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Infusion Pump (infusion + pump)
Selected AbstractsThe Use of Implanted Programmable Infusion Pumps in the Management of Nonmalignant, Chronic Low-Back PainNEUROMODULATION, Issue 4 2007Peter Staats MD ABSTRACT Objectives., To assess the mode-of-use of implanted programmable infusion pumps in patients with nonmalignant, chronic low-back pain. Materials and Methods., Charts from 101 consecutive eligible patients were analyzed retrospectively. Data were extracted relating to patient demographics, pump mode of infusion and flow rate, and medications used. Results., Morphine was the agent most frequently used and most patients received one medication at each visit. At the last visit, 94.1% of patients were receiving constant-flow treatment; 90.1% had received such treatment for , six months and 68.3% throughout the entire analysis period. For patients attaining constant-flow treatment, mean time from implantation to start of such treatment was 2.7 months. Discussion., The results suggest that many patients with nonmalignant low-back pain could be implanted with a constant-flow pump when their programmable device needs replacing or, in some cases, at the start of intrathecal treatment. This would reduce costs and the requirement for surgery. [source] Implementation of an intravenous medication infusion pump system: implications for nursingJOURNAL OF NURSING MANAGEMENT, Issue 2 2008Marilyn Bowcutt MSN Aim, To assess perceptions of nurses regarding the implementation of intravenous medication infusion system technology and its impact on nursing care, reporting of medication errors and job satisfaction. Background, Medication errors are placing patients at high risk and creating an economic burden for hospitals and health care providers. Infusion pumps are available to decrease errors and promote safety. Methods, Survey of 1056 nurses in a tertiary care Magnet hospital, using the Infusion System Perception Scale. Response rate was 65.43%. Results, Nurses perceived the system would enhance their ability to provide quality nursing care, reduce medication errors. Job satisfaction was related to higher ratings of the management team and nursing staff. Perceptions verified the pump was designed to promote safe nursing practices. Conclusions, It is important to consider relationships with job satisfaction, safe nursing practice and the importance of ratings of nursing staff and management teams when implementing infusion technology. Implications for nursing management, Infusion pumps are perceived by nurses to enhance safe nursing practice. Results stress the importance of management teams in sociotechnological transformations and their impact on job satisfaction among nurses. [source] Rapid acquisition of operant conditioning in 5-day-old rat pups: A new technique articulating suckling-related motor activity and milk reinforcementDEVELOPMENTAL PSYCHOBIOLOGY, Issue 6 2007Carlos Arias Abstract Newborn rats are capable of obtaining milk by attaching to a surrogate nipple. During this procedure pups show a gradual increase in head and forelimb movements oriented towards the artificial device that are similar to those observed during nipple attachment. In the present study the probability of execution of these behaviors was analyzed as a function of their contingency with intraoral milk infusion using brief training procedures (15 min). Five-day-old pups were positioned in a smooth surface having access to a touch-sensitive sensor. Physical contact with the sensor activated an infusion pump which served to deliver intraoral milk reinforcement (Paired group). Yoked controls received the reinforcer when Paired neonates touched the sensor. Paired pups trained under a continuous reinforcement schedule emitted significantly more responses than Yoked controls following two (Experiment 1) or one training session (Experiment 2). These differences were also observed during an extinction session conducted immediately after training. The level of maternal deprivation before training (3 or 6 hr) or the volume of milk delivered (1.0 or 1.5 µl per pulse) did not affect acquisition or extinction performances. In addition, it was observed that the rate of responding of Paired pups during the early phase of the extinction session significantly predicted subsequent levels of acceptance of the reinforcer. These results indicate that the frequency of suckling-related behaviors can be rapidly modified by means of associative operant processes. The operant procedure here described represents an alternative tool for the ontogenetic analysis of self-administration or behavior processes of seeking. © 2007 Wiley Periodicals, Inc. Dev Psychobiol 49: 576-588, 2007. [source] Insulin pump therapy vs. multiple daily injections in obese Type 2 diabetic patientsDIABETIC MEDICINE, Issue 8 2005J. Wainstein Abstract Aims To compare the efficacy of insulin pump treatment with multiple daily injections in the treatment of poorly controlled obese Type 2 diabetic patients already receiving two or more daily injections of insulin plus metformin. Methods Forty obese Type 2 diabetic subjects (using insulin) were randomized to treatment with continuous subcutaneous infusion pump (CSII) (Minimed®) or multiple daily insulin injections (MDI). At the end of the first 18-week treatment period, patients underwent a 12-week washout period during which they were treated with MDI plus metformin. They were then crossed-over to the other treatment for an 18-week follow-up period. Patients performed 4-point daily self blood-glucose monitoring (SBGM) on a regular basis and 7-point monitoring prior to visits 2, 8, 10 and 16. A subset of patients underwent continuous glucose monitoring using the Minimed® continuous glucose monitoring system (CGMS) at visits 2, 8, 10 and 16. A standard meal test was performed in which serum glucose was tested at fasting and once each hour for 6 h following a test meal. Glucose levels were plotted against time and the area under the curve (AUC) was calculated. HbA1c, weight, daily insulin dose and hypoglycaemic episodes were recorded. Results In obese Type 2 diabetic patients already treated with insulin, treatment with CSII significantly reduced HbA1c levels compared with treatment with MDI. An additional CSII treatment benefit was demonstrated by reduced meal-test glucose AUC. Initial reduction of daily insulin requirement observed in CSII-treated subjects during the first treatment period was attributable to a period effect and did not persist over time. Conclusions In the intent-to-treat analysis, CSII appeared to be superior to MDI in reducing HbA1c and glucose AUC values without significant change in weight or insulin dose in obese, uncontrolled, insulin-treated Type 2 diabetic subjects. [source] Real Time Myocardial Contrast Echocardiography During Supine Bicycle Stress and Continuous Infusion of Contrast Agent.ECHOCARDIOGRAPHY, Issue 6 2007Cutoff Values for Myocardial Contrast Replenishment Discriminating Abnormal Myocardial Perfusion Background: Myocardial contrast echocardiography (MCE) is a new imaging modality for diagnosing coronary artery disease (CAD). Objective: The aim of our study was to evaluate feasibility of qualitative myocardial contrast replenishment (RP) assessment during supine bicycle stress MCE and find out cutoff values for such analysis, which could allow accurate detection of CAD. Methods: Forty-four consecutive patients, scheduled for coronary angiography (CA) underwent supine bicycle stress two-dimensional echocardiography (2DE). During the same session, MCE was performed at peak stress and post stress. Ultrasound contrast agent (SonoVue) was administered in continuous mode using an infusion pump (BR-INF 100, Bracco Research). Seventeen-segment model of left ventricle was used in analysis. MCE was assessed off-line in terms of myocardial contrast opacification and RP. RP was evaluated on the basis of the number of cardiac cycles required to refill the segment with contrast after its prior destruction with high-power frames. Determination of cutoff values for RP assessment was performed by means of reference intervals and receiver operating characteristic analysis. Quantitative CA was carried out using CAAS system. Results: MCE could be assessed in 42 patients. CA revealed CAD in 25 patients. Calculated cutoff values for RP-analysis (peak-stress RP >3 cardiac cycles and difference between peak stress and post stress RP >0 cardiac cycles) provided sensitive (88%) and accurate (88%) detection of CAD. Sensitivity and accuracy of 2DE were 76% and 79%, respectively. Conclusions: Qualitative RP-analysis based on the number of cardiac cycles required to refill myocardium with contrast is feasible during supine bicycle stress MCE and enables accurate detection of CAD. [source] Evaluation of emergency medicine trainees' ability to use transport equipmentEMERGENCY MEDICINE AUSTRALASIA, Issue 3 2009Manoj Samuel Abstract Objective: To assess the skills of advanced emergency medicine trainees in the use of commonly used transport equipment and to determine what teaching has been undertaken and what level of confidence trainees have in their ability to use the equipment tested. Methods: This is a prospective multicentre observational study examining equipment use. Three pieces of equipment were examined: the infusion pump, defibrillator-monitor and transport ventilator. A questionnaire and a series of practical tasks were used. Advanced trainees from Victorian ED were enrolled as participants. Outcomes included proportion of participants able to perform all tasks successfully, subjective registrar confidence with use of equipment and departmental training practices. Eleven ED were represented, covering metropolitan tertiary, metropolitan peripheral and regional hospitals. Results: There were 47 participants enrolled in the study. The range of advanced training years of participants was 1,5+. Of the 47 participants, 39 (83%; 95% CI 72.2,93.7%) had been involved as medical escorts. Eighteen participants (38.3%; 95% CI 24.4,52.2%) described some form of teaching for equipment use. The median level of confidence of participants (on a 5-point scale) was 4 (25,75% interquartile range 3,4), which correlates with a moderate degree of confidence. Of 47 participants, 7 (14.9%; 95% CI 4.7,25.1%) rated themselves as not confident or somewhat under-confident (i.e. 1 or 2 on the scale). Of 47, 12 passed overall (25.5%; 95% CI 13.1,38%) and 8 completely failed (17.0%; 95% CI 6.3,27.8%) the skill testing. Conclusion: When tested in isolation, there appears to be deficits in the equipment skills of advanced ED trainees who are expected to be proficient in transport medicine. [source] Predisposing factors to phlebitis in patients with peripheral intravenous catheters: A descriptive studyJOURNAL OF THE AMERICAN ACADEMY OF NURSE PRACTITIONERS, Issue 4 2008Esin Uslusoy BSN, MS (Research Assistant) Abstract Purpose: The purpose of this study was to investigate the predisposing factors in the development of phlebitis in peripheral intravenous (IV) catheterization sites in patients treated with a variety of IV infusion solutions and drugs. Data sources: Systematic observation of 568 IV sites inserted for fluid infusion and drug administration in 355 patients in the Department of General Surgery of a University Hospital in Turkey. A data collection tool was based on standards established by the Infusion Nurses Society. Patients' infusion sites were monitored every 24 h during treatment and for 48 h after discontinuation of the IV. Conclusions: In contrast to the usual findings in the literature, the authors found that infusion through an infusion pump and insertion of catheters in the veins around the elbow increased the risk of phlebitis. Also, the number of times infusions were started led to an increased rate of phlebitis. However, conflicting results were obtained about the relation between phlebitis, gender, and catheter size. Implications for practice: Phlebitis causes sepsis, pain, additional diagnostic investigations, and treatments, and may lead to increased duration of hospitalization, patient's stress level, and financial burden, as well as increasing staff workload. Advanced practice nurses need to be aware of the factors that increase the likelihood of phlebitis and take appropriate measures to prevent it. [source] Suppression of the human spinal H-reflex by propofol: a quantitative analysisACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 2 2006J. H. Baars Background:, The spinal cord is an important site of anaesthetic action because it mediates surgical immobility. During anaesthesia with volatile anaesthetics, it has been shown that the suppression of the spinal H-reflex correlates with surgical immobility. To evaluate whether the H-reflex could also be a possible candidate for monitoring immobility during propofol anaesthesia, this study assessed the concentration-dependent suppression of the H-reflex by propofol. To discriminate different effect sites, the individual concentration response-curves and the t1/2ke0 of the H-reflex have been compared with those of two EEG parameters. Methods:, In 18 patients, anaesthesia was induced and maintained with propofol infused using a target-controlled infusion pump at stepwise increasing and decreasing plasma concentrations between 0.5 and 4.5 mg/l. The H-reflex of the soleus muscle was recorded at a frequency of 0.1 Hz. Calculated propofol concentrations and H-reflex amplitude were analysed in terms of a pharmacokinetic-pharmacodynamic (PKPD) model with a sigmoid concentration-response function. Results:, For slowly increasing propofol concentrations, computer fits of the PKPD model for H-reflex suppression by propofol yielded the following median parameters: EC50 1.1 (0.8,1.7) mg/l, slope parameter 2.4 (2.0,3.7), and a t1/2ke0 of 6.7 (2.8,7.5, 25,75% quantiles) min. For the bispectral index, the t1/2ke0 was 2.2 (1.8,3.1) min and for the spectral edge frequency at the 95th percentile of the power spectrum 2.8 (1.9,3.2) min. Conclusions:, Propofol, unlike sevoflurane, suppresses the spinal H-reflex at concentrations far lower than the C50 skin incision. The differences in t1/2ke0 -values indicate the presence of different effect compartments for effects on the H-reflex and the EEG. [source] Prolonged disease-free survival after orthotopic liver transplantation plus adjuvant chemoirradiation for cholangiocarcinomaLIVER TRANSPLANTATION, Issue 3 2000Ilja De Vreede Orthotopic liver transplantation (OLT) alone for unresectable cholangiocarcinoma is often associated with early disease relapse and limited survival. Because of these discouraging results, most programs have abandoned OLT for cholangiocarcinoma. However, a small percentage of patients have achieved prolonged survival after OLT, suggesting that adjuvant approaches could perhaps improve the survival outcome. Based on these concepts, a protocol was developed at the Mayo Clinic using preoperative irradiation and chemotherapy for patients with cholangiocarcinoma. We report our initial results with this pilot experience. Patients with unresectable cholangiocarcinoma above the cystic duct without intrahepatic or extrahepatic metastases were eligible. Patients initially received external-beam irradiation plus bolus fluorouracil (5-FU), followed by brachytherapy with iridium and concomitant protracted venous infusion of 5-FU. 5-FU was then administered continuously through an ambulatory infusion pump until OLT. After irradiation, patients underwent an exploratory laparotomy to exclude metastatic disease. To date, 19 patients have been enrolled onto the study and have been treated with irradiation. Eight patients did not go on to OLT because of the presence of metastasis at the time of exploratory laparotomy (n = 6), subsequent development of malignant ascites (n = 1), or death from intrahepatic biliary sepsis (n = 1). Eleven patients completed the protocol with successful OLT. Except for 1 patient, all had early-stage disease (stages I and II) in the explanted liver. All patients who underwent OLT are alive, 3 patients are at risk at 12 months or less, and the remaining 8 patients have a median follow-up of 44 months (range, 17 to 83 months; 7 of 9 patients > 36 months). Only 1 patient developed tumor relapse. OLT in combination with preoperative irradiation and chemotherapy is associated with prolonged disease-free and overall survival in highly selected patients with early-stage cholangiocarcinoma. [source] Alteration in flow delivery with antisyphon devicesANAESTHESIA, Issue 4 2000C. McCarroll The aim of this study was to determine whether infusion sets containing antisyphon devices increased the time to initial flow from syringe drivers. The antisyphon devices assessed were those manufactured by B Braun, Wescott and Vygon. Each device was placed between a 50-ml syringe and a spiral extension set and primed with saline. A fourth syringe and spiral extension set acted as a control. The infusion sets were placed in four identical syringe drivers and started simultaneously. The time from pressing the start button until the initial flow for each infusion set (start-up time) was recorded. The test was conducted 15 times each at 2 ml.h,1, 10 ml.h,1 and 50 ml.h,1. At 2 ml.h,1 the start-up time was significantly longer with all the antisyphon sets compared with the control (p < 0.0001). At higher infusion rates the differences between the antisyphon sets and the control were less pronounced. Clinicians who use syringe driver infusions should be aware of this delay between the activation of the infusion pump and the onset of flow and take steps to prevent it. [source] Feasibility of infusion pumps for continuous spinal administration of local anesthetics in post-operative pain therapyACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 5 2009M. WENK Background and Objectives: For completion of perioperative care and for general ethical considerations, any intraoperatively used catheter technique should be utilizable for post-operative pain therapy. Continuous spinal anesthesia (CSA) is an established form of local anesthetic application. However, for its use in post-operative therapy, infusion pumps are required that are technically able to deliver low rates and are distinctive in design to avoid possible pump or medication swaps. Because of a lack of devices specifically designed for CSA, we investigated the potential deployability of infusion pumps for post-operative pain therapy via CSA microcatheters, which were originally designed and approved for different applications. Methods: The accuracy of infusion rates of three different pumps was measured in a liquor model environment. Furthermore, we investigated safety and user-friendliness by interviewing 30 anesthesiologists and 15 pain nurses. Results: Except for the first hour of infusion, all pumps provided comparable and adequate flow profiles. However, interviews revealed significant risk factors for all pumps in terms of swapping devices, lines or medications and misprogramming the units. Discussion: All pumps tested were technically able to deliver accurate flow rates; however, because the non-CSA-specific design involves the risk of medication overdosage and syringe swaps, none of the systems tested can be recommended for routine use in post-operative CSA, irrespective of the fact that it was an off-label application anyway. Therefore, to ensure patient safety, continuous spinal administration of local anesthetics via microcatheters is a questionable method of post-operative pain therapy as long as non-specific pumps are used. [source] The Use of Implanted Programmable Infusion Pumps in the Management of Nonmalignant, Chronic Low-Back PainNEUROMODULATION, Issue 4 2007Peter Staats MD ABSTRACT Objectives., To assess the mode-of-use of implanted programmable infusion pumps in patients with nonmalignant, chronic low-back pain. Materials and Methods., Charts from 101 consecutive eligible patients were analyzed retrospectively. Data were extracted relating to patient demographics, pump mode of infusion and flow rate, and medications used. Results., Morphine was the agent most frequently used and most patients received one medication at each visit. At the last visit, 94.1% of patients were receiving constant-flow treatment; 90.1% had received such treatment for , six months and 68.3% throughout the entire analysis period. For patients attaining constant-flow treatment, mean time from implantation to start of such treatment was 2.7 months. Discussion., The results suggest that many patients with nonmalignant low-back pain could be implanted with a constant-flow pump when their programmable device needs replacing or, in some cases, at the start of intrathecal treatment. This would reduce costs and the requirement for surgery. [source] Chemical Stability of an Admixture Combining Ziconotide and Bupivacaine During Simulated Intrathecal AdministrationNEUROMODULATION, Issue 2007David Shields PhD ABSTRACT Objective., To determine the stability of an admixture combining ziconotide with bupivacaine hydrochloride during simulated intrathecal infusion under laboratory conditions at 37°. Materials and Methods., An admixture containing ziconotide (25 µg/mL) and bupivacaine hydrochloride (5 mg/mL) was stored in SynchroMed® II pumps at 37° and in control vials at either 37° or 5°. Using high-performance liquid chromatography, drug concentrations were determined from samples obtained at varying intervals during the 30-day study. Results., After 30 days, pump ziconotide and bupivacaine hydrochloride concentrations measured an average of 86.9% and 99.4% of their initial concentrations, respectively. Control vials displayed similar degradation rates for both drugs. Statistical evaluation of the ziconotide 95% confidence interval indicated that the ziconotide concentration would meet or exceed 90% and 80% of initial concentration for 22 days and 45 days, respectively. Conclusions., An admixture containing 25 µg/mL ziconotide and 5 mg/mL bupivacaine hydrochloride was 90% stable for 22 days and 80% stable for 45 days (extrapolated) in SynchroMed® II infusion pumps. [source] Dermatosurgery Using Subcutaneous Infusion Anesthesia with Prilocaine and Ropivacaine in ChildrenPEDIATRIC DERMATOLOGY, Issue 6 2001Matthias Moehrle MD Pediatric surgical procedures under local anesthesia have been limited by the pain of injections and, because of low body weight, rapidly reached maximum doses. In subcutaneous infusion anesthesia (SIA) highly diluted local anesthetics are administered by flow- and volume-controlled infusion pumps. This article presents a retrospective review of the use of SIA in children undergoing excision of dermatologic problem lesions. A total of 354 surgical procedures, predominantly excisions of nevi in 271 children (3 months,16 years) were performed in 1999: 67 children were operated on under general anesthesia and 204 children with local anesthesia. For local anesthesia we used SIA with diluted prilocaine and ropivacaine (equivalent mixtures of 0.3%, 0.15%, 0.08%). The 67 children operated on under general anesthesia were younger (mean age 3.05 ± 2.93 years, median age 2.00 years) than the 204 children who had surgery with SIA (mean age 9.00 ± 4.2 years, median age 9.00 years). The sizes of excisions under general anesthesia were larger (maximum 1060 cm2, mean 76 ± 225 cm2, median 7 cm2) than those under SIA (maximum 628 cm2, mean 22 ± 100 cm2, median 3 cm2). No side effects of local anesthesia were observed in these pediatric procedures. The additional use of ropivacaine resulted in prolonged postoperative analgesia. SIA in children is a well-accepted, safe anesthesia that in some cases offers an alternative to general anesthesia. [source] Bacterial contamination of PCA and epidural infusion devicesANAESTHESIA, Issue 7 2009M. Rothwell Summary We prospectively audited the bacterial contamination of re-useable analgesia infusion pumps. In a one-month period, 112 samples from the handset and keypads of our analgesia infusion pumps were cultured for bacterial contamination. Forty-five percent of handset swabs and 46% of keypad swabs grew bacteria; the commonest organism being coagulase-negative staphylococcus. An additional cleaning step using 70% isopropyl alcohol wipes was introduced and the contamination rate was re-audited in 100 samples. The contamination rate was reduced to 6% of handset swabs and 4% of keypad swabs. A high initial rate of bacterial contamination of re-useable analgesia infusion pumps was significantly reduced by the implementation of a simple, additional cleaning procedure. [source] | ||||||||||