INFUSION PUMPS ผศ. ต่อตระกูล อภัยวงศ์ โครงการวิจัยและพัฒนาอุปกรณ์ชีวการแพทย์ มหาวิทยาลัย มหิดล

รายละเอียดในการบรรยาย 1. Downstream Occlusion Alarm 2. Infusion pump performance 3. Free-flow protection

โครงสร้างการทำงาน Downstream Occlusion Upstream Occlusion Alarm Occlusion Detection Pressure Increments Alarm Downstream Occlusion Upstream Occlusion

Occlusion

1. Interruption to therapy 2. Ineffective therapy Occlusion 1. Interruption to therapy 2. Ineffective therapy 3. A potential sudden injection of unwanted bolus, on release of the occlusion.

Adjustable downstream occlusion pressure BAXTER Colleague Adjustable downstream occlusion pressure 2 - 15 PSIG Rate Occlusion Alarm Time to Bolus Pressure Setting Alarm Volume 1mL/hr 2 psig 4 – 8 min 0.05 – 0.16 mL 9 psig 12 – 27 min 0.18 – 0.26 mL

เวลาที่เตือนหลังจากการอุดตัน เครื่อง ARCOMED AG mVP5005 Rate Pressure Pressure (ml / h) ( 2.5 bar ) ( 500 mbar ) 1 >120 min 45 min 20 10 min 100 sec 100 100 sec 25 sec 999 12 sec 2.5 sec Bolus 2.3 ml 0.45 ml

Occlusion การตั้งระดับสัญญาณเตือนการอุดตัน ไว้ที่ระดับต่ำ ทำให้สามารถทราบการ อุดตันได้เร็วขึ้น และปริมาตรที่ปล่อยออกสู่ผู้ป่วยหลังจากการอุดตันมีขนาดลดลง

Is this the volume or flowrate accuracy ? Most intravenous infusion pumps are specified to deliver within +/- 5 % Is this the volume or flowrate accuracy ?

FLOW ACCURACY Most intravenous infusion pumps are specified to deliver within 5 % of flow setting , 10 % is acceptable for most applications ; for critical applications, the error should not exceed 5 % Inspection and Preventive Maintenance System 2001 ECRI . All Rights Reserved.

AIR BUBBLE

BAXTER Colleague Air detection Sen. (25 - 150mL) 25 mL 0.83 mL Air Bubble Accumulation Setting Volume 25 mL 0.83 mL 50 mL 1.67 mL 100 mL 3.33 mL 150 mL 5.00 mL

Infusion pump performance parameters

B A C Infusion pump performance parameters Good long term accuracy Alarm after occlusion Small occlusion bolus Able to detect small air embolus Small flow rate increments Bolus accuracy B A Good long term accuracy Good short term accuracy Rapid alarm after occlusion Small occlusion bolus Able to detect very small air embolus Small flow rate increments Good bolus accuracy Long term accuracy Alarm after occlusion Small occlusion bolus Able to detect small air embolus Increments flow rate C

B C A START is the patient a neonate ? N N Is a drug being delivered ? Y Y The drug have a short half life or narrow therapeutic index ? N Is the drug diamorphine ? Is the patient volume sensitive ? Y Y Y N N B C A

free flow protection

In the early 1990s First reported in the early 1990s by ISMP and the ECRI Institute , accidental, uncontrolled free-flow of IV solutions after removal of administration sets from infusion pumps was recognized as a serious problem that led to death and patient injury www.ismp.org/Newsletters/acutecare/articles/20070614.asp - 22k -

In September 1992 ECRI , issued a recommendation against purchasing any infusion device that dose not have a free flow protection built in to the administration sets

In 1994 FDA published an advisory with its own suggestions for preventing infusion-related errors.

In November 2000 JCAHO released a Sentinel Event Alert on infusion pump risks, noting that at least six deaths because of free-flow accidents.

2003 JCAHO National Patient Safety Goals: Goal 5 : Improve the safety of infusion pumps Ensure free-flow protection on all general-use and PCA intravenous infusion pumps used in organization.

2003 JCAHO National Patient Safety Goals: Free-flow protection refer to a design in which the protection is built in to the administration set used with the pump

Infusion Pump Requirement Dropped from 2006 JCAHO National Patient Safety Goals:

To test free flow protection

IV set primed

Infusion pump turn off Loaded in the infusion pump

All the tubing clamps are opened

No fluid flows out of the set

Then removed the set from the device ( with all the tubing clamps still open )

ECRI Health Devices Inspection and Preventive Maintenance System .....no fluid flows out of the set ECRI Health Devices Inspection and Preventive Maintenance System

To avoid freeflow, fallow the manufacture’s recommendations and, whenever possible,count the drops in the drop chamber, to check the drip rate , before leaving the patient.

เอกสารอ้างอิง 1. MDA : Medical Device Agency , Infusion Systems MDA DB 2003 ( 02 ) March 2003 2. Health Devices Inspection and Preventive Maintenance System , 2001 ECRI. 3. BAXTER Operator’s manual Colleague Volumetric Infusion Pump; 1996 – 2000 4. Environment of Care® News, November 2005, Volume 8, Issue 11 Copyright 2005 Joint Commission on Accreditation of Healthcare Organizations www.jcrinc.com/media/pubs/PSPPDFs/PE-23-ECN-1105-Infusion%20Pump.pdf