Medication Delivery Pumps. D. J. McMahon rev cewood

Transcription

1 Medication Delivery Pumps D. J. McMahon rev cewood

2 Key Points Medication Delivery Pumps: - Know the uses & differences between types of pump: - IV infusion pumps - syringe drivers - syringe pumps - patient-controlled analgesia (PCA) pumps - irrigation pumps - feeding pumps - contrast media injectors - Know the terms: VTBI, KVO, bolus, Luer-Lok, palliative - Understand peristaltic, piston, & diaphragm pump mechanisms - Know the safety features common to all infusion pumps - Know what features are specific to Smart Pumps - Know the essentials of a PM for an IV pump

3 Medication Delivery Pumps 1) Infusion devices & pumps 2) Syringe Drivers 3) Syringe Pumps 4) Patient-Controlled Analgesia (PCA) Pumps 5) Irrigation Pumps 6) Feeding Pumps 7) Contrast Media Injectors

4 Classification of Infusion Devices peristaltic volumetric infusion pumps are a big part of the BMET s job

5 1) Infusion devices: Gravity Flow Controllers: Not actually pumps. Use gravity to infuse, and use electro-mechanical means to control flow. > Manual Gravity Infusors -- Flow is in drops per minute. Electronics count the drops in a drip chamber and constricts the IV line to regulate flow. > Volumetric Controllers -- Drip rate controllers that set the rate more precisely by automatic adjustment of a clamp.

6 Infusion devices & pumps (IV Pumps): Infusion Pumps: > Volumetric Pumps Desired flow rate is set in ml per hour. Pumping action is based on a known volume displacement. May include a drip counter to alert when infusion bag is empty. Most common type. May be: -- Peristaltic (roller pump or linear cam) -- Piston -- Diaphragm

7 Infusion devices & pumps (IV Pumps): Infusion Pumps, cont d: > Syringe Pumps Syringe or a cartridge is driven with a plunger at a predetermined rate to infuse a set volume. Usually include a bolus option. Especially used in anesthesiology. > Patient-Controlled Analgesia (PCA) Pumps Pump designed to allow the patient to deliver limited amounts of pain meds, with pre-programmed limits on total drug given and lockout times. May have optional base rate. Settable only by clinical staff; patient does not have direct access.

8 Safety Features Common to All Infusion Pumps: Must be able to overcome natural resistance to flow in the fluid path, but must have an upper pressure limit ( Occlusion Pressure ) in the event that a catheter or vessel becomes occluded. basic: Automatic switch to battery if mains power fails. All should go to a very slow maintenance rate called KVO ( Keep Vein Open ) when the total VTBI has been infused. (may be called TKO, To Keep Open ) programming: All are based on the VTBI Volume to be Infused. alarms: Must include free-flow protection (stop if a line gets disconnected). All should alarm and stop when the fluid is depleted. All should alarm and stop if air is detected in the line.

9 Linear Peristaltic Pump: (animation) sequentially-operated cams (or fingers ) move fluid through flexible tubing

10 Peristaltic Roller Pump (animation) Fluid is moved through the tubing by two or more rollers Tend to be more pulsatile, but are capable of faster flows. (can also run in reverse)

11 Piston & Diaphragm Pumps Piston Pump Diaphragm Pump (animation) Requires a seal around the piston. (piston ring, o-ring) Pumping chamber is sealed and uses a flexible diaphragm. Each design is positive-displacement and requires two valves.

12

13

14 Features of the Smart Pump : - drug libraries in the pump firmware. - dose log recording for record-keeping. - wireless connectivity to log all activity in real time. - Dose Error Reduction System (DERS). (software that cross-checks dosage orders against the drug being delivered and the application) but... they can require: - software & drug library upgrades - software licensing fees. - software maintenance fees.

15 THE LIST FOR Alarm hazards 2. Infusion pump medication errors 3. CT radiation exposures in pediatric patients 4. Data integrity failures in EHRs and other health IT systems 5. Occupational radiation hazards in hybrid ORs 6. Inadequate reprocessing of endoscopes and surgical instruments 7. Neglecting change management for networked devices and systems 8. Risks to pediatric patients from adult technologies 9. Robotic surgery complications due to insufficient training 10. Retained devices and unretrieved fragments

16 THE LIST FOR Alarm hazards: Inadequate alarm configuration policies and practices 2. Data integrity: Incorrect or missing data in EHR and other IT systems 3. Mix-up of IV lines leading to misadministration of drugs and solutions 4. Inadequate reprocessing of endoscopes and surgical instruments 5. Ventilator disconnects not caught because of mis-set or missed alarms 6. Patient-handling device use errors and device failures 7. Dose creep : Unnoticed variations in diagnostic radiation exposures 8. Robotic surgery: Complications due to insufficient training 9. Cybersecurity: Insufficient protections for medical devices and systems 10. Overwhelmed recall and safety alert management programs

17 Baxter Colleague CX

18 Baxter Sigma Spectrum

19 Abbott Plum

20 Hospira Symbiq

21 Cardinal (Imed) Gemini (legacy model)

22 Carefusion (Alaris) Medley

23 one brain, up to four pump modules

24 linear peristaltic pump

25

26

27 The Luer tip and the Luer-Lok : Introduced over a century ago, standardized in 1986 (ISO 594-1) Syringes, needles, IV lines

28 2) Syringe drivers Usually used in research work or clinical lab settings

29 3) Syringe Pumps - Some medications are provided by the manufacturer in standard disposable syringes. Medfusion 3500 Baxter AS50

30 Atlanta Biomed 4100 Braun Perfusor

31 Baxter s InfusO.R. syringe pump Discontinued by Baxter in 2010 but still widely used Most parts still available. Uses a magnetic drug-specific plate which the user attaches to the front. Three magnetized zones in the plate serve as encoders to tell the pump which drug is being infused, which includes the volume limits.

32 Drug plate or label : Magnetically attaches to pump

33 Hall effect detectors Used to decode the magnetic code of the drug label

34

35

36 ASIC: application-specific integrated circuit

37

38

39 4) Patient-Controlled Analgesia (PCA) Pumps Enable the patient to administer pain medication on an as-needed basis. -- usually used for opiates -- reduces time delays in pain meds -- reduces nursing workload -- prevents overdoses Most often used for post-op patients, or pain management in palliative care. palliative: relieving pain or alleviating a problem without dealing with the underlying cause

40 MD prescribes the type and dose of med, and the patient is shown how to trigger a dose using a push-button pendant. Pump is programmed to limit the total amount of medication per hour or per day.

41 PCEA: Patient-Controlled Epidural Analgesia

42 Implanted intrathecal pain pumps deliver meds directly to the spinal canal by a thin catheter

43 5) Irrigation Pumps - Peristaltic roller pumps used in a variety of devices, to supply saline or water for irrigating or flushing, especially during surgical procedures.

44

45

46

47 6) Feeding pumps - Deliver nutritive preparations to the patient s digestive tract, usually thru a naso-gastric tube ( N-G tube ). - Delivery rates typically ml / hour - Can be used for continuous or intermittent feeding - Include alarms for over-pressure, end of delivery, etc - Most are battery-driven - Most often used for pediatric patients

48

49

50 7) Contrast Media Injectors Semi-automated syringe drivers specifically for injecting isotope solutions or solutions of radiopaque media for CT scans or MRI procedures. -- Usually pre-programmable -- Can deliver ~150 ml of injectate quickly and smoothly -- Can develop very high pressures

51 Liebel-Flasheim MedRad

52

53 Preventative Maintenance of Infusion Devices PM intervals every 6 months or annually. -- Check the service manual first. -- Essentials are to verify: > flow rates > volume delivered > occlusion pressure (Pressure at which the pump will stop, when it senses excessive pressure in the tubing.) > alarm functions -- Syringe pump PMs may be based on plunger travel

54 One of these infusion pumps failed to generate an audible alarm at occlusion, resulting in an incorrect dose delivered to the patient. Can you guess which one? Would you be willing to guess if a patient s life depended on it? Routine preventive maintenance testing is one of the best ways to ensure the proper functioning of infusion pumps. Test, don t guess. - Fluke ad, April 2015

55 Infusion pump analyzers for PM s BC Biomedical Model IPA-1000 Pronk s Flowtrax

56 Fluke Biomedical Model IDA 4 Plus (4 channels) Rigel Medical Multi-Flo (4 channels)

57 Fluke Biomedical Model IDA 1S (single channel)

58 Fluke Biomedical Model IDA 4 Plus

59 Rigel Medical Multi-Flo

60

61 Test automation software - Fluke s Ansur - Rigel s Med-eBase -

62 Major Players IV Pumps: Hospira (Abbott) Plum & Symbiq Baxter (Sigma) Colleague & Spectrum Cardinal (Alaris) (Imed) Gemini & Medley B. Braun Outlook Syringe Pumps: Medfusion 3500 Medtronic Synchromed Baxter InfuOR & AS50 Harvard PCA Pumps: Hospira Gemstar, Lifecare Baxter I-pump, PCA II Carefusion (Alaris) Smiths - Deltec

63