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Purpose Despite national recommendations to standardize infusion concentrations, there is minimal guidance on institution-specific strategies and outcomes related to epidural infusion concentration standardization and optimization. The purpose of this project is to identify the optimal compounded preparation for use in select adult epidural infusions and assess the impact on drug and fluid utilization and cost savings if the designated preparation is adopted. Methods A previously validated tool, the VERB (vial, exchange, rate, and bag) analysis, was applied to epidural infusion pump administration data to identify preparations optimized for efficient supply and resource utilization at a large academic medical center. Results Weighing all components of the VERB analysis, the preferred preparation of hydromorphone and bupivacaine for the hospital site was hydromorphone (10 µg/mL) and bupivacaine (0.125%) in 50 mL of 0.9% sodium chloride injection (2,500 µg of hydromorphone per epidural). The preferred preparation of fentanyl and bupivacaine was fentanyl (2 µg/mL) and bupivacaine (0.0625%) in 50 mL of 0.9% sodium chloride injection (100 µg of fentanyl per epidural). Both recommendations are different from the currently utilized preparations at the study site. Conclusion Analyzing historic drug administration data using the novel 4-step VERB analysis identified optimized drug preparations and fluid bag sizes for the most-prescribed epidural drug combinations at the hospital study site. [ABSTRACT FROM AUTHOR]

Target-controlled infusion (TCI) is a mature technology that enables the delivery of intravenous anaesthetics in the concentration domain. The accuracy of the pharmacologic models used by TCI systems is imperfect, especially regarding pharmacodynamic predictions. This shortcoming of TCI devices is not critical. That TCI systems produce steady-state effect-site concentrations at or near a specified target is a more important attribute than a high level of accuracy because anaesthesiologists titrate to a stable level of drug effect whatever the actual concentration is. In this sense, TCI functions as a 'gain switch'. Achieving a steady state is more important than perfect accuracy. [ABSTRACT FROM AUTHOR]

Ni Eochagain and colleagues report that programmed intermittent bolus and continuous infusion regimens in continuous erector spinae plane (ESP) block catheters produced similar quality of recovery (QoR-15) scores, pain scores, and use of rescue opioids after video-assisted thoracic surgery. This is a reassuring finding for practitioners without access to pumps with programmed intermittent bolus functionality. Nevertheless, it remains plausible that the benefit of one regimen over another might vary depending on the specific infusion parameters. There continues to be scope for research into optimising programmed intermittent bolus delivery and dosing regimens and identifying the most appropriate clinical applications for this mode of infusion. [ABSTRACT FROM AUTHOR]

Taku Yamada,1 Taketomo Kikuchi,1 Sachiko Nagasu,2,3 Kayoko Hashimoto,4 Eri Furukawa,4 Hirokazu Matsumoto,1 Kazuki Tsutsumi,1 Toshimitsu Tanaka,2,5 Miho Kugishima,3 Takumi Kawaguchi,5 Fumihiko Fujita,3 Kyouko Higuchi,1 Keisuke Miwa2 1Department of Pharmacy, Kurume University Hospital, Kurume, Fukuoka, Japan; 2Multidisciplinary Treatment Cancer Center, Kurume University Hospital, Kurume, Fukuoka, Japan; 3Department of Surgery, Kurume University School of Medicine, Kurume, Fukuoka, Japan; 4Department of Nursing, Kurume University Hospital, Kurume, Fukuoka, Japan; 5Division of Gastroenterology, Department of Medicine, Kurume University School of Medicine, Kurume, Fukuoka, JapanCorrespondence: Keisuke Miwa, Multidisciplinary Treatment Cancer Center, Kurume University Hospital, 67 Asahi-machi, Kurume, Fukuoka, 830-0011, Japan, Tel +81-942-31-7566, Fax +81-942-34-0709, Email miwa_keisuke@kurume-u.ac.jpPurpose: Elastomeric infusion pumps are widely used in colorectal cancer chemotherapy. However, no studies to date have investigated patient preferences regarding different infusion pump types.Patients and Methods: Twenty patients with unresectable colorectal cancer undergoing chemotherapy were initially treated with a portable hard-shelled continuous infusion pump, followed by a soft-shelled continuous infusion pump. The respondents used a numerical rating scale (0– 10) to rate their comfort when using each pump, their ease of carrying it, the pump size and shape, its weight, their ease of reading its memory, and their overall satisfaction with it. They were then asked to determine which pump they would ultimately prefer.Results: In terms of comfort, significantly higher user satisfaction was reported for the soft-shelled pump during the daytime and when going out (P < 0.001, P < 0.001, respectively). For pump portability, size, shape, and weight, the soft-shelled type also outperformed the hard-shelled one (P < 0.001, P=0.0011, P < 0.001, respectively). However, the hard-shelled pump scored significantly better in terms of ease of viewing memory (P < 0.001). Overall satisfaction was significantly higher for the soft-shelled pump than the hard-shelled type (P=0.0095). Finally, 13 patients (65%) indicated that they would prefer a soft-shelled pump for their next treatment, while only one patient (5%) preferred a hard-shelled alternative. A preference for soft-shelled pump was observed, particularly in female patients and those with a body mass index of < 22 kg/m2.Conclusion: The selection of portable elastomeric infusion pumps should consider the preferences of patients with colorectal cancer, as these devices have the potential to enhance their quality of life.Keywords: colorectal cancer, chemotherapy, infusion pump, elastomeric infusion pump, portable infusion pump, patient preference

Abstract The paper proposes design and investigates controllers for infusion pump systems to actuate air control flow with improved performance. The actuator is realized with a permanent magnet brushless DC motor controlled by a self-tune PID controller replaced self-tune fuzzy-PID controller. Using the nonlinear model of the infusion pump system includes the motor driver, fuzzy-PID controller, and gear head as the load connected to the analysis of experimental results. The proposed control topology will improve transient responses such as rise time and steady-state error of the infusion pump system. The actuation system needs an efficient actuator with a controller for tracking desired response with self-tuning depending on linear and nonlinear conditions. The complete electromechanical actuator for fin control is modeled in MATLAB/SIMULINK environment. The simulation results show a better transient response and fewer torque ripples in the proposed system and a comparison study is performed for fuzzy-PID and conventional PID controllers.

Introduction: Parenteral drug administration in the neonatal intensive care involves complex pharmacotherapy adjusted for the patient's weight, fluid allowance, and complex multi-infusion systems. Objectives: We investigated the delivery rate of a model drug through a multi-infusion system consisting of six intravenous infusions. Methods: Delivery rate of the model drug was determined after infusion initiation and termination. Measurements were collected spectrophotometrically in real time. Time to drug delivery and the amount of drug delivered were measured. Key findings: The longest time to drug delivery was observed for a 500 g neonate model with a distal infusion connection point and neutral pump position (337 ± 30 min, P < 0.001). The shortest time was observed for a 1000 g neonate model in the combination of proximal infusion connection point and neutral pump position (18 ± 12 min, P < 0.05). The expected 100% of the drug was delivered only in two combinations: 500 g and 1000 g neonate models, proximal infusion connection point and neutral pump position (100.4 ± 4.7%, P = 0.819 and 100.2 ± 2.7%, P = 0.874, respectively). While the least drug was delivered to a 500 g neonate model in the combination of distal infusion connection point and neutral pump position (27.5 ± 5.8%, P < 0.001). Conclusions: Delayed drug delivery to premature neonates due to multi-infusion systems may compromise accurate drug administration and lead to dosing errors. Graphical Abstract [ABSTRACT FROM AUTHOR]

Background: This randomized and controlled prospective study tested the hypothesis that closed-loop Target-Controlled Infusion (TCI) of propofol would be associated with better system performance when compared with open-loop controlled delivery of propofol. Methods: Patients scheduled for elective breast surgery were randomly assigned to two groups: a closed-loop group, in which propofol infusion was performed by a closed-loop TCI system that used the Bispectral Index (BIS) as a feedback parameter to titrate the rate of propofol infusion, and an open-loop group, in which propofol infusion was performed manually and guided by the bispectral index. Results: A total of 156 patients were recruited for this study (closed-loop group n = 79; open-loop group n = 77). The Global Score (GS) of the closed-loop group was lower than that of the open-loop group (34.3 and 42.2) (p = 0.044). The proportions of time with a BIS value between 40 and 60 were almost identical in the closed-loop group and the open-loop group (68.7 ± 10.6% and 66.7 ± 13.3%) (p = 0.318). The individuals in the closed-loop group consumed more propofol compared with those in the open-loop group (7.20 ± 1.65 mg.kg−1.h−1 vs. 6.03 ± 1.31 mg.kg−1.h−1, p < 0.001). No intraoperative recall, somatic events or adverse events occurred. No significant difference in heart rate was observed between the two groups (p = 0.169). Conclusion: The closed-loop protocol was associated with lower BIS variability and lower out-of-range BIS values, at the cost of a greater consumption of propofol when compared to the open loop group. Register number: ChiCTR-INR-17010399.

Ideally, the flow delivery of an infusion system is proportional only to the rate of mechanical actuation of the syringe pump plunger. However, in the real world, overall infusion system compliance may be affected by components such as an extension of tubing lines, or different sizes of syringes. With higher compliance, there may be greater chances of flow irregularity. In this experimental study, we investigated the effects of lengths of infusion lines and syringe sizes on the compliance of syringe pumps with low flow rate (2 ml h−1). In the first experiment, infusion system compliance was measured in various settings by occlusion release. As the infusion tubing length and size of the syringe increased, the time to reach each pressure was delayed and the infusion system compliance increased. The contributions to system compliance from syringes were significantly greater compared to those of extended infusion lines. In the occlusion alarm experiment, the occlusion alarm could be delayed by 69.76 ± 3.98 min for the 50-ml syringe with a 560 cm infusion line set-up. In conclusion, the compliance of a syringe pump system increases as the loaded syringe size, or the length of the infusion tubing increases. The occlusion alarm may be much delayed and not useful in highly compliant systems with respect to the potential occlusion of the infusion system, so more attention is required when using a highly compliant infusion system. [ABSTRACT FROM AUTHOR]

Purpose Standardized processes to order and prepare medications can decrease the potential for error and provider uncertainty. Our health system utilizes a standard concentration policy, smart infusion pumps, and the electronic health record (EHR) to catalog, order, and deliver intravenous medications. A need for a more proactive and formalized process to ensure medication listings are harmonized between these 3 resources was identified. Standardizing these resources can reduce confusion, reduce time spent in pharmacy operations and nursing workflow, and may improve patient safety. The purpose of this quality improvement project was to compare and resolve inconsistencies between these 3 sources and to create a new process to assure uniformity in a complex work environment. Summary An audit-style comparison and evaluation of entries for continuous infusions within the standard concentration policy, the pump library, and the EHR was conducted. All continuous infusion entries within any one of these 3 sources were included. Key exclusion criteria included pediatric and neonatal infusions, intermittent infusions, and infusions in procedural areas. We compared the policy, the pump library, and the EHR to identify, document, and resolve discrepancies in medication name, concentration, rate, and volume; fluid restriction concentration; and upper and lower pump limits. A new method to ensure proactive continuity and consistent updates to the 3 sources was implemented into existing operational workflows. We recommended a total of 82 updates to policy (n = 48), the pump library (n = 30), and the EHR (n = 4) out of 187 continuous infusion entries. Conclusion Standardizing infusion resources will reduce confusion, and improve pharmacy operations, nursing workflow, and patient safety. [ABSTRACT FROM AUTHOR]

Macromixing and drug control are becoming more essential in a wide range of chemical and biological applications. The efficacy of microfluidic macromixing devices, which are particularly beneficial to give an exact quantity of material at specified times, is greatly influenced by the infusion pump. The construction of a low-cost functional prototype of an infusion pump in the management of delivery rates that are variable and low in particular quantities is proposed in this study. The infusion pump may be seen working at various flow rates, proving that the device may be utilized to control the volume and rate of flow of chemical fluids in medical settings, in addition to microfluidic mixing investigations in specific and scientific studies, In general, the biomedical field. [ABSTRACT FROM AUTHOR]

A patient admitted for non-ST-elevation acute coronary syndrome showed an episode of ST-segment elevation on the monitor. These alterations were due to an artifact produced by the administration of a saline bolus through an infusion pump that disappeared at the end of the bolus. Our findings highlight that the interpretation of the electrocardiogram requires careful analysis and correlation with the clinical situation and with other physiological parameters. [ABSTRACT FROM AUTHOR]

Copyright of Journal of Transfusion Medicine is the property of VM Medica-VM Group (Via Medica) and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Abstract Objective Our previously modified propofol intravenous sedation (IVS) method using a target‐controlled infusion (TCI) pump with initial target blood concentration (TBC) set at 2.2 μg/ml enables the prediction of the personal optimal intraoperative TBC during induction with a minimal gap. This study aimed to verify whether this method can be useful in case of higher initial TBCs to reduce induction time. Methods Forty‐five patients scheduled to undergo oral surgery under IVS with propofol were randomly divided into three groups (group 1, TCI started with TBC set at 2.2 μg/ml; group 2, TBC was set at 2.6 μg/ml; group 3, TBC was set at 3.0 μg/ml). Immediately after reading the calculated brain concentration when the target sedation was achieved (value A), the initial TBC was manually reset to value A. We manually controlled the intraoperative TBC to maintain moderate sedation, according to the clinical signs and bispectral index values. Of the regulated TBC values, the value farthest from value A was defined as value B. The maximum discrepancy between values B and A and the induction time were compared among the three groups. Results The maximum discrepancy (mean ± standard deviation [SD]) was significantly larger in group 3 (1.0 ± 1.3 μg/ml, p = .005) and group 2 (0.8 ± 0.2 μg/ml p = .008) than in group 1 (0.5 ± 0.3 μg/ml). The induction time (mean ± SD) was significantly shorter in group 3 (124 ± 126 min, p = .004) and group 2 (135 ± 33 min, p = .006) than in group 1 (245 ± 1913 min). With the initial TBC set at 2.6 μg/ml, the maximum discrepancy was large at 0.8 μg/ml, but with a small SD (0.2 μg/ml). Conclusion Considering this discrepancy, this method with an initial TBC set at 2.6 μg/ml may be acceptable for clinical use for moderate sedation (UMIN 000017197).

Background: There have been several studies of postoperative pain control, but studies comparing paracetamol and ketamine on postoperative pain control have been limited. The purpose of this study is to compare the effects of ketamine and paracetamol on pain intensity after laminectomy through Patient-Controlled Analgesia pump (PCA). Methods: This clinical trial was performed on two groups of 45 patients who were candidates for laminectomy. After laminectomy, patients in groups 1 and 2 were treated with (paracetamol + morphine) and (ketamine + morphine) by PCA pump, respectively. Pain intensity and the prevalence of nausea and vomiting in the two groups were assessed. Findings: Pain intensity decreased significantly in both groups over time; But the mean pain intensity in the ketamine group during 6, 12, 18 and 24 hours after surgery was significantly lower than the paracetamol group. While 11.1% of patients in paracetamol group and 28.9% of patients in ketamine group experienced nausea and vomiting after administration of analgesia. Conclusion: This study showed that in patients undergoing laminectomy, combining (ketamine + morphine) has significantly led to better pain relief effects than with the combination of (paracetamol + morphine) in PCA pump. However, the incidence of side effects is higher in this group.

Introduction: Parenteral Nutrition (PN) is a means of providing the necessary nutrients intravenously when the clinical situation requires it. The provision of PN carries a risk due to the invasive nature of the procedure, which usually varies depending on the type used. Therefore, the medical devices used must be characterized according to the criteria of safety, comfort, effectiveness and economic cost to optimize and maximize the resources available in the administration of PN. Method: A narrative bibliographic review was carried out based on the search, in different databases such as Medline, Science Direct and Scopus, of all the articles published, up to March 2022, on devices for the administration of PN. Results: The administration of PN requires medical devices that guarantee the techno-pharmaceutical properties of the PN, as well as the safety of its administration. Conclusions: Infusion bags and pumps, together with catheters and their filters, are the key devices on which their characteristics and safety systems must be improved in order to optimize administered PN. [ABSTRACT FROM AUTHOR]

Schematic of IV multi-infusion system used in the study. [Display omitted] Sick neonates with haemodynamic instability often require complex medication regimens, which may result in the connection of a catecholamine infusion distally. This increases the dead volume of the infusion system, extending the time to medication delivery. This study evaluated the effects of body weight, and infusion connection point on the delivery rate of two medications infused through a multi-infusion system at infusion rates suitable for extremely and very low birth weight (ELBW and VLBW) neonates. An infusion system consisting of six infusions was used to investigate time to delivery, drug concentration at time to delivery and quantity of adrenaline and dopamine administered by intravenous infusions at infusion rates suitable for premature neonates. In an ELBW neonate model, the measured adrenaline and dopamine concentration at 1 2 T was higher than expected (66.7 (7.5)% (mean (SD)) and 68.0 (4.4)%, respectively, P < 0.001). At the calculated time to delivery, neither drug reached target concentration. In a VLBW neonate model, the measured adrenaline and dopamine concentration at 1 2 T was higher than expected (92.2 (7.1)% and 97.1 (3.1)%, respectively, P < 0.001). Adrenaline reached target concentration at 27 (11) min and dopamine at 56 (12) min, times significantly shorter than calculated. The measured quantity of adrenaline and dopamine delivered was lower (P < 0.001) than calculated in all tested combinations except adrenaline at proximal connection (97.2 (3.4)%, P = 0.097) in the VLBW neonate model. Using the most proximal available infusion connection considerably improves drug delivery times and drug doses delivered, which is critical during the administration of short-acting cardiovascular medications. [ABSTRACT FROM AUTHOR]

Objective: Our previously modified propofol intravenous sedation (IVS) method using a target‐controlled infusion (TCI) pump with initial target blood concentration (TBC) set at 2.2 μg/ml enables the prediction of the personal optimal intraoperative TBC during induction with a minimal gap. This study aimed to verify whether this method can be useful in case of higher initial TBCs to reduce induction time. Methods: Forty‐five patients scheduled to undergo oral surgery under IVS with propofol were randomly divided into three groups (group 1, TCI started with TBC set at 2.2 μg/ml; group 2, TBC was set at 2.6 μg/ml; group 3, TBC was set at 3.0 μg/ml). Immediately after reading the calculated brain concentration when the target sedation was achieved (value A), the initial TBC was manually reset to value A. We manually controlled the intraoperative TBC to maintain moderate sedation, according to the clinical signs and bispectral index values. Of the regulated TBC values, the value farthest from value A was defined as value B. The maximum discrepancy between values B and A and the induction time were compared among the three groups. Results: The maximum discrepancy (mean ± standard deviation [SD]) was significantly larger in group 3 (1.0 ± 1.3 μg/ml, p =.005) and group 2 (0.8 ± 0.2 μg/ml p =.008) than in group 1 (0.5 ± 0.3 μg/ml). The induction time (mean ± SD) was significantly shorter in group 3 (124 ± 126 min, p =.004) and group 2 (135 ± 33 min, p =.006) than in group 1 (245 ± 1913 min). With the initial TBC set at 2.6 μg/ml, the maximum discrepancy was large at 0.8 μg/ml, but with a small SD (0.2 μg/ml). Conclusion: Considering this discrepancy, this method with an initial TBC set at 2.6 μg/ml may be acceptable for clinical use for moderate sedation (UMIN 000017197). [ABSTRACT FROM AUTHOR]

Copyright of Chinese Medical Equipment Journal is the property of Chinese Medical Equipment Journal Editorial Office and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Intravenous (IV) fluid therapy is a common current medical practice, and the method has remained unchanged for more than a century. The IV bag is suspended from an IV stand or pole, and the pressure created by gravity is used to administer the drug. However, this method inevitably reduces the mobility of patients, and may cause accidents such as falls during movement. To solve these problems faced in home care, nursing home, and hospital settings, this study aims to develop a non-hanging, non-electrically driven IV infusion pump with reasonable portability and operability. In this study, instead of gravity, atmospheric pressure was used as the driving force. We developed several prototypes based on different pressurization mechanisms using vacuum piston cylinders as the driving mechanism, in order to find an optimum mechanism capable of producing a stable flow rate comparable to the suspended drip system. Tests on performance in terms of discharge flow rate were conducted on three feasible prototypes, based on three different pressurization mechanisms, using a gravimetric test bench built for this purpose. The tests showed that the pressurization mechanism using an inflating sleeping-bag-shaped air bag to compress a drip bag achieved the best performance in terms of flow rate stability. [ABSTRACT FROM AUTHOR]

Introduction: This study was a qualitative research which was conducted in Shiraz Amir Hospital of Oncology. Interviews were conducted during the sessions of 30 - 60 minutes in the form of deep and semi - structured questions about their views, the disadvantages and advantages of this method from their point of view and the facilities needed to assure patients of home chemotherapy. The sample consisted of 32 patients, 7 nurses and 10 doctors. Methods: Interviews 5 were extracted from the main source. Concerns related to chemotherapy, concerns related to facilities, awareness, emotions and costs. Concerned about the complications of chemotherapy in the two categories of concern(Infection, platelet and white blood cell counts,....) Other classes included access to equipment, access to team therapy, team awareness, team awareness, home comfort, home comfort, team cost, equipment costs, and drug costs. Results: A 39 - year - old man with leukemia expressed his concern about the lack of availability of ambulances and other emergency services: "Look, went to the hotel, got sick." has a record at Namazieh Hospital, when my platelet fell, got a call from the lab and the man said, "Sir, you should use your own car and come here The family may be exposed with chemo."Another nurse with five years of work - experience mentioned her concern about the inability of the family to carry out the plan and the lack of compliance with the sterilization injections and said: "Because of the environmental pollution that is caused for the caretaker or her children or someone may take care of the patient who has no literacy or is not able to help which may cause an error to occur and may lead to infection. Conclusions: It is clear that the arrangements for this work and all positive and negative aspects of it should be reviewed by experts With regard to chemotherapy at home, ethical issues, the cost and safety of patient and his family are the priorities of the plan. [ABSTRACT FROM AUTHOR]

Objectives: In the absence of widely accepted criteria, determining when a patient with Parkinson's disease (PD) may benefit from more advanced treatments such as device‐aided therapy (DAT) so far remains a matter of physician judgment. This analysis investigates how classification of PD varies across countries relative to measures of disease severity. Materials and Methods: The OBSERVational, cross‐sEctional PD (OBSERVE‐PD) study included consecutive patients with PD at centers that offer DATs in 18 countries. In this subgroup analysis, we explore intercountry differences in identification of advanced versus non‐advanced PD based on physician's clinical judgment, symptoms assessed using Delphi consensus criteria, use of DAT, motor and non‐motor symptoms, and caregiver support. Demographic and clinical characteristics were obtained through review of medical records. Results: Overall, 1342 of 2615 patients (51.3%) were assessed by physicians as having advanced PD. The proportion of patients in different countries identified as having advanced PD (24.4–82.2%) varied. In 15 of 18 countries, a greater proportion of patients with advanced PD, according to select Delphi criteria, were identified by physicians as having advanced PD than with non‐advanced PD. There was a wide variability across countries in the proportion of patients with no dyskinesia, disabling dyskinesia, dyskinesia pain, and non‐motor symptoms who were identified by physicians as having advanced versus non‐advanced PD. Conclusions: The proportion of patients identified with advanced PD symptoms varies widely across countries, despite differences on the patients' profiles, indicating a need for objective diagnostic criteria to help identify patients who may benefit from DAT. [ABSTRACT FROM AUTHOR]

Abstract Background Cobalamin (cbl)-related remethylation disorders are a heterogeneous group of inherited disorders comprising the remethylation of homocysteine to methionine and affecting multiple organ systems, most prominently the nervous system and the bone marrow. To date, the parenteral, generally intramuscular, lifelong administration of hydroxycobalamin (OHCbl) is the mainstay of therapy in these disorders. The dosage and frequency of OHCbl is titrated in each patient to the minimum effective dose in order to account for the painful injections. This may result in undertreatment, a possible risk factor for disease progression and disease-related complications. Results We describe parenteral administration of OHCbl using a subcutaneous catheter together with a portable infusion pump in a home therapy setting in four pediatric patients with remethylation disorders, two patients with cblC, one patient with cblG, and one patient with cblE deficiency, in whom intramuscular injections were not or no longer feasible. The placement of the subcutaneous catheters and handling of the infusion pump were readily accomplished and well accepted by the patients and their families. No adverse events occurred. The use of a small, portable syringe driver pump allowed for a most flexible administration of OHCbl in everyday life. The concentrations of total homocysteine levels were determined at regular patient visits and remained within the therapeutic target range. This approach allowed for the continuation of OHCbl therapy or the adjustment of therapy required to improve metabolic control in our patients. Conclusions Subcutaneous infusion using a subcutaneous catheter system and a portable pump for OHCbl administration in combined and isolated remethylation disorders is safe, acceptable, and effective. It decreases disease burden in preventing frequent single injections and providing patient independence. Thus, it may promote long-term adherence to therapy in patients and parents.

Copyright of Enfermería en Cardiologia is the property of Asociacion Espanola de Enfermeria en Cardiologia and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: Mechanical stress on red blood cells is associated with using infusion pumps for blood administration. Current standards in North America leave it to healthcare facilities to consult with manufacturers about infusion pump safety for transfusion; studies on various pumps and red blood cell (RBC) conditions are scarce. Study design and methods: RBC units were pumped through four infusion pumps on d22 (22 days postcollection), d40, d28 after gamma irradiation on d14 (I14d28), and d22 after irradiation on d21 (I21d22). For each experiment, three units were pooled and split among four bags. Samples were collected at gravity and after pumping at clinical nonemergency rates. Hemolysis %, microvesicles, potassium, lactate dehydrogenase, mechanical fragility index levels, and morphology evaluations were performed (n = 5–6). Results: Hemolysis levels of Piston and Linear Peristaltic pump samples were not different from hemolysis of corresponding gravity samples. Peristaltic samples had significantly higher hemolysis compared to gravity, and other pumps, however, maximum mean difference was limited to 0.05%. Pumping at 50 mL/h resulted in the highest hemolysis level. Change in hemolysis % due to pumping was significantly higher in d40 and I21d22 units. No combination of pumps and RBCs conditions led to hemolysis >0.8%. Besides hemolysis, lactate dehydrogenase release was the only marker that demonstrated some differences between infusions via pump versus gravity. Conclusion: The pump design affects the degree of hemolysis. However, for all tested pumps and RBC conditions, this increase was minimal. Hemolysis measurement on d40 and I21d22 at 50 mL/h were concluded to be appropriate parameters for pump evaluation. [ABSTRACT FROM AUTHOR]

Continuous peripheral nerve block catheters are simple in concept: percutaneously inserting a catheter adjacent to a peripheral nerve. This procedure is followed by local anesthetic infusion via the catheter that can be titrated to effect for extended anesthesia or analgesia in the perioperative period. The reported benefits of peripheral nerve catheters used in the surgical population include improved pain scores, decreased narcotic use, decreased nausea/vomiting, decreased pruritus, decreased sedation, improved sleep, and improved patient satisfaction. [ABSTRACT FROM AUTHOR]

The retention of human milk (HM) fat in nasogastric probes of infusion pumps can be observed during the feed of infants unable to suck at the mother's breast. The lack of homogenisation of HM could contribute to the fat holding. Therefore, the present study evaluated (i) the influence of homogenisation on milk fat retaining in infant feeding probes and (ii) the in vivo effect of the homogenisation on lipid absorption by Wistar rats. The animals were fed with HM treated following two processing conditions, that is, pasteurised and homogenised–pasteurised. The animals were randomly subdivided into four experimental groups: water-fed (control), pasteurised milk, homogenised–pasteurised milk and pasteurised–skimmed milk. The results of food consumption, mass body gain, corporate metrics and plasma blood levels of total cholesterol did not show any difference (P < 0·05) among the three types of HM used in the experiments. The liver, intestine and intra-abdominal adipose tissue of the four groups of animals presented normal and healthy histology. The composition of fatty acids in the brain tissue of animals fed with homogenised HM increased when compared with the groups fed with non-homogenised HM. These values were 11·08 % higher for arachidonic acids, 6·59 % for DAH and 47·92 % for nervous acids. The ingestion of homogenised HM promoted higher absorption of milk nutrients. Therefore, the addition of the homogenisation stage in HM processing could be an alternative to reduce fat retention in probes and to improve the lipids' absorption in the body. [ABSTRACT FROM AUTHOR]

Copyright of Chinese Medical Equipment Journal is the property of Chinese Medical Equipment Journal Editorial Office and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Electrospinning is a cost-effective technique for synthesizing polymeric fibers with nanometers diameters. Electrospun nanofibers act as ideal scaffolds for tissue engineering and drug delivery systems because they can mimic the functions of native extracellular matrices. However, it is difficult to gathering nanofibers with simple design and reasonable price device. This study presents a cost effective and safe electrospinning system with similar capabilities to standard electrospinning device. As standard current electrospinning system consists of three constructed parts, a hand-constructed electrical power supply to provide a voltage source direct current (DC), a low cost three-dimensional (3D) printed syringe pump and handmade collectors. The device components are entirely constructed off-the-shelf components, and structural elements are 3D printer. The electrospinning process was carried out using PLA materials. The general parameters in the production process are resolution of the spraying rate μL/min and the power supply provides electricity in kilovolt. The prototype is an affordable device; its cost is around 99.5% less than the laboratory commercial devices. The average diameters of the fibers were determined from SEM micrographs with the aid of Image J software, which shows that the electrospinning device successfully produces fibres on a nanometer scale. Henceforth, this project can help educational institutions to have such electrospinning system with ultra-low cost comparing with readymade systems in the market.

Volumetric infusion pumps are electronic devices used for fluid replacement as well as constant rate infusion of anesthetic drugs. The device provides the infusion of the fluid in the set by performing peristaltic pressure on the IV (intravenous) serum set hose. Although IV sets are preferred by their peristaltic pressure properties, the random IV sets selected from the clinical field are mostly used in anesthesia. A reference infusion set which was a special product for a volumetric infusion pump, and fifteen different branded IV serum sets were used in this study. After measuring the diameters and dead spaces, serum sets were connected to the infusion pump, tap water was passed from each serum set for an hour, and collected in a graduated cylinder and measured. It was observed that the serum sets, including the reference set, may change the expected fluid volume by 19%. The diameter of the IV set affected the dead spaces and infused fluid volume. It was concluded that to overlap the expected and observed fluid volumes, the brands' infusion capacity on the pump should be tested on the device before the anesthesia for the clinical fields is a requirement. [ABSTRACT FROM AUTHOR]

Objectives: Haemolysis caused by the use of peristaltic infusion pumps (PIPs) has been described in human and canine packed red blood cells (pRBCs). The aim of this study was to evaluate the effects of two different linear PIPs on the haemolysis of feline pRBC units stored for a long time. Methods: Feline pRBC units stored with adenine, dextrose, mannitol and sodium chloride (SAGM) were manufactured. After 35–42 days of storage at 2–4°C, a line administration system with a 180 µm filter was attached to every pRBC bag, the system was drained by gravity alone (8 drops/min) and a 1.3 ml sample was collected (G). A NIKI V4 pump was then used at a flow rate of 25 ml/h, the flow was stopped when the infusion system was filled with blood coming from the infusion pump and another 1.3 ml sample was collected (NK). Finally, an Infusomat FmS pump was evaluated, collecting another 1.3 ml sample (IM). Packed cell volume (PCV) was measured in all samples by microhaematocrit centrifugation, total haemoglobin (HGB) was measured using a specific haemoglobin analyser and, after centrifugation, free HGB was determined by spectrophotometry. The percentage of haemolysis was calculated. Friedman's test was used to compare the samples. Results: Fifteen feline pRBC units were evaluated. The average degree of haemolysis for sample G (gravity-assisted) was 1.12%. Comparison of the degree of gravity-assisted haemolysis with haemolysis in PIP NK (1.13%) and IM (1.14%) samples revealed no significant differences, with differences of only 0.01% and 0.02%, respectively. Conclusions and relevance: The results of this study demonstrate that the use of two common PIPs in veterinary hospitals does not produce levels of haemolysis that are significantly different than that caused by gravity alone during transfusion of feline pRBCs at a rate of 25 ml/h. [ABSTRACT FROM AUTHOR]

Infusion pumps are frequently used when transferring critically ill patients via patient transport cart, ambulance, or helicopter. However, the performance of various infusion pumps under these circumstances has not been explored. The aim of this study was to evaluate the flow rate accuracy of infusion pumps under various clinical vibration conditions. Experiments were conducted with four different types of pumps, including two conventional syringe pumps (Injectomat MC Agilia, Fresenius Kabi and TE-331, Terumo), one conventional peristaltic pump (Volumed μVP7000; Arcomed), and one new cylinder pump (H-100, Meinntech). The flow rate was measured using an infusion pump analyzer on a stable table (0 m/s2) for 1 h with 1 ml/h and 5 ml/h. Experiments were repeated in mild vibration (2 m/s2) (representing vibration of patients in a moving stretcher or ambulance), and in moderate vibration (6 m/s2) (representing vibration in helicopter transport). Any accidental bolus occurrence in extreme vibration situations (20 m/s2) was also analyzed. Simulated vibrations were reproduced by a custom-made vibration table. In the resting state without vibration and in mild vibration conditions, all pumps maintained good performance. However, in moderate vibration, flow rates in syringe pumps increased beyond their known error ranges, while flow rates in peristaltic pumps remained stable. In extreme vibration, accidental fluid bolus occurred in syringe pumps but not in peristaltic pumps. The newly developed cylinder pump maintained stable performance and was unaffected by external vibration environments. [ABSTRACT FROM AUTHOR]

Abstract Background We developed a Vital-signs-integrated Patient-assisted Intravenous opioid Analgesia (VPIA) analgesic infusion pump, a closed-loop vital signs monitoring and drug delivery system which embodied in a novel algorithm that took into account patients’ vital signs (oxygen saturation, heart rate). The system aimed to allow responsive titration of personalized pain relief to optimize pain relief and reduce the risk of respiratory depression. Moreover, the system would be important to enable continuous monitoring of patients during delivery of opioid analgesia. Methods Nineteen patients who underwent elective gynecological surgery with postoperative patient controlled analgesia (PCA) with morphine were recruited. The subjects were followed up from their admission to the recovery room/ ward for at least 24 h until assessment of patient satisfaction on the VPIA analgesic infusion pump. Results The primary outcome measure of incidence of oxygen desaturation showed all patients had at least one episode of oxygen desaturation (

Objective The long-term efficacy of deep brain stimulation (DBS) for motor fluctuations in advanced Parkinson’s disease (PD) has been well established; however, motor fluctuations may recur over time despite multiple adjustments of DBS settings and medications. Methods We conducted a retrospective chart review of three patients for whom levodopa-carbidopa intestinal gel (LCIG) was additionally administered as a rescue therapy for secondary DBS failure due to the recurrence of motor fluctuations. Results The three patients had advanced PD with a disease duration of 14–19 years, and had undergone DBS for motor fluctuations refractory to standard medical management. LCIG was administered to the patients because of symptom recurrence years after DBS and provided complementary effects in all patients. Conclusion The cases presented here show that rescue LCIG therapy may be a complementary treatment option for patients with post-DBS advanced PD who have a recurrence of troublesome motor complications.

Whole lung lavage (WLL) is a therapeutic procedure to remove accumulated material by infusing and draining the lungs with lavage fluid. This procedure has been regarded as the current standard of care to treat pulmonary alveolar proteinosis. However, the WLL protocol has not yet been standardized and the technique has been refined and modified a number of times. A rapid infusion system is a device used to infuse blood or other fluids at precise rates and normothermic conditions. This device is not typically used in WLL, which relies on the passive infusion of fluids using the gravitational force. However, in this study we performed WLL using a rapid infusion system, since we aimed to take advantage of its shorter operation time and greater degree of control over fluid volume and temperature. The patient’s symptoms improved without the occurrence of any complications.

The revolutionary change in recent technologies has dominated the Medical field. Huge medical devices are deployed in hospitals and in-home environment. The innovations of smart medical devices are prominent which can be used in the fully automated and semi-automated environment. For several decades, numerous medical devices are designed and utilized effectively. These devices are designed for the past few years, manufactured in micro and nanotechnologies with smart sensing techniques. Such devices are network-enabled and integrated into the cyber world in physical means, leading to a medical cyber physical system. The design, working, and optimal control of smart medical devices are essential. In this paper, the emphasis on the review of infusion pump control mechanism with essential parameters such as drug delivery, flow rate, pump control has been considered. [ABSTRACT FROM AUTHOR]

The revolutionary change in recent technologies has dominated the Medical field. Huge medical devices are deployed in hospitals and in-home environment. The innovations of smart medical devices are prominent which can be used in the fully automated and semi- automated environment. For several decades, numerous medical devices are designed and utilized effectively. These devices are designed for the past few years, manufactured in micro and nanotechnologies with smart sensing techniques. Such devices are network-enabled and integrated into the cyber world in physical means, leading to a medical cyber physical system. The design, working, and optimal control of smart medical devices are essential. In this paper, the emphasis on the review of infusion pump control mechanism with essential parameters such as drug delivery, flow rate, pump control has been considered.

Background. In the context of the ongoing COVID-19 pandemic, the vector of healthcare development is aimed at minimizing contacts among citizens, which is especially important for cancer patients, given the immunosuppression caused by cytostatics.The objective of the review is to present the development prospects of hospital-substituting technologies for drug antitumor treatment. Two main components are considered that allow effective and safe infusion of anticancer drugs in a day hospital: central venous access devices and infusion pumps, various types of these devices, their safety and experience of use today are described.Materials and methods. We searched for available literature published in PubMed, Medline, eLIBRARY, Cochrane Library, CyberLeninka, Global.health, etc. 42 sources were found and analyzed, published from 2002 to 2021.Results. Outpatient anticancer drug treatment is a real alternative to hospital stay, based on many years of world experience. The qualifications level of medical personnel involved in the treatment process should allow early monitoring of various adverse events development. With the ongoing COVID-19 pandemic, it is important to ensure the continuity of the treatment process while minimizing risks to the patient.Conclusion. With a careful approach and adequate infrastructure availability, drug treatment in a day hospital can reduce the burden on round-the-clock stay hospital and positively affect the patients’ quality of life and their compliance with treatment.

Aggressive infusion pump flow rates can lead to central venous catheter (CVC) occlusion resulting from thrombus reflux into the CVC lumen. Methods: A single-center prospective comparative study was performed, including all consecutive cases of occlusion events in hematology oncology patients using a CVC (Hickman® nº7) since August 2018 to September 2019 (Phase 1), and October 2019 to September 2020 (Phase 2) at the Onco-Hematology Department of the Portuguese Institute of Oncology (Porto). Two phases were described: Phase 1: Observational period using a platinum-based regime (DHAP) undergoing continuous infusion pump rate ≥ 200 mL/hr. Phase 2: Intervention period using a platinum-based regime (DHAP) undergoing continuous infusion pump rate ≤ 200 mL/hr. Results: Overall, 39 DHAP regimens were reported with a total number of 43 occlusions identified in the study period (phase 1, n=28 vs phase 2, n=15). Occlusion risk associated with the infusion pump rates between phases was higher in phase 1 (phase 1, n=11 vs phase 2, n=3, RR 3.313 [1.010 to 13.863], ≤0.05). When aspiration clot (n=5) was identified, CVC always was removed. No aspiration clot was observed in phase 2. Conclusion: Aggressive infusion pump flow rates can increase occlusion risk resulting from thrombus reflux into the CVC lumen and aspiration clot.

Background: Deep brain stimulation (DBS), levodopa‐carbidopa intestinal gel (LCIG) and subcutaneous apomorphine infusion are device‐aided therapies (DATs) for advanced Parkinson's disease (PD). We present a case series from the Cretan PD Registry who required 2 DATs for optimal management along with a systematic review of similar studies. Cases: From 2009 to 2020, we retrospectively studied all PD patients who were simultaneously treated with 2 DATs. Six patients on DBS required an infusion treatment for persisting or re‐emergent fluctuations because of disease progression. Two patients on LCIG infusion received DBS as a levodopa‐sparing strategy because of drug‐induced complications. Fluctuations and quality of life improved in all patients. Literature review: We identified 4 case series, 1 prospective and 1 retrospective study that included a total of 50 DBS‐treated patients who required an infusion therapy. Improvement in motor outcomes, assessed in different ways, was a constant finding. Conclusions: Selected PD patients on 1 DAT may experience additional benefit from a second DAT, for several reasons along the course of their disease. Although infusion therapies optimize dopaminergic drug delivery in fluctuating DBS‐treated patients, DBS added on LCIG treatment has an additive symptomatic effect that allows levodopa dose reduction in patients with drug‐induced side effects. [ABSTRACT FROM AUTHOR]

Intravenous (IV) fluid therapy is a common current medical practice, and the method has remained unchanged for more than a century. The IV bag is suspended from an IV stand or pole, and the pressure created by gravity is used to administer the drug. However, this method inevitably reduces the mobility of patients, and may cause accidents such as falls during movement. To solve these problems faced in home care, nursing home, and hospital settings, this study aims to develop a non-hanging, non-electrically driven IV infusion pump with reasonable portability and operability. In this study, instead of gravity, atmospheric pressure was used as the driving force. We developed several prototypes based on different pressurization mechanisms using vacuum piston cylinders as the driving mechanism, in order to find an optimum mechanism capable of producing a stable flow rate comparable to the suspended drip system. Tests on performance in terms of discharge flow rate were conducted on three feasible prototypes, based on three different pressurization mechanisms, using a gravimetric test bench built for this purpose. The tests showed that the pressurization mechanism using an inflating sleeping-bag-shaped air bag to compress a drip bag achieved the best performance in terms of flow rate stability.

Background: Cobalamin (cbl)-related remethylation disorders are a heterogeneous group of inherited disorders comprising the remethylation of homocysteine to methionine and affecting multiple organ systems, most prominently the nervous system and the bone marrow. To date, the parenteral, generally intramuscular, lifelong administration of hydroxycobalamin (OHCbl) is the mainstay of therapy in these disorders. The dosage and frequency of OHCbl is titrated in each patient to the minimum effective dose in order to account for the painful injections. This may result in undertreatment, a possible risk factor for disease progression and disease-related complications.Results: We describe parenteral administration of OHCbl using a subcutaneous catheter together with a portable infusion pump in a home therapy setting in four pediatric patients with remethylation disorders, two patients with cblC, one patient with cblG, and one patient with cblE deficiency, in whom intramuscular injections were not or no longer feasible. The placement of the subcutaneous catheters and handling of the infusion pump were readily accomplished and well accepted by the patients and their families. No adverse events occurred. The use of a small, portable syringe driver pump allowed for a most flexible administration of OHCbl in everyday life. The concentrations of total homocysteine levels were determined at regular patient visits and remained within the therapeutic target range. This approach allowed for the continuation of OHCbl therapy or the adjustment of therapy required to improve metabolic control in our patients.Conclusions: Subcutaneous infusion using a subcutaneous catheter system and a portable pump for OHCbl administration in combined and isolated remethylation disorders is safe, acceptable, and effective. It decreases disease burden in preventing frequent single injections and providing patient independence. Thus, it may promote long-term adherence to therapy in patients and parents. [ABSTRACT FROM AUTHOR]

For effective patient therapy and improved patient safety, it is critical to administer medication accurately in accordance with doctor's prescription. However, accidents owing to the erroneous programing of infusion pumps caused by users have been consistently reported in several documents. In this study, the authors propose a novel surveillance technique for infusion pumps to continuously monitor the variations in panel digits using a convolutional neural network model, and evaluate the performance of the implemented technique. During the experimental evaluation, 1st-step ROIs and 2nd-step ROIs were successfully extracted from the frame images regardless of the ambient lighting conditions. The final accuracies of the implemented CNN model are 99.9% for both the training (172,800 images) and validation (1080 images) dataset while the final losses for the training and validation datasets are 0.48 and 0.45 after 13th epoch, respectively. In the 24-h continuous monitoring test, the accuracy of the model for volume recognition considering all the 1440 measurements (960 for day-lighting and 480 for night-lighting) is 95.5%, whereas in day-lighting and night-lighting modes the accuracies of the model are 98.2% and 90.0%, respectively. Based on these experimental results, the proposed surveillance technique incorporating infusion pumps is expected to improve the safety of patients who need long-term treatments via infusion pumps, reducing the burden on the nurses and hospitals. [ABSTRACT FROM AUTHOR]

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Intravenous (IV) medication administration processes have been considered as high-risk steps, because accidents during IV administration can lead to serious adverse effects, which can deteriorate the therapeutic effect or threaten the patient's life. In this study, we propose a multi-modal infusion pump (IP) monitoring technique, which can detect mismatches between the IP setting and actual infusion state and between the IP setting and doctor's prescription in real time using a thin membrane potentiometer and convolutional-neural-network-based deep learning technique. During performance evaluation, the percentage errors between the reference infusion rate (IR) and average estimated IR were in the range of 0.50–2.55%, while those between the average actual IR and average estimated IR were in the range of 0.22–2.90%. In addition, the training, validation, and test accuracies of the implemented deep learning model after training were 98.3%, 97.7%, and 98.5%, respectively. The training and validation losses were 0.33 and 0.36, respectively. According to these experimental results, the proposed technique could provide improved protection functions to IV-administration patients. [ABSTRACT FROM AUTHOR]

Abstract Background Infusion sets designed for peristaltic finger smart pumps (PFSPs) are necessary for the pumps’ accurate handling. We previously found that medication dispensing is occasionally incomplete following the calculated infusion time when using certain combinations of PFSPs and infusion sets at a Japanese hospital. Thus, in this study, we investigated the cause of this observed delay by determining the effect of infusion set attachment technique on dispensing time using a combination of three kinds of PFSPs and five kinds of polyvinyl chloride (PVC) and polybutadiene (PB) infusion sets. Methods PFSPs with their exclusive infusion sets were used. The PVC and PB infusion sets were either not stretched or stretched to 1–3 cm and attached to the PFSP’s liquid delivery system. PFSP dispensing rates were set at 25–400 mL/h. The primary outcome was the time required to dispense 100 mL of saline in a volumetric flask. Results The complete dispensing time correlated with the input time for all equipment combinations when the infusion sets were not stretched before attachment to the PFSP (R2 = 0.9998–1.0000). When stretched, the complete dispensing time was longer than the input time (P

Background: Levodopa/carbidopa intestinal gel (LCIG) infusion is an efficacious treatment of motor and non-motor fluctuations in people with Parkinson's disease (PD). Real-life use of the treatment is not previously studied. Objective: The aims of the study were to explore the use of LCIG and to determine how extra doses of LCIG are used in daily life. Methods: Twenty-five PD patients with ongoing LCIG therapy were consecutively included. Pump data was retrieved from 30 days on average, by means of software, extracting the most recent pump events. Results: The daily duration of infusion was 15 hours on average, in 18 patients, whereas the remaining 7 patients used 24-hour infusion. Morning doses ranged from 38–190 mg levodopa, for patients who utilized this function. Median number of daily extra doses was 2.5 (range: 0–10.6) and median size of the extra dose was 24 mg (0–80 mg) levodopa. Median total daily levodopa intake with LCIG was 1201 mg (range: 417–2322 mg). Conclusion: Retrieving pump data is possible and may be important for evaluating the at-home use of LCIG, to optimize the therapy. Adherence to treatment should be monitored, which is not technically difficult, at least in device-aided treatments for PD. [ABSTRACT FROM AUTHOR]

Background: Arterial pressure lability is common during the process of replacing syringes used for norepinephrine infusions in critically ill patients. It is unclear if there is an optimal approach to minimise arterial pressure instability during this procedures. We investigated whether 'double pumping' changeover (DPC) or automated changeover (AC) reduced blood pressure lability in critically ill adults compared with quick syringe changeover (QC).Methods: Patients requiring a norepinephrine infusion syringe change were randomised in a non-blinded trial undertaken in six ICUs. Randomisation was minimised by norepinephrine flow rate at inclusion and centre. The primary outcome was the frequency of increased/decreased mean arterial pressure (defined by 15 mm Hg from baseline measurements) within 15 min of switching the syringe compared with QC.Results: Patients (mean age: 64 (range:18-88)) yr were randomly assigned to QC (n=95), DPC (n=95), or AC (n=96). Increased MAP was the commonest consequence of syringe changeovers. MAP variability was most frequent after DPC (89/224 changeovers; 39.7%) compared with 57/223 (25.6%) changeovers after quick syringe switch and 46/181 (25.4%) in patients randomised to receive automated changeover (P=0.001). Fewer events occurred with QC compared with DPC (P=0.002). Sensitivity analysis based on mixed models showed that performing several changeovers on a single patient had no impact. Both type of changeover and norepinephrine dose before syringe changeover were independently associated with MAP variations >15 mm Hg.Conclusions: Quick changeover of norepinephrine syringes was associated with less blood pressure lability compared with DPC. The prevalence of MAP variations was the same between AC and QC.Clinical Trial Registration: NCT02304939. [ABSTRACT FROM AUTHOR]

Purpose To outline a data-driven analysis involving use of intravenous (i.v.) pump data to identify optimal drug and fluid amounts for various continuous infusions, with the primary goal of minimizing medication waste. This methodology incorporates analysis of vial sizes, infusion rates, number of bag exchanges, and bag volumes to determine optimal concentrations that improve operational efficiencies and decrease drug and fluid waste. Methods A retrospective evaluation of i.v. infusion pump utilization data for continuous infusions of norepinephrine, phenylephrine, vasopressin, and cisatracurium was performed using data provided by 9 hospitals in North Carolina during January, April, and June of 2015. Results The recommended medication concentrations and fluid volumes were determined using a novel 4-step analysis, the VERB (Vial, Exchange, Rate, and Bag) analysis, which applied optimal practices for cost reduction, operational efficiency, and patient safety. The application of the VERB analysis to the i.v. infusion pump utilization data resulted in the following recommended medication concentrations: norepinephrine, 4 mg/100 mL (final concentration, 40 µg/mL) and 16 mg/250 mL (final concentration, 64 µg/mL); phenylephrine, 10 mg/100 mL (final concentration, 100 µg/mL); vasopressin, 20 units/100 mL (final concentration, 0.2 unit/mL); and cisatracurium, 200 mg/100 mL (final concentration, 2 mg/mL). It was determined that implementation of the recommended concentrations by the 9 study hospitals would result in significant medication cost savings and fluid volume savings. Conclusion Analysis of i.v. infusion pump data from multiple hospitals using VERB analysis resulted in standardized medication concentrations and bag sizes for continuous infusions that reduce drug and fluid waste and improve operational efficiencies. [ABSTRACT FROM AUTHOR]

Objective: The current study aimed to evaluate the extent of the slide‐stick phenomenon in differently designed infusion syringes at various infusion rates and filling positions. Methods: Fluid delivery from three 50‐mL infusion syringe brands (BD; Codan; Fresenius) was investigated using a flow sensor at flow rates of 0.5, 1.0, or 5.0 mL h−1, with the syringes filled with either 10, 30, or 50 mL of distilled water. Two identical models (A/B) of the same infusion pump model were used. The effect of flow rate variations on the plasma concentration of a continuous epinephrine infusion in a 3 kg neonate receiving a continuous infusion of 0.1 μg kg min−1 epinephrine was studied using a pharmacokinetic simulation model. Results: Considerable variations in calculated plasma epinephrine concentration were detected between flow rates of 5 and 0.5 or 1 mL h−1 for all syringe types and filling volumes. The median deviation of plasma concentration for the 5 mL h−1 flow rate varied depending on assembly from 1.3% (Codan) to 1.8% (Fresenius). This was more pronounced for lower flow rates, where at 1 mL h−1 the deviation varied from 3.3% (BD) to 4.8% (Fresenius) and at 0.5 mL h−1from 4.9% (BD) to 5.4% (Fresenius). Differences between filling volumes (within syringe type and flow rate) did not appear to have relevant influence on variations in calculated plasma epinephrine concentration. Conclusion: Infusion set rate rather than syringe brand or filling volume was a major predictor for syringe stiction‐related amount of variation in the calculated plasma epinephrine concentration. [ABSTRACT FROM AUTHOR]