Drug Infusion Systems: Technologies, Performance, and Pitfalls

Abstract

This review aims to broadly describe drug infusion technologies and raise subtle but important issues arising from infusion therapy that can potentially lead to patient instability and morbidity. Advantages and disadvantages of gravity-dependent drug infusion are described and compared with electromechanical approaches for precise control of medication infusion, including large-volume peristaltic and syringe pumps. This review discusses how drugs and inert carriers interact within infusion systems and outlines several complexities and potential sources of drug error. Major topics are (1) the importance of the infusion system dead volume; (2) the quantities of coadministered fluid and the concept of microinfusion; and (3) future directions for drug infusion.The infusion system dead volume resides between the point where drug and inert carrier streams meet and the patient's blood. The dead volume is an often forgotten reservoir of drugs, especially when infusion flows slow or stop. Even with medications and carriers flowing, some mass of drug always resides within the dead volume. This reservoir of drug can be accidentally delivered into patients. When dose rate is changed, there can be a significant lag between intended and actual drug delivery. When a drug infusion is discontinued, drug delivery continues until the dead volume is fully cleared of residual drug by the carrier. When multiple drug infusions flow together, a change in any drug flow rate transiently affects the rate of delivery of all the others. For all of these reasons, the use of drug infusion systems with smaller dead volumes may be advantageous.For critically ill patients requiring multiple infusions, the obligate amount of administered fluid can contribute to volume overload. Recognition of the risk of overload has given rise to microinfusion strategies wherein drug solutions are highly concentrated and infused at low rates. However, potential risks associated with the dead volume may be magnified with microinfusion. All of these potential sources for adverse events relating to the infusion system dead volume illustrate the need for continuing education of clinical personnel in the complexities of drug delivery by infusion.This review concludes with an outline of future technologies for managing drug delivery by continuous infusion. Automated systems based on physiologic signals and smart systems based on physical principles and an understanding of dead volume may mitigate against adverse patient events and clinical errors in the complex process of drug delivery by infusion.

Intravenous Smart Pumps During Actual Clinical Use

“…Data support that deviations from manufacturer recommendations decrease both flow rate and flow rate accuracy. 16 , 17 , 24 …”

Digital droplet infusion

“…Using infusion pumps to deliver medications intravenously has been widely practiced in clinical settings for treating patients that are not responsive to other drug delivery routes such as oral administration. 1 Infusion drug delivery has a long history of nearly 200 years, dating back to the early 19th century when Dr. Thomas Latta had successfully infused a saline solution into patients to provide life-saving rehydration during the deadly cholera epidemic. 2,3 The modern infusion system is commonly utilized in clinical scenarios, such as chemotherapy, surgery, and pain management, and has been used in the delivery of various medications and supplements including antibiotics, analgesia, anesthesia, and alimentation.…”

“…Automated infusion pumps are frequently used, and they have proven to be beneficial in patient care due to their delivery control, precision, and safety compared to manual administration. 1 Infusion pumps vary by type, and these include external pumps and implanted pumps, ambulatory (portable) and stationary pumps, microinfusion pumps and macroinfusion pumps, etc. Microinfusion pumps function to provide accurate and precise infusion of fluids and medications at an infusion rate typically smaller than 10 mL h −1 , commonly found in treating pediatric patients or neonates and for administrating shortacting or highly concentrated drugs such as vasoactive drugs and inotropic agents.…”

Alarm fatigue in infusion pumps in the pediatric context: integrative review / Fadiga de alarmes em bombas de infusão no contexto pediátrico: revisão integrativa

“…Alarms in Medical Assistive Equipment (MES) are barriers that can minimize human error and prevent patient safety risk, thus identifying incorrect use of the equipment, or changes in the patient's clinical status; requiring immediate corrective action. 1 In the context of pediatric patient safety, these alarms represent an alert to the "holes" in Reason's Swiss cheese model. 2 On the subject, studies reveal that in Intensive Care Units (ICU), the number of alarms can vary from 100 to more than 350; where the healthcare professional is exposed per work shift, to more than a thousand alarms.…”