Published online Mar 27, 2014. doi: 10.5313/wja.v3.i1.119
Revised: August 15, 2013
Accepted: August 28, 2013
Published online: March 27, 2014
AIM: Providing analgesia via peripheral nerve catheters attached to an infusion pump is an effective pain management option in children.
METHODS: Portable infusion pumps are being used with increased frequency in pediatric patients. Because these pumps are infusing potentially toxic doses of medications, the accuracy and consistency of these devices becomes very important in this patient population. This study is a comparison of the actual delivery volume of local anesthetic of three elastomeric infusion devices approved for patient use in the ambulatory setting. Three brands of disposable elastomeric infusion devices were used (Five On-Q, Five Baxter, and Five Ambu pumps). Each was filled with 200 mL of Ropivicaine 0.1% and connected to a single, end hole infusion catheter and set to infuse at 12 mL/h. The devices were run simultaneously. The fluid delivered was measured every hour with a graduated column over a tenhour period. The ambient temperature was also recorded.
RESULTS: There were statistically significant differences in the output from each elastomeric device over the 10 h infusion period when compared to the nominal rate of 12 mL/h. The output from the Ambu and Baxter pumps was less than that set on the regulator, while the output from the On-Q pump was greater than that set on the regulator. The results remained statistically significant after adjusting the nominal rate to correct for differences in temperature. The Ambu infusion device was the most consistent, while the Baxter infusion device was the most accurate. This emphasizes the importance of health care providers understanding the infusion profile of the pump being used for continuous peripheral nerve block, as these alterations in flow could result in inadequate analgesia, early reservoir exhaustion, excessive muscle weakness or potential toxicity, especially when used in pediatric patients.
CONCLUSION: This investigation demonstrates that three modern elastomeric infusion pumps have significantly different output than the nominal rate set on the regulator.
Core tip: This study demonstrates that three single use elastomeric infusion devices have rates that are significantly different from the set nominal delivery volume. These alterations in flow may be clinically significant, resulting in either inadequate analgesia, early exhaustion of the reservoir, excessive muscle weakness or the potential for toxicity, especially when used with pediatric patients. Therefore, in order to provide the best care, physicians must not only take into account the temperature at which the pump will be kept, viscosity of the solution used, and the height of the reservoir but also the infusion profile of the individual pump being used.