pressure fluid into the surrounding tissue.

Evaluation of a balloon constant rate infusion system for treatment of septic arthritis, septic tenosynovitis, and contaminated synovial wounds: 23 cases (2002–2005)

OBJECTIVE-To determine clinical findings and outcome in horses treated by means of a balloon constant rate infusion system. DESIGN-Retrospective case series. ANIMALS-23 horses. PROCEDURES-Medical records of horses examined at The Ohio State University veterinary teaching hospital from 2002 to 2005 that had septic arthritis, septic tenosynovitis, or penetration of a synovial structure and in which treatment involved a balloon constant rate infusion system were searched. Information pertaining to signalment, history, physical examination findings, clinicopathologic data, treatment, and duration of hospitalization was recorded. RESULTS-Mean+/- SD duration of hospitalization was 11.5+/-5.26 days. No correlation between duration of clinical signs and duration of hospitalization or duration of infusion pump use was detected, but correlations between WBC count and duration of hospitalization and WBC and duration of infusion-pump use were observed. All horses survived to discharge. Follow-up information was obtained on 17 horses, 16 of which were alive at the time of follow-up. Twelve of 13 horses for which followup information was available for at least 5 months were alive 5 months or longer after discharge. Thirteen of the 16 horses alive at follow-up were reported by owners as not lame, whereas the remaining 3 were mildly lame or intermittently moderately lame or had developed angular limb deformity in the contralateral limb. CONCLUSIONS AND CLINICAL RELEVANCE-Balloon constant rate infusion systems may be used effectively in treatment of septic arthritis, septic tenosynovitis, and contaminated synovial wounds. Clinical response and long-term outcome appeared to be comparable to results obtained with other techniques.

Medication Errors Involving Wrong Administration Technique

Wrong administration technique has consistently been one of the most harmful types of medication error in health systems participating in MEDMARX. Administration technique errors typically are made by nurses administering medications on the patient care unit, although errors in administration technique also occur in other phases of medication use and involve other health care personnel and locations. The most commonly reported causes of error have been performance deficit, failure to follow procedures or protocols, and knowledge deficit. Educating and training health care personnel on proper administration techniques and use of infusion pumps and dispensing devices could reduce the risk of error. The drug products most often associated with administration technique errors and patient harm could be targeted in staff education and training programs.

Medication Safety Alerts

SMP Canada has completed preparations for a research study entitled “Impact of Interventions for Improvement of Medication Use Systems in Ontario Hospitals”, which is being funded by the Ontario Ministry of Health. Letters of agreement have been mailed to the presidents and CEOs of hospitals that have expressed interest in participating in the study. Approximately 30 hospitals will be enrolled and randomized to the control group or the study group. Because of the number of reports and concerns related to infusion pump devices, ISMP Canada considers infusion device problems a priority issue in this country. Dr John Doyle of the University Health Network and Dr Kim Vicente of the University of Toronto's Cognitive Engineering Laboratory will lead a project to review the use of infusion pumps in Canadian hospitals. This joint project with ISMP Canada will involve a comprehensive survey of Canadian hospitals concerning their use of infusion pumps, problems related to the pumps, and other issues. CSHP has been invited to provide input and assistance with this important initiative.

Debate over use of infusion pumps

Debate over use of infusion pumps

A Phase II Trial of UFT-E and Oral Leucovorin in Advanced Colorectal Cancer.

To determine the efficacy and toxicity of UFT-E plus oral calcium leucovorin in the treatment of patients with advanced colorectal cancer. Forty-three patients with advanced, bidimensionally measurable colorectal adenocarcinoma were enrolled in the trial. No patients had received prior palliative chemotherapy. The patients that had received previous adjuvant chemotherapy were enrolled when more than 6 months had elapsed after the completion of adjuvant therapy. Patients were treated with 300 mg/m2/day of UFT-E (tegafur-based) plus 90 mg/day of leucovorin administered orally in three divided daily doses, every 8 hours for 28 days followed by a 7-day rest period. Response was evaluated after two or three courses of therapy. Thirty-six of forty-three patients were evaluable for response; seven dropped out due to infection, toxicity and patients' refusal. Ten patients had partial responses and one patient complete response (response rate, 31%; 95% confidence interval, 16~46%). The median response duration for the UFT-E plus leucovorin regimen was 28 weeks. Grade III toxicity was seen in one case, with diarrhea. This oral regimen proved effective and well tolerated. This schema also avoided inconveniences, such as hospitalization and the use of infusion pumps, which are associated with 5-FU infusion regimens. The regimen used showed minimal toxicity, especially in the upper digestive tract, with good patient compliance.

Intravenous Infusion Sets (IV Set) In Anesthesia Practice: A Survey On Their Use And A Look Into The Future

Establishing reliable intravenous infusion is an essential component of anesthesia practice. Infusion of fluids is used to replenish fluid deficit caused by fasting before the surgery, to replace ongoing losses of fluids and as a vehicle to administer intravenous medications and anesthetics (Figure 1). While the advances in technology have brought number of powered infusion devices (infusion pumps), the gravity–driven intravenous infusion sets (Figure 1) remain most prevalent in majority of applications, including anesthesia practice. Commonly cited reasons for the infrequent use of infusion pumps in anesthesia practice are the expense-related to acquisition, expense-related to their maintenance, and the continuing cost of specialized infusion cartridges of IV sets. In addition, the old fashioned gravitydriven infusion sets are much easier and quicker to set-up and more cost-effective.

20.10 Vein valve autotransplantation in non-obstructive chronic venous insufficiency (new technique)

When planning parenteral nutrition (PN), the proper choice, insertion, and nursing of the venous access are of paramount importance. In hospitalized patients, PN can be delivered through short-term, non-tunneled central venous catheters, through peripherally inserted central catheters (PICC), or – for limited period of time and with limitation in the osmolarity and composition of the solution – through peripheral venous access devices (short cannulas and midline catheters). Home PN usually requires PICCs or – if planned for an extended or unlimited time – long-term venous access devices (tunneled catheters and totally implantable ports).The most appropriate site for central venous access will take into account many factors, including the patient's conditions and the relative risk of infective and non-infective complications associated with each site. Ultrasound-guided venepuncture is strongly recommended for access to all central veins. For parenteral nutrition, the ideal position of the catheter tip is between the lower third of the superior cava vein and the upper third of the right atrium; this should preferably be checked during the procedure.Catheter-related bloodstream infection is an important and still too common complication of parenteral nutrition. The risk of infection can be reduced by adopting cost-effective, evidence-based interventions such as proper education and specific training of the staff, an adequate hand washing policy, proper choices of the type of device and the site of insertion, use of maximal barrier protection during insertion, use of chlorhexidine as antiseptic prior to insertion and for disinfecting the exit site thereafter, appropriate policies for the dressing of the exit site, routine changes of administration sets, and removal of central lines as soon as they are no longer necessary.Most non-infective complications of central venous access devices can also be prevented by appropriate, standardized protocols for line insertion and maintenance. These too depend on appropriate choice of device, skilled implantation and correct positioning of the catheter, adequate stabilization of the device (preferably avoiding stitches), and the use of infusion pumps, as well as adequate policies for flushing and locking lines which are not in use.

Pumps and warmers during amnioinfusion: Is either necessary?

To determine if there is evidence from published reports that the use of infusion pumps or solution warmers during amnioinfusion is beneficial. We identified all English-language amnioinfusion reports published since 1983 through Medline and references. Fourteen prospective papers with at least 40 subjects were identified. For the amnioinfusion and control groups in each study, odds ratios (OR) were calculated for cesarean delivery, fetal distress, meconium below the cords, low 5-minute Apgar score, and endometritis. Cumulative ORs were calculated using the Mantel-Haenszel inverse variance method. This process was repeated after separation into pump-gravity and warmed-unwarmed groups. Multiple regression analyses were performed. Amnioinfusion improved the ability of the fetus to tolerate labor (fetal distress OR 0.40), decreased the incidence of meconium below the cords (OR 0.16), and decreased the rate of cesarean delivery (OR 0.56). There were no demonstrable benefits associated with the use of warmers or pumps. In multiple regression analysis, infusion pumps were associated with a significantly increased risk of fetal distress (P = .01). The use of amnioinfusion is associated with a decreased risk of fetal distress, meconium below the cords, and cesarean delivery. To date, there is no demonstrable benefit using infusion pumps or solution warmers during amnioinfusion.

Con: Early extubation after cardiac surgery does not decrease intensive care unit stay and cost

Con: Early extubation after cardiac surgery does not decrease intensive care unit stay and cost

Infusion pumps: guidelines and pitfalls

The use of infusion pumps is increasing in the community. To ensure that a patient receives the

Compartment syndrome secondary to prolonged intraosseous infusion: Pediatr Emerg Care 1994; 10/3: 157–159

Intraosseous infusions are a valuable means of establishing intravascular access in pediatric emergencies. We report a case of compartment syndrome from prolonged intraosseous infusion (53 hours). We postulate that chemical irritation from medications, infections, the tenuous nature of intraosseous infusions, and the use of infusion pumps may all play a role in the development of compartment syndrome. We recommend that, when possible, intraosseous lines be used only temporarily until more permanent vascular access is established, that lines that do not flow with gravity be removed, and that drugs known to cause chemical burns be used with caution. In addition, the use of x-ray and hourly measurement of leg circumference may help to determine whether a line is still in place. Also, given the changing circumstances and technology under which intraosseous infusions are used, new prospective studies of their complications are needed.

Care of the elderly patient receiving continuous 5-Fluorouracil at home

Fifty percent of all cancers occur in individuals over age 60. Participation in their own antineoplastic therapy is particularly important for persons in this age group. The authors offer information on the normal aging process, the management of side effects and line complications, and the use of infusion pumps. The goal of a well-planned program for self-administration is to provide the optimum in care for elderly persons suffering from cancer.

Effect of insulin infusion pump use on diabetic retinopathy.

Ten patients with insulin-dependent diabetes mellitus (IDDM) had fundus photographs and fluorescein angiograms obtained before and after a control period characterized by conventional insulin injections and a test period characterized by continuous subcutaneous insulin infusion (CSII). The mean glycosylated hemoglobin value at the end of the control period was 14.3% +/- 3.8% and decreased to 10.1% +/- 3.3% at the end of the test period. During the control period, none of the patients' eyes changed more than one grade in a modified Early Treatment Diabetic Retinopathy Study classification. All seven eyes without retinopathy at the start of the control period were still without retinopathy at its completion. One eye improved three grades during the test period, but four eyes, including two without retinopathy when CSII was initiated, progressed one grade. The data suggest that metabolic control that is improved but not normalized by CSII neither reverses retinopathy in IDDM nor prevents its development.

The initial experience with the use of a portable infusion pump in the delivery of human menopausal gonadotropins

The initial experience with the use of a portable infusion pump for the delivery of human menopausal gonadotropins (hMG) in the therapy of ovulation dysfunction of women who failed to conceive following (1) either clomiphene citrate (five patients with polycystic ovary syndrome) or danazol (three patients with mild endometriosis) and (2) standard intramuscular hMG-human chorionic gonadotropin therapy is reported. In six of these patients this approach was used because of suboptimal response of serum estradiol levels to standard hMG therapy, and all six patients had an increase in estradiol response with infusion therapy; therapy duration and total dosage of hMG were similar in both treatment modalities. Sonography suggested stimulation of several follicles with infusion therapy. Advantages and disadvantages of the use of the infusion pump for hMG therapy are discussed. In conclusion, hMG therapy via the infusion pump is feasible. This mode of administration appears to lead to more satisfactory follicular development in selected patients. Multiple follicular stimulation is to be expected. Self-administration of medication is readily achieved by the educated patient. Further consideration and exploration of hMG infusion therapy is suggested.

Use of infusion pump for intravenous enhanced computed tomography.

For enhanced computed tomography, rapid injections through small bore needles can be easily accomplished utilizing an infusion pump. A reduction in radiation exposure to medical personnel is an associated benefit.

Problems Associated with the Use of Infusion Pumps in Pediatric Patients

Problems Associated with the Use of Infusion Pumps in Pediatric Patients

Skin necrosis from extravasation of intravenous fluids in children.

From 16,380 administrations of I.V. fluid in children during a 6-month period, there were 1,800 extravasations (11%) with 40 skin sloughs. All that resulted in either partial or full-thickness skin loss were treated by one of 3 conservative protocols, and no skin grafts were needed in this series. Most of the extravasations resulting in skin loss were associated with hypertonic fluids and the use of infusion pumps. Careful hourly monitoring of such cases seems highly desirable. We found no discernible differences in the healing among the 3 treatment regimens used. The importance of systematic monitoring of children receiving I.V. fluids by nursing personnel, the elevation of an extremity involved in an extravasation, and the care of any resulting wounds are discussed.