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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]