Continuous Drug Delivery is Significantly Affected by Relative Height Changes Between Patient and Syringe Driver.

OBJECTIVE: Syringe drivers are the principle method of giving small-volume continuous infusions of important drugs to patients. Many of these drugs are critical for the maintenance of normal physiology. Anecdotal evidence abounds of severe patient instability on movement of syringe drivers during infusion. We aimed to define the variation in drug delivery seen in three syringe drivers, with changes in relative height between the syringe driver and the end of the giving set. DESIGN: Three syringe drivers (Alaris CC [Becton Dickinson], Perfusor Space [B Braun], and Synamed µSP6000 [Arcomed]) were analyzed for reliability of flow at 0.5, 1, 2, and 5 mL/h. SETTING AND SUBJECTS: This is an in vitro investigation. INTERVENTIONS: A small air bubble was introduced into the giving set, and the progression of this was documented before and after a vertical movement of the syringe driver by 25 or 50 cm upward or downward relative to the delivery port. MEASUREMENTS AND MAIN RESULTS: For all pumps, delivery was interrupted on movement of the pumps downward, and a bolus was given with movement of the pump upward. Delivery halted at lower pump speeds for longer than higher pump speeds. The maximum delivery interruption was 11.8 minutes. Boluses given on moving the pump up were calculated as the equivalent number of minutes needed to deliver the bolus volume at steady state. The maximum bolus given was equivalent to 15.8 minutes of delivery. We were unable to eliminate the effects seen by very slow, steady movement of the pumps up or down. Static height differences made no difference to delivery. CONCLUSIONS: Syringe drivers should not be moved vertically in relation to the patient. Critical drug delivery is interrupted for up to 12 minutes with relative downward movements, and significant boluses of drugs are given with relative upward movements. As far as possible, elimination of relative height movements is advised, and extreme caution is necessary if any movements are unavoidable.

Where is my infusion pump? Harnessing network dynamics for improved hospital equipment fleet management.

OBJECTIVE: Timely availability of intravenous infusion pumps is critical for high-quality care delivery. Pumps are shared among hospital units, often without central management of their distribution. This study seeks to characterize unit-to-unit pump sharing and its impact on shortages, and to evaluate a system-control tool that balances inventory across all care areas, enabling increased availability of pumps. MATERIALS AND METHODS: A retrospective study of 3832 pumps moving in a network of 5292 radiofrequency and infrared sensors from January to November 2017 at The Johns Hopkins Hospital in Baltimore, Maryland. We used network analysis to determine whether pump inventory in one unit was associated with inventory fluctuations in others. We used a quasi-experimental design and segmented regressions to evaluate the effect of the system-control tool on enabling safe inventory levels in all care areas. RESULTS: We found 93 care areas connected through 67,111 pump transactions and 4 discernible clusters of pump sharing. Up to 17% (95% confidence interval, 7%-27%) of a unit's pump inventory was explained by the inventory of other units within its cluster. The network analysis supported design and deployment of a hospital-wide inventory balancing system, which resulted in a 44% (95% confidence interval, 36%-53%) increase in the number of care areas above safe inventory levels. CONCLUSIONS: Network phenomena are essential inputs to hospital equipment fleet management. Consequently, benefits of improved inventory management in strategic unit(s) are capable of spreading safer inventory levels throughout the hospital.

Bombas de infusión parenteral en internación general / Parenteral infusion pumps in general hospitalization

CONTEXTO CLÍNICO: La administración endovenosa de fármacos es esencial en el tratamiento de la mayoría de los pacientes hospitalizados. La administración de medicamentos intravenosos puede causar eventos adversos y es un problema importante para la seguridad del paciente en cualquier entorno hospitalario. En una revisión sistemática del Reino Unido los errores fueron hasta cinco veces más probables en la administración de drogas en forma intravenosa comparada con las no intravenosas. Las tasas de error publicadas varían del 18% al 73% de las dosis intravenosas administradas. La probabilidad de cometer al menos un error en todo el proceso que conlleva la preparación y administración de una dosis de medicación intravenosa es de 73% y la mayoría de los errores ocurren en los pasos de reconstitución de los fármacos y en su administración. Las bombas de infusión intravenosa se encuentran entre las tecnologías más utilizadas en la atención de la salud. Un porcentaje importante de los pacientes hospitalarios recibe medicamentos a través de estos dispositivos remarcando su relevancia clínica, particularmente en entornos de atención crítica y aguda. Se postula el uso de bombas de infusión parenteral en salas de internación general dado que podrían reducir los errores asociados a la administración de fármacos. TECNOLOGÍA: Una bomba de infusión es un dispositivo médico que suministra líquidos al cuerpo del paciente en cantidades controladas. Las bombas de infusión, al contrario de la administración manual o por gravedad de fluidos, permite administrar líquidos en volúmenes muy pequeños, y posee la capacidad de administrar líquidos a velocidades programadas con precisión o intervalos automáticos. Pueden suministrar nutrientes o medicamentos, como insulina u otras hormonas, antibióticos, medicamentos de quimioterapia y analgésicos. La capacidad de las bombas de infusión para producir presiones altas pero controladas hace que estos dispositivos sean muy útiles para inyectar cantidades controladas de fluidos en la vía subcutánea o epidural. OBJETIVO: El objetivo del presente informe es evaluar la evidencia disponible acerca de la eficacia, seguridad y aspectos relacionados a las políticas de cobertura de bombas de infusión para la administración endovenosa de fármacos en salas de internación general en comparación con sistemas de infusión por gravedad. MÉTODOS: Se realizó una búsqueda en las principales bases de datos bibliográficas, en buscadores genéricos de internet, y financiadores de salud. Se priorizó la inclusión de revisiones sistemáticas (RS), ensayos clínicos controlados aleatorizados (ECAs), evaluaciones de tecnologías sanitarias (ETS), evaluaciones económicas, guías de práctica clínica (GPC) y políticas de cobertura de diferentes sistemas de salud. RESULTADOS: Se incluyeron un ECAs, dos RS, dos ETS, cuatro GPC, y 14 informes de políticas de cobertura del uso de bombas de infusión parenteral en internación general. CONCLUSIONES: No se encontró evidencia que compare el potencial impacto del uso extensivo en internación general de las bombas de infusión parenteral en comparación con dispositivos de control de infusión por gravedad. Debido a la mayor precisión en la infusión con bombas en comparación a los sistemas de infusión por gravedad existe consenso en normativas hospitalarias y políticas de cobertura en recomendar y brindar cobertura para la infusión controlada por bomba para drogas de alto riesgo y en pacientes lábiles a volumen a pesar de la falta de evidencia que haya evaluado el impacto en desenlaces clínicos de esta práctica.

IV DripAssist: An Innovative Way to Monitor Intravenous Infusions Away From an Outlet?

Intravenous (IV) administration of fluids and medications are a significant part of patient treatment. In austere environments, typical methods of counting drops from gravity drips or infusion pumps both have limitations such as accuracy, weight, and need for power. The DripAssist device calculates drip rates by counting drops in IV tubing drip chambers and may provide a useful patient safety monitor adjunct. The protocol was IRB approved, prospective, and designed as a pilot study involving 28 Madigan Army Medical Center Emergency Department personnel. After a brief didactic introduction to the device for clinical staff with no prior experience using the device, participants were timed setting three normal saline infusions at rates of 250 mL/h, 125 mL/h and 83 mL/h with 15gtt/mL tubing. Participants filled out a survey on perceived ease of use and utility of the device compared to pumps and manual counting. Most participants felt the DripAssist device was easy to understand and set up, but nurses and physician assistants were more likely than medics to perceive a benefit versus IV pumps or gravity drips. The DripAssist device may offer a safe, low-weight, functional tool which could improve care in a variety of resource-limited environments. However, additional studies using the device during actual field exercises would be beneficial.

A multi-method review of home-based chemotherapy.

This study summarises research- and practice-based evidence on home-based chemotherapy, and explores existing delivery models. A three-pronged investigation was conducted consisting of a literature review and synthesis of 54 papers, a review of seven home-based chemotherapy programmes spanning four countries, and two case studies within the Canadian province of Ontario. The results support the provision of home-based chemotherapy as a safe and patient-centred alternative to hospital- and outpatient-based service. This paper consolidates information on home-based chemotherapy programmes including services and drugs offered, patient eligibility criteria, patient views and experiences, delivery structures and processes, and common challenges. Fourteen recommendations are also provided for improving the delivery of chemotherapy in patients' homes by prioritising patient-centredness, provider training and teamwork, safety and quality of care, and programme management. The results of this study can be used to inform the development of an evidence-informed model for the delivery of chemotherapy and related care, such as symptom management, in patients' homes.

[Study of a pharmacy performing homecare pump rental business].

In the Japanese home care, doctors are not required to purchase their own pump; the pump can be rented from a rental company. However, the rental company cannot do a medical support. Therefore, the Yanase-pharmacy(pharmacist)performs a pump rental business, doing a medical support to patients, doctors and nurses. The contents of the medical support are: To attend the conference before the patient was leaving the hospital , To describe how to use the pump to the patient and medical staff while the patient is still in the hospital , To describe how to use the pump to the patient and medical staff when the patient is at home , To propose how to connect the infusion route to the pump .

Suboptimal use of intravenous contrast during radiotherapy planning in the UK.

We aimed to evaluate the use of intravenous (IV) contrast during acquisition of radiotherapy planning (RTP) scans and to compare current usage with the Royal College of Radiologists' (RCR) recommendations. Questionnaires were circulated via the Academic Clinical Oncology and Radiobiology Research Network (ACORRN) website, email and post to 60 UK radiotherapy centre managers. Questions were asked regarding the (i) tumour sites where IV contrast was used, (ii) person administering the contrast, (iii) availability of dynamic pump, (iv) tumour sites that centres wished to use contrast, (v) reasons for not using contrast and (vi) awareness of RCR recommendations. 50 (83%) centres responded to the questionnaire, of which 27 responded via the ACCORN website and 18 by e-mail. Despite 38 out of 50 responding centres using IV contrast, and accessibility to dynamic pumps existing in 39 centres, IV contrast usage was suboptimal, with more than half of the centres (27/50; 54%) wishing to use it at more tumour sites. IV contrast was most often used during RTP of the brain, with suboptimal usage in lung tumours. None of the 50 centres administered IV contrast during RTP scan acquisition in all of the 8 RCR recommended tumour sites. Radiographers were mainly responsible for contrast administration, and a lack of staff was cited as the main reason for suboptimal contrast usage. Disappointingly, only 35 of the 50 radiotherapy managers (70%) were aware of the RCR recommendations. Redress of the underlying reasons for suboptimal IV contrast administration during RTP, including acquisition of the necessary skill mix by staff and implementation of RCR recommendations, would help standardize UK practice.

Patient safety challenges in treprostinil therapy.

Treprostinil (Remodulin) is a new therapy for pulmonary hypertension. A multidisciplinary plan for safely managing the drug is described, and includes a flow chart to guide practice through high-risk issues.

The latest developments in insulin injection devices.

The next several years promise dramatic changes in the treatment of diabetes, many of which will be driven by rapidly developing technology. Today's patient with diabetes has ready access to more information about the disease and its treatment options. As a result of this increased knowledge base, insulin-treated patients have become more autonomous in the management of their diabetes and may be better prepared to participate in making informed choices regarding insulin delivery devices. As with any insulin regimen, diabetes educators are encouraged to provide ongoing patient education and follow-up to assure optimal use of these new technologies.

Infusion perfusion: i.v. pumps for every need.

Infusion pumps offer many options to improve patient care. Learn the latest technology and use this guide to choose the right pumps for your units.

Pump primer: how to choose the right infusion device.

Twenty questions to help you and your selection committee pinpoint the right infusion devices for your needs.