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Objective: This study aimed to assess the impact of the coronavirus disease (COVID-19) pandemic on the quality of life (QOL) of children with type 1 Diabetes Mellitus (T1DM) and their families, specifically focusing on the effects of insulin infusion pumps. We also aimed to identify changes in both children's and parents' QOL during the pandemic period. Method: This study utilized the KINDL (KINDer Lebensqualitätsfragebogen: Children's QOL) questionnaire for the children, and the World Health Organization Quality of Life (WHOQOL)-BREF Turkish Version (TR) (WHO-QOL-BREF-TR) scale for their parents. Data were collected using Google Forms, with assessments performed before and during the pandemic. Results: The study included 61 participants, 38 of whom were female (62.3%), with a mean age of 12.7±2.9 years and a mean diabetes duration of 6.4±2.5 years. Pre-pandemic KINDL scores for "emotional health" and "school" were significantly higher than those during the pandemic (p=0.022 and p=0.002, respectively). Surprisingly, HbA1c levels improved during the pandemic compared to the pre-pandemic values (p<0.001). There were strong correlations between children's and parents' QOL before and during the pandemic (p<0.001). Parents' physical health scores on the WHOQOL-BREF decreased significantly during the pandemic (p=0.012). Conclusion: Improvement in HbA1c levels during the pandemic warrants further investigation. Additionally, the pandemic negatively affected the emotional well-being of children and the physical health of parents, highlighting the need for more support in these areas during times of crisis. [ABSTRACT FROM AUTHOR]

BACKGROUND: Elastomeric pumps have a curved infusion rate profile over infusion time. Chemically driven pumps can overcome such limitations of elastomeric pumps and infuse constantly. However, studies on the pharmacokinetic benefit of chemically-driven pumps are insufficient. OBJECTIVE: This study aimed to determine effects of constant infusion with a chemically-driven pump on plasma drug concentrations compared to elastomeric pumps. METHODS: Infusion rate profiles of a chemically driven pump and two elastomeric pumps were measured in vitro tests under three height conditions of drug reservoir. Plasma drug concentrations were estimated using a pharmacokinetic model of 5-fluorouracil (5FU). RESULTS: The chemically-driven pump was more accurate than elastomeric pumps during the total infusion time (Root-mean-square-error (RMSE): 3% vs. 13%) which thus reduced its deviation of plasma 5FU concentration over time to one-fifth of that with an elastomeric pump. The chemically-driven pump had less than 5% of RMSE despite the influence of height difference. CONCLUSION: Although chemically-driven pumps maintained plasma 5FU concentration successfully and elastomeric pumps did not, both pumps were proper for 5FU infusion because the time-dependent changes in infusion rate did not affect the area under the curve. Chemically driven pumps would be more advantageous for drugs that are sensitive to their plasma concentrations. [ABSTRACT FROM AUTHOR]

The article presents the results of a randomized controlled trial comparing the efficacy of Apotel and remifentanil patient-controlled analgesia in managing postoperative pain in patients who underwent total knee arthroplasty (TKA). Data collected include hemodynamic parameters, analgesic duration, pain levels, and drug consumption. Based on the results, remifentanil is better than Apotel in providing pain relief to patients.

Background: Standard concentration infusions and 'smart-pumps' are recognised as best practice in the paediatric setting. Implementation rates in European hospitals remain low. Children's Health Ireland (CHI) developed a paediatric 'smart-pump' drug library using standardised concentrations. At time of development, other Irish hospitals continued to use traditional pumps and weight-based paediatric infusions. Aim: To expand best paediatric infusion practices by nationalising use of the CHI drug library. Setting: Tertiary paediatric, maternity and general acute hospitals, and associated transport services in Ireland. Development: The CHI drug library was first developed for paediatric intensive care and then adapted over a 10-year period for use in emergency departments, general paediatric wards, neonatal units, adult intensive care and transport services. The original library (42 drug lines, 1 'care-unit') was substantially expanded (223 drug lines, 6 'care-units'). A neonatal sub-library was created. Implementation: Executive support, dedicated resources and governance structures were secured. Implementation and training packages were developed. Implementation has occurred across CHI, in paediatric and neonatal transport services, 58% (n = 11) of neonatal units, and 23% (n = 6) of paediatric sites. Evaluation: A before and after study demonstrated significant reductions in infusion prescribing errors (29.0% versus 8.4%, p < 0.001). Direct observation of infusions (n = 1023) found high compliance rates (98.9%) and low programming errors (1.6%). 100% of nurses (n = 132) surveyed 9 months after general ward implementation considered the drug library had enhanced patient safety. Conclusion: Strategic planning and collaboration can standardise infusion practices. The CHI drug library has been approved as a National Standard of Care, with implementation continuing. [ABSTRACT FROM AUTHOR]

Purpose Smart pump bidirectional interoperability offers automated infusion programming and documentation that can improve patient safety and workflow efficiency. This technology has been poorly implemented across US hospitals, and there is little guidance on the tracking or monitoring of interoperability systems. The purpose of this report is to describe the successful implementation of intravenous (IV) smart pump interoperability in a large health system. Summary Bidirectional IV smart pump interoperability and compliance monitoring were implemented across a large Midwestern health system using ICU Medical's Plum 360 and LifeCare PCA devices and Smith Medical's MedFusion 4000 Syringe Pump devices. The hospital system's experience in implementing and monitoring IV smart pump compliance using automated reports and a dedicated medication safety integration nurse is described. Compliance trends suggest that the implementation of IV smart pump interoperability has achieved a reduction in programming outside of the dose error reduction system, manual overrides, and IV medication administration error rates. Conclusion The monitoring of smart pump compliance has had demonstrated benefits in investigating usability concerns, recognizing system errors, and identifying increased needs for nurse training. This program can serve as an example for other healthcare systems adopting IV smart pump interoperability. [ABSTRACT FROM AUTHOR]

Background: Patient-controlled analgesia (PCA) pumps are complex medical devices frequently used for postoperative pain control. Differences in how nurses program PCA pumps can lead to preventable medication errors. Purpose: To describe similarities and differences in how surgical nurses program PCA pumps. Methods: We conducted a qualitative study using video reflexive ethnography (VRE) to film nurses as they programmed a PCA pump. We spliced and collated videos into separate clips and showed to nursing leaders for their deliberation and action. Results: We found nurses ignored or immediately silenced alarms, were uncertain about the correct programming sequence, and interpreted how to load a syringe in the pump in multiple ways; in addition, the PCA pump design did not align with nurses’ workflow. Conclusions: VRE was effective in visualizing common challenges nurses experienced during PCA pump programming. Nursing leaders are planning several nursing process changes due to these findings. [ABSTRACT FROM AUTHOR]

Purpose With the implementation of a new electronic health record (EHR) system across Mayo Clinic, a project was approved to standardize and converge 9 region-specific large-volume infusion pump (LVP) drug libraries for Baxter SIGMA Spectrum pumps. Summary The objectives of the project were to (1) develop recommendations for identified variances in practice, (2) consolidate regional drug libraries into a converged enterprise library, (3) improve the drug library management process, and (4) maintain or exceed previous Dose Error Reduction System (DERS) compliance for infusions administered. Harmonization efforts with infusion pumps decreased the number of drug libraries maintained, reduced content maintenance time, and increased readiness for smart infusion pump–EHR interoperability. Seven of the 8 regions for which change in DERS compliance was assessed showed improved compliance relative to baseline in the 30-day postwashout period. Furthermore, when comparing pre- and postimplementation DERS compliance, the number of regions meeting the minimum compliance rate of 95% increased from 5 to 6 regions. Conclusion The project improved the drug library management process, allowed for DERS compliance to be accurately compared across regions, and ensured that patients across the enterprise receive the same standard of care with the administration of intravenous medications. [ABSTRACT FROM AUTHOR]

Background: Intrathecal Drug Delivery Systems are underutilised in the management of refractory cancer pain despite evidence of their efficacy. Not all patients who are offered this treatment modality accept it. There is no current evidence that indicates if the use of intrathecal drug delivery systems impacts on place of care for patients with cancer related pain. Aims: This service evaluation compared place of care, place of death and morphine equivalent daily dose at end of life for patients in whom Intrathecal Drug Delivery was successfully established versus those who chose comprehensive medical management. Setting/participants: A retrospective longitudinal cohort study of 45 patients with cancer pain comparing those who had ongoing analgesia successfully delivered via an implanted Intrathecal Drug Delivery System (n = 28) with those who continued to receive comprehensive medical management (n = 17). Results: There was a markedly greater time spent in the community in the intrathecal group than the medical management group (median 126.5vs 25.5 days; p = 0.002) and a lower morphine equivalent daily dose at end of life (median 127.5vs 440.0 p = 0.022). Conclusion: In patients with advanced cancer, the successful establishment of intrathecal analgesia is associated with more time in the community and a lower morphine equivalent daily dose at end of life. The study has low numbers, and the sample was retrospectively selected. Nevertheless, these findings suggest the initial investment of time in an inpatient setting may be beneficial. Further research is required, using larger, prospective studies of patient outcomes in this setting. [ABSTRACT FROM AUTHOR]

Abstract Background Infusion Pumps (IP) are medical devices that were developed in the 1960s and generate fluid flow at pressures higher than that of normal blood pressure. Various hospital sectors make use of them, and they have become indispensable in therapies requiring continuity and precision in the administration of medication and/or food. As they are classified Class III (high risk) equipment, their maintenance is crucial for proper performance of the device, as well as patient and operator safety. The principal consideration of the pump is the volume infused, and the device demands great attention to detail when being calibrated. A lack of necessary care with this equipment can lead to uncertainty in volume and precision during the administration of substances. Because of this, it is essential to evaluate its reliability, to prevent possible failures at time of execution. This control aims at the quality of the intended infusion result, becoming an indication of quality. Methods This systematic review summarizes studies done over the last 10 years (2011 to December 2021) that address the reliability and accuracy of hospital infusion pumps, in order to identify planning of maintenance and/or other techniques used in management of the equipment. The Prisma method was applied and the databases utilized were Embase, MEDLINE/Pubmed, Web of Science, Scopus, IEEE Xplore, and Science Direct. In addition, similar reviews were studied in Prospero and the Cochrane Library. For data analysis, softwares such as Mendeley, Excel, RStudio, and VOSviewer were used, and Robvis helped in plotting risk of bias results for studies performed with Cochrane tools. Results The six databases selected produced 824 studies. After applying eligibility criteria (inclusion and exclusion), removing duplicates, and applying filters 1 and 2, 15 studies were included in the present review. It was found that the most relevant sources came from the Institute of Electrical and Electronics Engineers (IEEE) and that the most relevant keywords revolved around the terms (“device failure”, “infusion pumps”, “adverse effects”, “complications”, etc.). These results made clear that there remains substantial room for improvement as it relates to the study of accuracy and reliability of infusion. Conclusions We verified that the reliability and precision analysis of hospital infusion pumps need to be performed in a more detailed and consistent way. New developments, considering the model and IP specification, are intended, clearly explaining the adopted methodology.

Background and Aims : This study aimed to compare manual infusion versus target-controlled infusion (TCI) in total intravenous anaesthesia (TIVA) utilising laryngeal mask airway (LMA)-gastro during endoscopic retrograde cholangio-pancreatography (ERCP) procedures. Methods: This was a single-blind randomised trial. Patients were randomly allocated into two groups. TCI group included 27 patients, where TCI of propofol was implemented with the Schnider pharmacokinetic model driven by a computer-controlled syringe pump. The TIVA group included 27 patients with a loading dose of 2 mg/kg of propofol, followed by manual infusion of 15 mg/kg/h for the first 15 min, 13 mg/kg/h for the next 15 min, then 11 mg/kg/h for 30 min and 10 mg/kg/h for 60 min and finally maintained at 9 mg/kg/h. The primary objective was to compare recovery time following cessation of propofol infusion in both groups. The difference in the total dose of propofol, time to achieve anaesthesia induction, first attempt success rate, ease of LMA-gastro insertion, ease of insertion, success rate of endoscope device and post-anaesthesia care unit (PACU) discharge time were the secondary objectives. T-test and Chi-square test were used for statistical analysis. Results: The time required for the recovery was significantly less in the TCI group than in the TIVA group (mean ± standard deviation; 11.60 ± 2.27 versus 15.4 ± 3.25 minutes, P < 0.001). The duration of ERCP, ease of LMA and endoscope insertion were comparable between the groups. There was no post-operative recall of intra-operative events in the groups. Conclusion: TCI offers earlier recovery than TIVA in patients undergoing ERCP procedures using LMA-gastro.

"IV ALERT" is a portable and light-weight device for monitoring the volume of fluid delivered from a gravity-fed infusion bottle and activating an alarm at 80%, 90% and 100% of the preset target volume. A load cell with a high accuracy strain gauge is used to activate a microcontroller and an internal timer. We hypothesized that the accuracy of the device to sound an alarm will be unaffected by the viscosity of the fluid suspended. The experimental set-up was established after ethical approval. Normal saline, Ringer's Lactate, Dextrose 5% and Dextrose Normal Saline were suspended with different settings of target volume from the device. The drained volume of fluid was collected in the measuring cylinder and the experiment terminated on activation of the alarm. Calculation of the percentage error {difference between the measured volume and theoretical value (preset target volume), divided by the theoretical value and multiplied by 100} was used to assess the accuracy of the device to sound the alarms. Total of 1818 observations were made and the percentage error was 0.017 ± 0.016 (mean ± SD) which was comparable at 80%, 90% or 100% of set target volumes for all the four types of fluids. Using the same principle in the reverse order, it is being tested as a urinometer where increase in weight of the urobag suspended from it due to the collection of urine is displayed as volume. IV Alert has also been made Wi-Fi-enabled for remote monitoring from the nursing station. [ABSTRACT FROM AUTHOR]

Background and Aims: This study aimed to compare manual infusion versus target-controlled infusion (TCI) in total intravenous anaesthesia (TIVA) utilising laryngeal mask airway (LMA)-gastro during endoscopic retrograde cholangio-pancreatography (ERCP) procedures. Methods: This was a single-blind randomised trial. Patients were randomly allocated into two groups. TCI group included 27 patients, where TCI of propofol was implemented with the Schnider pharmacokinetic model driven by a computer-controlled syringe pump. The TIVA group included 27 patients with a loading dose of 2 mg/kg of propofol, followed by manual infusion of 15 mg/kg/h for the first 15 min, 13 mg/kg/h for the next 15 min, then 11 mg/kg/h for 30 min and 10 mg/kg/h for 60 min and finally maintained at 9 mg/kg/h. The primary objective was to compare recovery time following cessation of propofol infusion in both groups. The difference in the total dose of propofol, time to achieve anaesthesia induction, first attempt success rate, ease of LMA-gastro insertion, ease of insertion, success rate of endoscope device and post-anaesthesia care unit (PACU) discharge time were the secondary objectives. T-test and Chi-square test were used for statistical analysis. Results: The time required for the recovery was significantly less in the TCI group than in the TIVA group (mean ± standard deviation; 11.60 ± 2.27 versus 15.4 ± 3.25 minutes, P < 0.001). The duration of ERCP, ease of LMA and endoscope insertion were comparable between the groups. There was no post-operative recall of intra-operative events in the groups. Conclusion: TCI offers earlier recovery than TIVA in patients undergoing ERCP procedures using LMA-gastro. [ABSTRACT FROM AUTHOR]

Abstract Aim To understand the experience of critical care nurses when performing common, yet error‐prone, programming tasks on two unfamiliar intravenous smart pumps. Design A qualitative descriptive study using data collected during a previous quantitative pilot study. Methods Following completion of common intravenous programming tasks each participant was interviewed using a semi‐structured interview guide. All interview data were coded line‐by‐line and thematic analysis revealed themes across all participants' interviews. Results The following four themes were identified: appreciation for attractive design features, the need for efficiency, the importance of intuitive use and concern for patient outcomes. Overall, these themes provide evidence that nurses strongly prefer a more usable intravenous smart pump interface that integrates safeguards to efficiently improve patient outcomes. Findings support the need for intravenous smart pump technology to be developed with an intuitive interface that decreases the level of cognitive demand and will lead to improved patient safety.

Purpose Medication errors are a significant and preventable source of patient harm, especially in the neonatal population. Standardized infusion concentrations increase patient safety and streamline the workflow for pharmacists, nurses, and physicians. Methods Neonatal continuous infusion concentrations were standardized and implemented into the electronic health record using an automated order panel. Pre- and postimplementation data were collected to assess the impact of this quality improvement initiative. The primary endpoint was the proportion of neonatal intensive care unit infusion orders that were compatible with "bolus from infusion" functionality in the syringe pump. Results Before implementation, only 40% of eligible infusions were compatible with the "bolus from infusion" function, compared to 93% after implementation (P < 0.00001). Within the syringe pump, the ratio of total options to the number of concentrations per medication was reduced by 31%. Conclusion Implementation of an order panel with defaulted standard infusion concentration selection improved workflow and optimized technology in the neonatal intensive care unit. [ABSTRACT FROM AUTHOR]

BACKGROUND: Introduction of fluids, medicaments and nutrients into the human body during hospitalization is fundamental for treatment and healing of patients. Fluids are introduced by means of infusion pumps while nutrients and medicaments are introduced by perfusion pumps. It is of vital importance for these devices to deliver exact amounts of the aforementioned substances as significant deviations can result in severe patient harm. Therefore it is important to effectively monitor their performance and prevent failures. OBJECTIVE: This paper proposes a novel method for conformity assessment testing of infusion and perfusion pumps for post-market surveillance purposes. METHOD: The method was developed on the basis of metrology characteristics of the devices. In addition to the evaluation of essential safety and visual integrity of infusion and perfusion pumps, their performance in terms of delivered volumes was assessed and monitored. RESULTS: The developed method was validated between 2018 and 2021 in healthcare institutions of all levels. The results obtained during validation suggest that conformity assessment testing of infusion and perfusion pumps as a method used during PMS contributes to significant improvement in devices' accuracy and reliability. CONCLUSION: A standardized approach in conformity assessment testing of infusion and perfusion pumps during PMS, besides increasing reliability of the devices, is the first step in digital transformation of management of these devices in healthcare institutions opening possibility for use of artificial intelligence. [ABSTRACT FROM AUTHOR]

Parkinson's disease (PD) is in some cases predisposed-or-caused by genetic variants, contributing to the expression of different phenotypes. Regardless of etiology, as the disease progresses, motor fluctuations and/or levodopa-induced dyskinesias limit the benefit of pharmacotherapy. Device-aided therapies are good alternatives in advanced disease, including deep brain stimulation (DBS), levodopa-carbidopa intestinal gel, and continuous subcutaneous infusion of apomorphine. Candidate selection and timing are critical for the success of such therapies. Genetic screening in DBS cohorts has shown a higher proportion of mutation carriers than in general cohorts, suggesting that genetic factors may influence candidacy for advanced therapies. The response of monogenic PD to device therapies is not well established, and the contribution of genetic information to decision-making is still a matter of debate. The limited evidence regarding gene-dependent response to device-aided therapies is reviewed here. An accurate understanding of the adequacy and responses of different mutation carriers to device-aided therapies requires the development of specific studies with long-term monitoring. [ABSTRACT FROM AUTHOR]

Home infusion therapy is a rapidly growing field in healthcare, allowing patients to receive postacute care at home at a fraction of the cost of an inpatient stay. Understanding the various drug delivery systems can facilitate a more seamless discharge to home with improved patient outcomes. Herein we review several home infusion methods of administration utilized to transition patients from hospital to home care for a variety of therapies. [ABSTRACT FROM AUTHOR]

Peristaltic pumps have been put to use in various biomedical applications like devices for the transfer of body fluids as well as devices for controlled release of medication, including implantable infusion pumps. Out of the various components of a peristaltic pump, tubing is considered the most vulnerable part. This study focuses on the performance of Silicone micro-pump tubing used in such an implantable drug delivery device. Long-term implantable medical devices are expected to be operational for about 10 years. But experimental testing of the reliability of components under normal working speeds are time-consuming and thus delays the product development cycle. While simulating the conditions in the laboratory under accelerated speeds, the effect of increasing the speed must be accounted. In this study, the effect of accelerated speed and rotor material on pump tubing life is investigated. A test jig is developed which simulates the running conditions of the infusion pump for long-duration operation. Different rotor speeds and material configurations are investigated to obtain their effect on long-duration performance. Thermal effects on the roller junctions are studied and found that the Delrin silicone combination has twice the rise in junction temperature than the titanium silicone combination. The failure modes are inspected using microstructure analysis and the best configuration is identified. [ABSTRACT FROM AUTHOR]

Objective: The prehospital treatment for stable patients with atrial fibrillation with rapid ventricular response is rate-controlling agents such as calcium channel blockers, often diltiazem given as a bolus. At our agency we encourage the use of a bolus given via the infusion pump over two to four minutes immediately followed by a maintenance infusion, given concerns of recurrent tachycardia or hypotension secondary to rapid bolus administration. We examined if administering a bolus and infusion via an infusion pump shows better heart rate (HR) control at arrival to the emergency department (ED) compared with administration of a bolus only, while maintaining hemodynamic stability during transport. We also analyzed if a patient received a second bolus within 60 min of arrival to the ED., Methods: We used a retrospective propensity-matched cohort of prehospital patients with atrial fibrillation for whom diltiazem was administered, from 1/1/2018 to 12/31/2021, in our system of 10 New Jersey paramedic units. We analyzed the age, gender, and initial HR and used it to match groups. We analyzed the mode and time of administration, dosage of the bolus, and presence of hypotension prehospitally., Results: The matched groups contained 145 patients who received a prehospital diltiazem bolus only (BO) and 146 patients who received a diltiazem bolus and infusion (BI). There was no significant difference between the mean change in HR from initial paramedic arrival to ED arrival between the two groups (BO 38 vs. BI 34, p  = 0.16). There was no significant difference in the need for a second bolus within the first 60 min of arrival to the ED (BO 9.7% vs. BI 11.6%, p  = 0.30). Patients in the BO group were more likely to experience prehospital hypotension then in the BI group (BO 17.2% vs BI 8.2%, p  = 0.01), despite receiving smaller initial bolus doses (BO 14.2 mg vs. BI 17.4 mg, p  < 0.001)., Conclusion: Our results show no significant differences in HR control or need for repeat bolus at the ED with the use of a diltiazem infusion following a diltiazem bolus. However, even when administering larger boluses, the use of an infusion pump resulted in less hypotension.

Background: Parkinson's disease (PD) is a neurodegenerative disorder affecting both sexes, but differences exist between male and female in clinical manifestations, functional impact of symptoms and hormonal influences. Therefore, representativeness of females in PD trials indirectly determines the external validity of the clinical research in this field., Objective: To estimate the representativeness of female in infusion therapy trials for advanced PD., Methods: PubMed and EMBASE databases were searched (1980 to September 2023), along with congress abstracts, to identify controlled clinical trials and large non-controlled studies on infusion therapies in PD enrolling >100 patients. Random-effect meta-analysis was conducted to estimate mean pooled prevalence of females included in the studies. Subgroup analyses were conducted accordingly to study design and intervention., Results: We included 15 studies (six studies on levodopa-carbidopa intestinal gel, six on subcutaneous levodopa, two on subcutaneous apomorphine, and one on levodopa-carbidopa-entacapone intestinal gel). Sex was not a randomisation stratification factor in any of these studies. Only one study explored differences in the outcome estimated according to sex. Overall, the proportion of female included was 38% (95% CI:33%-43%; I 2  = 74%), without differences between studies assessing different type of interventions (p = 0.72) or between study design (p = 0.35). In two studies, females represented the majority of included patients., Conclusion: Female with advanced PD are underrepresented in infusion therapy trials. Most trials have overlooked sex-based biological differences that can impact clinical and functional outcomes, raising concerns about the generalizability of these findings to real-world contexts., (© 2025 The Author(s). European Journal of Neurology published by John Wiley & Sons Ltd on behalf of European Academy of Neurology.)

Background: Flushing catheter seems to be a crucial procedure for preventing centrally inserted central catheter (CICC) occlusion, which can flush the liquid and blood attached to the lumen into the bloodstream. The continuous infusion technique is characterized by continuous perfusion of flushing fluid and maintaining positive pressure in the lumen, which has been demonstrated to effectively prevent peripheral indwelling needle occlusion. However, the use of continuous infusion technique in CICC care among critically ill patients has been rarely described., Objective: To determine the feasibility and direct outcomes of continuous infusion technique in preventing CICC occlusion among critically ill patients., Methods: Participants from the intensive care unit who had a new centrally inserted central catheter placed within 24 hours were randomly assigned to 2 groups at a ratio of 1:1. They received pulsed infusion or continuous catheter infusion using pre-filled elastic pumps. During the trial period, on days 3 and 7 and whenever there were signs of catheter occlusion, whether the catheter occlusion was evaluated by the Catheter Injection and Aspiration Classification. Moreover, nurses meticulously observed the incidence of catheter-related complications, altered vital signs, and dysfunctions of elastic pump., Results: The catheter occlusion rates were 17.4% and 43.5% in participants who received continuous infusion (n = 23) and those who received pulsed infusion (n = 23), respectively. There was no significant difference in catheter occlusion rate between the 2 groups (χ² = 3.696, P = .06). The Kaplan-Meier curve results showed that the cumulative probability of central catheter occlusion events (within 7 days) in the continuous infusion group decreased (χ²=4.322, Log rank P = .04). Moreover, multivariate Cox regression indicated that the continuous infusion can reduce the risk of occlusion within 7 days by 91.8% (hazard ratio = 0.082, 95% confidence interval [0.014-0.487], P = .006). During the trial, no cases of detrimental altered vital signs and catheter-related complications in addition to occlusion were documented., Conclusions: In this study, continuous infusion technique with pre-filled elastic pumps was successfully used in critically ill patients for prevention of CICC occlusion, without major undesired effects. A larger cohort and a randomized clinical trial are warranted in order to establish its absolute efficacy in CICC care., Competing Interests: The authors have no conflicts of interest to disclose., (Copyright © 2024 the Author(s). Published by Wolters Kluwer Health, Inc.)

Background: Propofol accounts for a substantial proportion of medication waste. Evidence-based waste reduction methods are scarce., Methods: In a retrospective analysis of 331 procedures, the total propofol waste per surgery was compared between manual and syringe pump induction of anaesthesia during total intravenous anaesthesia (TIVA), with a syringe pump used to maintain TIVA after induction. The secondary endpoint was the amount of propofol administered. Subgroup analyses examined the influence of biological sex, age, weight or BMI, American Society of Anesthesiologists (ASA) physical status, substance use, and anaesthesia duration on propofol waste., Results: Syringe pump induction was associated with 32.8% less waste of propofol (P<0.001); this effect was most pronounced in procedures lasting 20-60 min (up to 46.9% less in procedures lasting 20-40 min, P<0.001) and 80-120 min (up to 48.8% less in procedures lasting 100-120 min, P=0.003). The amount of waste was not affected by biological sex, age, weight, BMI, or ASA physical status. Syringe pump induction was consistently associated with less waste, except in patients with obesity. Patients with active substance use had 27.6% more waste with manual induction (P=0.031) but not with syringe pump induction. In patients with and without active substance use, syringe pump induction resulted in less waste (substance use: 48.7% less, P=0.0015; without substance use: 22.7% less, P=0.0045)., Conclusions: Syringe pump induction reduced propofol waste during TIVA, regardless of patient characteristics. Manual induction using a separate syringe should be reconsidered from an environmental and economic viewpoint., Clinical Trial Registration: DRKS00032518I., (Copyright © 2024 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

Health care providers use several types of syringes in their daily routine to provide or safely deliver therapeutic agents to patients. Pump infusion with a syringe (PIS) are used for the rapid delivery of large amounts of fluid or blood to patients in critical conditions, such as hypovolemic shock. Patients often experience bacterial infections, such as catheter-related bloodstream infections, specifically when they are in critical condition in the intensive care unit (ICU) after surgery or undergoing resuscitation in an emergency department. A previous study has shown that PIS may cause intraluminal contamination. This study compared PIS-induced contamination among different types of available syringes, including disposable plastic syringes produced by several companies, glass syringes, and syringes with plastic covers. The authors found that plastic syringes caused approximately equivalent PIS-induced contamination and that glass syringes caused substantially more contamination than plastic syringes. However, syringes equipped with a plastic cover exhibited no contamination. Furthermore, disinfection with ethanol completely prevented PIS-induced contamination. This study supports the evidence that PIS may cause bacterial contamination and that a thorough aseptic technique is needed, especially when using glass syringes. These findings highlight the need to develop alternative devices for rapid infusion., Competing Interests: Conflict of Interest:The authors of this article have no conflicts of interest to disclose., (Copyright © 2024 Infusion Nurses Society.)

Background: The Institute for Safe Medication Practices and The Joint Commission recommend the implementation of bidirectional smart infusion pump interoperability with the electronic health record (EHR) to improve medication safety. However, there are barriers associated with implementation of this process., Purpose: The purpose of this process improvement project was to identify, evaluate, and implement improvements in pump integration with the EHR to decrease manual programming and increase the use of the smart pump functions (the dose error reduction system or infusion guardrails)., Methods: A medication safety task force was formed, and end users were surveyed for barriers. The task force found and implemented solutions to improve the process., Results: Infusion pump integration rates for seven hospitals improved from 79.4% to 91.8% ( p < .001), and the use of smart pump programming increased from 84.7% to 93.6%., Conclusions: Including all stakeholders in the project allowed barriers to be identified and solutions to be implemented. As more healthcare systems implement technology-related processes to improve patient safety, this work can guide medication safety teams on how to optimize technology use by removing barriers to the use of pump integration with the EHR., Competing Interests: The authors declare no conflicts of interest., (Copyright © 2024 National Association for Healthcare Quality.)

Infusion pump-based therapies are an effective treatment option for patients with advanced Parkinson´s disease. Achieving monotherapy with infusion-based therapies could simplify the treatment regimen, provide better medication adherence, reduce adverse events and drug interactions. This review presents the literature data on the efficacy, safety, and achievability of monotherapy with all available infusion-based therapies, including apomorphine, levodopa-carbidopa-intestinal gel (LCIG), levodopa-entacapone-carbidopa intestinal gel (LECIG), and foslevodopa-foscarbidopa (LDp/CDp). In summary, monotherapy is achievable and effective in most patients on intestinal levodopa infusion therapy and in some patients on apomorphine infusion. There is a need for further investigation of monotherapy compared to polytherapy, especially in new pump treatment options (LECIG and LDp/CDp). Future research should reveal which patients on infusion-based therapies could benefit from monotherapy, including identification of potential baseline predictors of achieving monotherapy in patients treated with specific infusion-based therapies., (© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Austria, part of Springer Nature.)

Background and Aims: Propofol is the drug of choice for sedation in daycare procedures due to its pharmacokinetic properties. Propofol delivery using target-controlled infusion (TCI) pump reduces adverse effects like hypotension and apnoea. In this study, we estimated the median effective effect-site concentration of propofol in patients undergoing dilatation and curettage. Methods: Patients of the American Society of Anesthesiologists physical status class I–III, aged 40–70 years, undergoing elective dilatation and curettage were recruited for the study. All patients received 1 μg/kg fentanyl and 20 mg lignocaine. The first patient received an effect-site concentration of propofol at 4 μg/mL with TCI Schneider pharmacokinetic model. Failure was defined as patient movement at any time during the procedure. According to the 'BiasedCoin Design' up-and-down sequential method, the response of the previous patient determined the effect-site concentration of propofol of the next patient. The study was terminated once forty patients completed the procedures successfully. Probit analysis was used to determine EC50. Results: Fifty-three patients were recruited for the study. The various effect-site concentrations of propofol EC50, EC90, and EC95 in providing sedation for dilatation and curettage were 3.38 μg/mL, 4.29 μg/mL, and 4.60 μg/mL, respectively. The incidence of hypotension and apnoea were comparable among the various concentrations of propofol. The mean duration of the propofol infusion was 20 ± 2.86 min. The time to recovery from propofol sedation was 6.97 ± 1.76 min. Conclusion: A median effective effect-site concentration of 3.38 μg/mL of propofol is required to prevent patient movement during uterine dilatation and curettage.

Time lags between the initiation of a continuous drug infusion and achievement of a steady state delivery rate present an important safety concern. At least 3 factors contribute to these time lags: (1) dead volume size, (2) the ratio between total system flow and dead volume, and (3) startup delay. While clinicians employ both peristaltic pumps and syringe pumps to propel infusions, there has been no head-to-head comparison of drug delivery between commercially available infusion pumps with these distinct propulsion mechanisms. We quantified the delivery of a model drug by peristaltic and syringe pumps at clinically relevant flow rates using spectrophotometric absorbance. Delivery curves were modeled and compared, and the time required to reach 5% (T5), 50% (T50), and 95% (T95) of the intended delivery rate was reported. The ability to overcome the combined effects of startup delay and dead volume differed between syringe and peristaltic pumps. T5, T50, and T95 were shorter for the peristaltic pump at higher flow rates. T50 and T95 were shorter for the syringe pump at lower flow rates. The ability to overcome the effects of dead volume was overall similar between the syringe and peristaltic pumps, as was the response to consecutive changes in drug infusion rates. Startup delay and dead volume in carrier-based infusion systems cause substantial time lags to reaching intended delivery rates. Peristaltic and syringe pumps are similarly susceptible to dead volume effects. Startup performance differed between peristaltic and syringe pumps; their relative performance may be dependent on flow rate. [ABSTRACT FROM AUTHOR]

Purpose Although outpatient parenteral antibiotic therapy (OPAT) can be a good approach to treatment of infections, a lack of data regarding antibiotic stability in portable elastomeric infusion devices restricts its safe, appropriate, and effective use. The objective of this work was to complete a systematic peer-reviewed analysis of published articles about antibiotic stability in elastomeric infusion devices that provide evidence supporting their use in OPAT. Summary A systematic review following PRISMA guidelines was conducted in January 2021 to identify published articles about antibiotic stability in portable elastomeric infusion devices. The databases used were PubMed, Embase, Web of Science, and a Cochrane database. A total of 1,615 original studies and conference communications were found. After title, abstract, and full-text review, 33 articles met the inclusion criteria. The data obtained included information about the stability of 30 different antibiotics. To our knowledge, this is the first review to summarize the available published data on the stability of antibiotics in portable elastomeric infusion devices. The results highlight the poor stability of some antibiotics in solution and the variability of the laboratory conditions in the included studies. Conclusion This systematic review can serve as a useful resource for healthcare professionals involved in providing OPAT using portable elastomeric infusion devices. However, further stability studies should be performed, especially high-quality studies simulating real-life time and temperature conditions. [ABSTRACT FROM AUTHOR]

Abstract Background Occlusions of intravenous (IV) tubing can prevent vital and time-critical medication or solutions from being delivered into the bloodstream of patients receiving IV therapy. At low flow rates (≤ 1 ml/h) the alarm delay (time to an alert to the user) can be up to 2 h using conventional pressure threshold algorithms. In order to reduce alarm delays we developed and evaluated the performance of two new real-time occlusion detection algorithms and one co-occlusion detector that determines the correlation in trends in pressure changes for multiple pumps. Methods Bench-tested experimental runs were recorded in triplicate at rates of 1, 2, 4, 8, 16, and 32 ml/h. Each run consisted of 10 min of non-occluded infusion followed by a period of occluded infusion of 10 min or until a conventional occlusion alarm at 400 mmHg occurred. The first algorithm based on binary logistic regression attempts to detect occlusions based on the pump’s administration rate Q(t) and pressure sensor readings P(t). The second algorithm continuously monitored whether the actual variation in the pressure exceeded a threshold of 2 standard deviations (SD) above the baseline pressure. When a pump detected an occlusion using the SD algorithm, a third algorithm correlated the pressures of multiple pumps to detect the presence of a shared occlusion. The algorithms were evaluated using 6 bench-tested baseline single-pump occlusion scenarios, 9 single-pump validation scenarios and 7 multi-pump co-occlusion scenarios (i.e. with flow rates of 1 + 1, 1 + 2, 1 + 4, 1 + 8, 1 + 16, and 1 + 32 ml/h respectively). Alarm delay was the primary performance measure. Results In the baseline single-pump occlusion scenarios, the overall mean ± SD alarm delay of the regression and SD algorithms were 1.8 ± 0.8 min and 0.4 ± 0.2 min, respectively. Compared to the delay of the conventional alarm this corresponds to a mean time reduction of 76% (P = 0.003) and 95% (P = 0.001), respectively. In the validation scenarios the overall mean ± SD alarm delay of the regression and SD algorithms were respectively 1.8 ± 1.6 min and 0.3 ± 0.2 min, corresponding to a mean time reduction of 77% and 95%. In the multi-pump scenarios a correlation > 0.8 between multiple pump pressures after initial occlusion detection by the SD algorithm had a mean ± SD alarm delay of 0.4 ± 0.2 min. In 2 out of the 9 validation scenarios an occlusion was not detected by the regression algorithm before a conventional occlusion alarm occurred. Otherwise no occlusions were missed. Conclusions In single pumps, both the regression and SD algorithm considerably reduced alarm delay compared to conventional pressure limit-based detection. The SD algorithm appeared to be more robust than the regression algorithm. For multiple pumps the correlation algorithm reliably detected co-occlusions. The latter may be used to localize the segment of tubing in which the occlusion occurs. Trial registration Not applicable.

Both public and private hospitals are increasingly under pressure to reduce costs while improving patient care across all medical disciplines and departments. Hospitals must become patient-oriented, lean, and agile in order to properly realign and integrate health care processes, helping to reconcile efficiency imperatives with patient needs and hospital mission. One of the highest potential for improvement can be found in supply chain management (SCM) practices for medical supplies, which often represent more than 40% of a hospital’s operating budget. We report on 3 case studies of business process management and reengineering projects, relying on advanced information technology, focused on the supply chains of two major urban hospitals, involving $2 million in minimum stocks for drug inventory. Case study 1 deals with an in-depth analysis of SCM practices around a key medical asset in pharmaceutical supply, i.e. infusion pumps. Case study 2 builds upon the findings of case 1, and proposes an radio-frequency identification solution to support a new hospital-wide asset location process and system, aiming for just-in-time availability of infusion pumps for critical drugs administration. Case study 3 complements cases 1 and 2 by analysing the feasibility of integrating the various components of the hospital pharmacy inventories, which in turn could be integrated to asset location systems. Our 3 case studies lead us to a number of conclusions on how hospitals can develop a patient-oriented, agile, and lean perspectives and practices, as well as ensure the proper integration of patient needs within optimised supply chains. [ABSTRACT FROM AUTHOR]

• Extended reality training improved significantly students' motivation to transfer learning, learning self-efficacy, and performance confidence. • Participants showed high levels of competency after training. • Participants had positive experiences; they were satisfied with the learning environment. • Concerns include difficulties and limitations associated with learning devices. • Research on developing and applying components of extended reality content is needed. Practical education is required to address the inexperience of nursing students in operating medical devices and improve their clinical practice competencies. This study confirms the effectiveness and participant experience of extended reality training for nursing students regarding intravenous therapy using an infusion pump. This study used a concurrent mixed methods design. Forty-six nursing students, who were initially trained virtually using a head-mounted device participated in the study, followed by practice using an actual infusion pump and arm model. Motivation to transfer learning, learning self-efficacy, and performance confidence were measured using self-report scales; competency was evaluated using an observational checklist by the co-researcher, and the data were analyzed. Motivation to transfer learning, learning self-efficacy, and performance confidence improved significantly after extended reality training, and enhanced competency was observed. Furthermore, the participants experienced design elements for effective learning, satisfaction with the learning environment, and convenience and efficiency of learning, thus realizing their needs. In the future, extended reality training programs should be implemented and tested using other medical devices in nursing education. [ABSTRACT FROM AUTHOR]

Aim: To understand the experience of critical care nurses when performing common, yet error‐prone, programming tasks on two unfamiliar intravenous smart pumps. Design: A qualitative descriptive study using data collected during a previous quantitative pilot study. Methods: Following completion of common intravenous programming tasks each participant was interviewed using a semi‐structured interview guide. All interview data were coded line‐by‐line and thematic analysis revealed themes across all participants' interviews. Results: The following four themes were identified: appreciation for attractive design features, the need for efficiency, the importance of intuitive use and concern for patient outcomes. Overall, these themes provide evidence that nurses strongly prefer a more usable intravenous smart pump interface that integrates safeguards to efficiently improve patient outcomes. Findings support the need for intravenous smart pump technology to be developed with an intuitive interface that decreases the level of cognitive demand and will lead to improved patient safety. [ABSTRACT FROM AUTHOR]

What is known and objective: Proton pump inhibitors are potent suppressors of gastric acid secretion, and are commonly prescribed in palliative medicine. Despite multiple relevant indications in patients at the end‐of‐life, their use is often precluded as oral and intravenous administration is frequently inappropriate or not possible. Limited anecdotal evidence suggests proton pump inhibitors may be administered subcutaneously. Our objective was to investigate the tolerability and effectiveness of the administration of esomeprazole as a continuous subcutaneous infusion over 24 h via a syringe driver. Methods: Case series (n = 7) design assessing sequential patients admitted to a specialist inpatient centre for palliative care, who required parenteral proton pump inhibitor therapy. Results and Discussion: Four patients reported complete resolution of dyspeptic and reflux symptoms post commencement of esomeprazole. Two patients developed upper gastrointestinal bleeding, which via observation of vomitus and stools, resolved with the initiation of esomeprazole. A single patient, deemed high risk of gastrointestinal bleeding, was commenced on esomeprazole and no bleeding events occurred. What is new and conclusion: Esomeprazole when administered via a syringe driver over 24 h appears well tolerated and effective for the symptomatic management of dyspepsia and treatment of gastrointestinal bleeding. Overall, this series adds to the limited evidence base for using subcutaneous proton pump inhibitors in the palliative demographic. [ABSTRACT FROM AUTHOR]

Background: Connecting an infusion line to a closed stopcock results in pressurization of fluid within the syringe infusion pump assembly leading to flow irregularities when opening the stopcock and activating the pump., Aims: It was the purpose of this study to assess the extent of pressurization under different conditions and its impact on start-up fluid delivery., Methods: Intraluminal pressures and start-up fluid delivery at 1 mL/h flow rate were assessed with connection of the infusion line 1 min (delayed connection) or immediately after purging (immediate connection) using two different infusion lines made from polyvinylchloride (PVC) or polyethylene (PE)., Results: Delayed connection resulted in an increase of intraluminal pressures from zero to 5.1 [4.5 to 5.7] mmHg with the PVC line and from zero to 47.1 [44.8 to 49.3] mmHg with the PE line (mean difference 42.0 [95% CI 39.3-44.7] mmHg; p < .0001). Immediate connection resulted in an increase of intraluminal pressures from zero to 44.3 [41.8-46.8] mmHg with the PVC line and from zero to 61.3 [57.2-65.4] mmHg with the PE line (mean difference 17.0 [95% CI 11.8-22.2] mmHg; p < .0001). The increase in intraluminal pressures was significantly higher with PE lines for both delayed and immediate connection when compared to the PVC lines (mean difference 29.5 [95% CI 19.3-39.7] mmHg; p < .0001). Related fluid volumes delivered at 10 s and 360 s after starting the pump ranged from -252% to 1321% (10 s) of expected infusion volumes and from 59% to 129% (360 s), respectively., Conclusions: Both, timing of infusion line connection after purging and infusion line characteristics considerably affect intraluminal pressures and start-up fluid delivery when connecting a new syringe infusion pump assembly to a closed stopcock. Consecutive alterations in drug administration can have considerable hemodynamic consequences when dealing with catecholamine infusions in critically ill patients., (© 2024 The Author(s). Pediatric Anesthesia published by John Wiley & Sons Ltd.)

ABSTRACT Objective: To investigate infusion pumps start-up delay according to different brands of infusion pumps, flow rates and intravenous sets priming techniques. Method: The experimental study simulated clinical practice under controlled conditions, using a 50 mL syringe with NaCl 0.9% solution, two syringe infusion pumps (A and B), six rates (0.3, 0.5, 1.0, 5, 10 and 20 mL/h), two purging techniques (manually or infusion pump’s electronic bolus). Data were analyzed according to mean, standard deviation, Student’s t and ANOVA tests (p

Background: Critically ill patients frequently need blood transfusions. For safety, blood must be delivered via syringe infusion pumps, yet this can cause red cell damage and increase the rate of haemolysis. Aims and objectives: To evaluate biochemical and haemolytic markers of red blood cells transfused in three different types of syringe infusion pumps at two different infusion rates (10 and 100 mL/h). Design and Methods: A lab‐based study using aliquots of 16 red blood cell bags was undertaken. Haemolysis markers (total haemoglobin [g/dL], haematocrit [%], free haemoglobin [g/dL], potassium [mmol/L], lactate dehydrogenase [U/L], osmolality [mOsm/kg], pH, degree of haemolysis [%]) were measured before and after red blood cell infusion and exposure. Three different syringe infusion pumps brands (A, B, and C) were compared at two different infusion rates (10 and 100 mL/h). Results: Total haemoglobin fell significantly in all red blood cell units during manipulation (pre‐infusion: 26.44 ± 5.74; post‐exposure: 22.62 ± 4.00; P =.026). The degree of haemolysis significantly increased by 40% after manipulation of the red blood cells. Syringe infusion pump A caused a 3‐fold increase in potassium levels (3.78 ± 6.10) when compared with B (−0.14 ± 1.46) and C (1.63 ± 1.98) (P =.015). This pump also produced the worst changes, with an increase in free haemoglobin (0.05 ± 0.05; P =.038) and more haemolysis (0.08 ± 0.07; P =.033). There were significant differences and an increase in the degree of haemolysis (P =.004) at the infusion rate of 100 mL/h. Conclusions: Syringe infusion pumps may cause significant red blood cell damage during infusion, with increases in free haemoglobin, potassium, and the degree of haemolysis. Some pump types, with a cassette mechanism, caused more damage. Relevance to clinical practice: In many intensive care units, bedside nurses are able to consider infusion pump choice, and understanding the impact of different pump types on red blood cells during a transfusion provides the nurses with more information to enhance decision‐making and improve the quality of the transfusion. [ABSTRACT FROM AUTHOR]

Background and Aims: Propofol is the drug of choice for sedation in daycare procedures due to its pharmacokinetic properties. Propofol delivery using target-controlled infusion (TCI) pump reduces adverse effects like hypotension and apnoea. In this study, we estimated the median effective effect-site concentration of propofol in patients undergoing dilatation and curettage. Methods: Patients of the American Society of Anesthesiologists physical status class I–III, aged 40–70 years, undergoing elective dilatation and curettage were recruited for the study. All patients received 1 μg/kg fentanyl and 20 mg lignocaine. The first patient received an effect-site concentration of propofol at 4 μg/mL with TCI Schneider pharmacokinetic model. Failure was defined as patient movement at any time during the procedure. According to the 'BiasedCoin Design' up-and-down sequential method, the response of the previous patient determined the effect-site concentration of propofol of the next patient. The study was terminated once forty patients completed the procedures successfully. Probit analysis was used to determine EC50. Results: Fifty-three patients were recruited for the study. The various effect-site concentrations of propofol EC50, EC90, and EC95 in providing sedation for dilatation and curettage were 3.38 μg/mL, 4.29 μg/mL, and 4.60 μg/mL, respectively. The incidence of hypotension and apnoea were comparable among the various concentrations of propofol. The mean duration of the propofol infusion was 20 ± 2.86 min. The time to recovery from propofol sedation was 6.97 ± 1.76 min. Conclusion: A median effective effect-site concentration of 3.38 μg/mL of propofol is required to prevent patient movement during uterine dilatation and curettage. [ABSTRACT FROM AUTHOR]

Abstract Background Multi-drug intravenous (IV) therapy is one of the most common medical procedures used in intensive care units (ICUs), operating rooms, oncology wards and many other hospital departments worldwide. As drugs or their solvents are frequently chemically incompatible, many solutions must be administered through separate lumens. When the number of available lumens is too low to facilitate the safe administration of these solutions, additional (peripheral) IV catheters are often required, causing physical discomfort and increasing the risk for catheter related complications. Our objective was to develop and evaluate an algorithm designed to reduce the number of intravenous lumens required in multi-infusion settings by multiplexing the administration of various parenteral drugs and solutions. Methods A multiplex algorithm was developed that schedules the alternating IV administration of multiple incompatible IV solutions through a single lumen, taking compatibility-related, pharmacokinetic and pharmacodynamic constraints of the relevant drugs into account. The conventional scheduling procedure executed by ICU nurses was used for comparison. The number of lumens required by the conventional procedure (LCONV) and multiplex algorithm (LMX) were compared. Results We used data from 175,993 ICU drug combinations, with 2251 unique combinations received by 2715 consecutive ICU patients. The mean ± SD number of simultaneous IV solutions was 2.8 ± 1.6. In 27% of all drug combinations, and 61% of the unique combinations the multiplex algorithm required fewer lumens (p 3 lm, versus 12% using the conventional procedure. Conclusion The multiplex algorithm addresses a major issue that occurs in ICUs, operating rooms, oncology wards, and many other hospital departments where several incompatible drugs are infused through a restricted number of lumens. The multiplex algorithm allows for more efficient use of IV lumens compared to the conventional multi-infusion strategy.

Background: The optimal goal of naloxone infusion in intensive care units is to ameliorate opioid-induced side effects in therapy or eliminate the symptoms of opioid toxicity in overdoses. Accurately monitoring and regulating the doses is critical to prevent adverse effects related to naloxone administration. The present study aimed to compare treatment outcomes when using two methods of intravenous naloxone infusion: an infusion pump or the standard method. Methods: This study involved 80 patients with signs and symptoms of opioid overdose. The patients were randomly assigned into two groups with respect to intravenous infusion of naloxone by either an infusion pump or the standard method. Results: Comparison of study parameters between the two groups at 12 and 24 hours after intervention showed significantly more compensatory acid-base imbalance in the naloxone infusion pump group. In the group that received naloxone by pump, only one patient experienced withdrawal symptoms, but withdrawal symptoms appeared in 12 patients (30.0%) in the standard intravenous infusion group within 12 hours and in seven additional patients (17.5%) within 24 hours of intervention. In the group receiving pump-based naloxone infusion therapy, no another complications were reported; however in the standard infusion group, the 12-hour and 24-hour complication rates were 55.0% and 32.5%, respectively. The length of hospital stay was 2.85±1.05 and 4.22±0.92 days for the pump and standard infusion groups, respectively (P

Hospitals at home are increasingly offering outpatient parenteral antimicrobial therapy (OPAT) in an attempt to reduce costly inpatient care, but these settings favour broad-spectrum antibiotics that require less frequent dosing than penicillin. Benzyl penicillin could be delivered via continuous infusion pumps (eCIPs), but studies on their safety and efficacy in OPAT are scarce, and it remains unclear how much the availability of eCIPs increases penicillin use in real-life settings. We examined 462 electronic healthcare records of erysipelas patients treated between January 2018 and January 2022 in a large Finnish OPAT clinic. Average marginal effects from logistic models were estimated to assess how the introduction of eCIPs in December 2020 affected penicillin use and to compare clinical outcomes between patients with and without eCIPs. Introduction of eCIPs increased the predicted probability of penicillin treatment by 36.0 percentage points (95% confidence interval 25.5-46.5). During eCIP implementation, patients who received an eCIP had 73.1 (58.0-88.2) percentage points higher probability than patients without an eCIP to receive penicillin treatment. They also had about 20 percentage points higher probability to be cured at the time of discharge and 3 months after it. Patient and nurse satisfaction regarding eCIPs was very high. Benzyl penicillin eCIP treatment is effective and safe, and substantially increases the use of penicillin instead of broad-spectrum antibiotics. To reduce the risk of antimicrobial resistance, eCIPs could increasingly be promoted for use in OPAT clinics, and there should be adequate education and support in their implementation., (© The Author(s) 2024. Published by Oxford University Press on behalf of the European Public Health Association.)

Purpose: This study aimed to present real-life data on the use, effectiveness, and safety of administering Ceftolozane/Tazobactam (C/T) through elastomeric pumps (EP) in the outpatient setting., Methods: This case series study was conducted from January 2022 to July 2023 in a large University Hospital in Rome, Italy. Patients receiving continuous infusion of C/T via EP were included up to a follow-up period of 90 days after the end of antibiotic therapy. The primary endpoint was the infection's clinical cure rate. Secondary endpoints were adverse events attributable to continuous home infusion of Ceftolozane/Tazobactam via elastomeric pumps., Results: Seven patients received C/T continuously infused via EP and were included in the final analysis. Three patients suffered from prosthetic joint infection ( n  = 3/7; 43%), two patients from osteomyelitis ( n  = 2/7; 29%), one patient from otomastoiditis ( n  = 1/7; 15%) and one from pneumonia ( n  = 1/7; 15%). All infection were sustained by P. aeruginosa. Five strains had MDR-type susceptibility profiles ( n  = 5/7; 71%) and two of these were DTR ( n  = 2/7; 29%). The infection cure rate reached 86% ( n  = 6/7). Two patients reported a complication related to the vascular catheter for drug infusion ( n  = 2/7; 29%)., Conclusions: Continuous infusion of Ceftolozane/Tazobactam by elastomeric pumps has been shown to be safe and effective in practice representing a viable option of intravenous treatment in outpatient setting for infection sustained by P. aeruginosa especially for multidrug-resistant strains.

The purpose of this in vitro study was to evaluate the impact of the vertical level of the stopcock connecting the infusion line to the central venous catheter on start-up fluid delivery in microinfusions. Start-up fluid delivery was measured under standardized conditions with the syringe outlet and liquid flow sensors positioned at heart level (0 cm) and exposed to a simulated CVP of 10 mmHg at a set flow rate of 1 ml/h. Flow and intraluminal pressures were measured with the infusion line connected to the stopcock primarily placed at vertical levels of 0 cm, + 30 cm and - 30 cm or primarily placed at 0 cm and secondarily, after connecting the infusion line, displaced to + 30 cm and - 30 cm. Start-up fluid delivery 10 s after opening the stopcock placed at zero level and after opening the stopcock primarily connected at zero level and secondary displaced to vertical levels of + 30 cm and - 30 cm were similar (- 10.52 [- 13.85 to - 7.19] µL; - 8.84 [- 12.34 to - 5.33] µL and - 11.19 [- 13.71 to - 8.67] µL (p = 0.469)). Fluid delivered at 360 s related to 65% (zero level), 71% (+ 30 cm) and 67% (- 30 cm) of calculated infusion volume (p = 0.395). Start-up fluid delivery with the stopcock primarily placed at + 30 cm and - 30 cm resulted in large anterograde and retrograde fluid volumes of 34.39 [33.43 to 35.34] µL and - 24.90 [- 27.79 to - 22.01] µL at 10 s, respectively (p < 0.0001). Fluid delivered with the stopcock primarily placed at + 30 cm and - 30 cm resulted in 140% and 35% of calculated volume at 360 s, respectively (p < 0.0001). Syringe infusion pumps should ideally be connected to the stopcock positioned at heart level in order to minimize the amounts of anterograde and retrograde fluid volumes after opening of the stopcock., (© 2024. The Author(s).)

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., (Copyright © 2024. Published by Elsevier Ltd.)

This study investigates the impact of intravenous (IV) infusion protocols on the stability of Intravenous Immunoglobulin G (IVIG) and Rituximab, with a particular focus on subvisible particle generation. Infusion set based on peristaltic movement (Medifusion DI-2000 pump) was compared to a gravity-based infusion system (Accu-Drip) at different flow rates. The impacts of different diluents (0.9 % saline and 5.0 % dextrose) and plastic syringes with or without silicone oil (SO) were also investigated. The results from the aforementioned particular case demonstrated that peristaltic pumps generated high levels of subvisible particles (prominently < 25 µm), exacerbated by increasing flow rates, specifically in formulations lacking surfactants. Other factors, such as diluent type and syringe composition, also increased the number of subvisible particles. Strategies that can help overcome these complications include surfactant addition as well as the use of SO-free syringes and a gravity infusion system, which aid in reducing particle formation and preserving antibody monomer during administration. Altogether, these findings highlight the importance of the careful selection of formulations and infusion protocols to minimize particle generation during IV infusion both for patients' safety and treatment efficacy., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier B.V. All rights reserved.)

Background: Three settings are required on a programmed intermittent epidural bolus (PIEB) pump for labor analgesia: the PIEB next bolus (PIEBnb), PIEB interval (PIEBi), and PIEB volume (PIEBv). The ideal settings for these parameters are still unknown. We hypothesized a mathematical modeling tool, response surface methodology (RSM), could estimate 3 PIEB pump parameters while balancing 3 clinically important patient outcomes simultaneously. The study objective was to use RSM to estimate PIEB settings (PIEBnb, PIEBi, and PIEBv) while maximizing maternal satisfaction, minimizing the need for clinician-administered boluses, and optimizing the ratio of delivered/requested patient-controlled epidural analgesia (PCEA) boluses simultaneously., Methods: With institutional ethics approval, a double-blind randomized trial was completed in a tertiary care labor and delivery center. Nulliparous, English-speaking American Society of Anesthesiologists (ASA) physical status II patients aged 18 to 45 years at full term, single gestation in vertex presentation, in spontaneous labor and ≤7 cm cervical dilation were included. Patients with comorbidities, contraindications to neuraxial analgesia, using chronic analgesics, <152 cm, or body mass index (BMI) >45 kg/m 2 were excluded. After informed consent, labor analgesia was initiated using 10 mL ropivacaine 0.2% with 10 µg/mL fentanyl solution and PCEA (volume 6 mL every 10 minutes). Patients were randomized to predetermined PIEB settings. RSM identified 3 pump settings that represented a stationary point that best maximized or minimized 3 outcomes simultaneously: PCEA ratio (a ratio closest to 1), clinician bolus (optimal is 0), and maternal satisfaction (visual analog scale, 0-100, ideal response is ≥90)., Results: Of 287 potential participants, 192 did not meet inclusion criteria or declined to participate, and 26 were withdrawn, leaving 69 patients for study inclusion. Using RSM, the suggested PIEB settings for all the primary study outcomes were as follows: PIEBnb = 29.4 minutes, PIEBi = 59.8 minutes, and PIEBv = 6.2 mL. These PIEB settings corresponded to the following clinical outcomes: maternal satisfaction at 93.9%, PCEA ratio at 0.77, and need for clinician bolus at 0.29. The dermatome sensory score was between T10 and T5 in 89% of the patients. The median lowest Bromage score was 4., Conclusions: This novel study used a mathematical model to estimate PIEB pump settings while simultaneously maximizing 3 clinical outcomes. Equally weighted clinical outcomes prevent maximal outcome optimization and may not reflect patient priorities. Future studies or quality improvement endeavors could use RSM methodology to estimate PIEB pump settings targeting optimal values for a single clinical outcome of determined importance to parturients., Competing Interests: The authors declare no conflicts of interest., (Copyright © 2024 International Anesthesia Research Society.)

Background: Hepatic arterial infusion pump (HAIP) treatment is a technique used to treat liver localized malignancy with intra-arterial chemotherapy. Methylene blue is generally administered to verify hepatic perfusion and exclude inadvertent extrahepatic perfusion. The use of indocyanine green dye (ICG) combined with near-infrared (NIR) fluorescence imaging during robot-assisted HAIP placement may be an attractive alternative by providing high contrast without blue discoloration of the operative field., Methods: Data was collected retrospectively from 2 centers in the Netherlands. Intraoperative perfusion of the liver segments and extrahepatic perfusion were assessed using ICG/NIR as well as methylene blue on video imaging and correlated to postoperative 99 m-Tc perfusion scintigraphy., Results: 13 patients underwent robot-assisted surgery for HAIP placement; median length of stay was 4 days, complications occurred in 4 patients. Hepatic perfusion showed identical patterns when ICG was compared with methylene blue. In 1 patient, additional extrahepatic perfusion was found using ICG, leading to further vessel ligation. Intraoperative ICG perfusion was concordant with 99 m-Tc perfusion scintigraphy., Discussion: Liver and extrahepatic perfusion determined by ICG fluorescence imaging is concordant with blue dye perfusion and 99 m-Tc perfusion scintigraphy. Therefore, ICG fluorescence imaging is deemed a safe and reliable technique for perfusion testing during robot-assisted HAIP placement., (© 2024. The Author(s).)

Prostate-specific membrane antigen (PSMA) targeted tracers show increased uptake in several malignancies, indicating a potential for peptide radioligand therapy. Intra-arterial injection of radiotracers can increase the therapeutic window. This study aimed to evaluate the feasibility of intra-arterial injection of [ 68 Ga]Ga-PSMA-11 for intrahepatic cholangiocarcinoma and compare tracer uptake after intrahepatic arterial injection and intravenous injection. Three patients with intrahepatic cholangiocarcinoma received [ 68 Ga]Ga-PSMA-11 through a hepatic arterial infusion pump, followed by positron emission tomography/computed tomography (PET/CT). Two-three days later, patients underwent PET/CT after intravenous [ 68 Ga]Ga-PSMA-11 injection. All tumours showed higher uptake on the intra-arterial scan compared with the intravenous scan: the intra-arterial / intravenous standardised uptake value normalised by lean body mass ratios were 1.40, 1.46, and 1.54. Local intra-arterial PSMA injection is possible in patients with intrahepatic cholangiocarcinoma. Local injection increases tumour-to-normal tissue ratios, increasing the therapeutic window for theranostic applications. RELEVANCE STATEMENT: Intra-arterial Prostate specific membrane antigen (PSMA) injection increases the therapeutic window for potential theranostic application in intrahepatic cholangiocarcinoma. KEY POINTS: Three patients with intrahepatic cholangiocarcinoma underwent PET/CT after intra-arterial and intravenous injection of [ 68 Ga]Ga-PSMA-11. Intra-arterial injection showed higher uptake than intravenous injection. PSMA-targeted imaging could be valuable for a subset of intrahepatic cholangiocarcinoma patients., (© 2024. The Author(s).)