Permanent mechanical deformation of an intrathecal baclofen pump secondary to scuba diving: a case report

Draulans, Nathalie; Roels, E; Kiekens, Carlotte; Nuttin, Bart; Peers, Koen

doi:10.1038/sc.2013.43

Cited by 6 publications

(5 citation statements)

References 3 publications

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“…Whole‐body shock wave lithotripsy is a precaution for intrathecal delivery systems due to the potential for electronic damage to the device by the sound waves. Exposure to pressures from SCUBA diving and hyperbaric oxygen therapy places the patient at risk for pump damage or temporary under‐ or overinfusion, particularly if exposure is repeated and the reservoir is not close to full volume . There is also a case report of battery failure of an intrathecal delivery system following exposure to high‐dose radiation therapy .…”

Section: Diagnostic Evaluation Processmentioning

confidence: 99%

Best Practices for Intrathecal Baclofen Therapy: Troubleshooting

Saulino

Anderson

Doble

et al. 2016

Neuromodulation: Technology at the Neural Interface

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Section: Diagnostic Evaluation Processmentioning

confidence: 99%

Best Practices for Intrathecal Baclofen Therapy: Troubleshooting

Saulino

Anderson

Doble

et al. 2016

Neuromodulation: Technology at the Neural Interface

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“…Implanted pumps such as IDD pumps are unique even among these neurological devices, with an additional consideration arising from the possibility that hyperbaric exposure could result in a change in reservoir size during compression and decompression phases of treatment, leading to rupture or warping of the device and subsequent malfunction or improper refilling and storage of medication for subsequent use [15,17,18,27,28]. From a technical point of view, prior to the application of HBOT, formal clearance should be obtained from the manufacturer whenever possible regarding feasibility and maximum tolerable pressure for each specific device to allow for accurate assessment and minimization of possible complications such as hardware malfunctions or reservoir deformities.…”

Section: Discussionmentioning

confidence: 99%

Clinical Considerations for Implanted Neurological Devices in Patients Undergoing Hyperbaric Oxygen Therapy: A Case Report and Review of Manufacturer Guidelines

Schiavo

Brenna

Bhatia

et al. 2023

IJERPH

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Patients with implanted medical devices are increasingly referred for hyperbaric oxygen therapy (HBOT), and the safety of exposing some of these devices to hyperbaric environments has not previously been explored. There is a paucity of evidence surrounding the management of implanted neurological devices such as neurostimulators and intrathecal drug delivery (IDD) pumps in the context of HBOT. However, these devices can be expected to harbor unique risks; for example, vacant space in the reservoir of an implanted IDD pump may change in pressure and volume during the compression and decompression phases of HBOT, resulting in a damaged or dysfunctional device. We present the case of a 27-year-old woman with cerebral palsy referred for HBOT to manage a necrotizing soft tissue infection cultured from a dehiscent abdominal wound at the previous implantation site of an intrathecal baclofen pump. An HBOT protocol was ultimately chosen in partnership with the patient and her family, but treatment was not performed due to a paucity of evidence that the implanted IDD pump could safely withstand hyperbaric exposure. In this review, we have synthesized manufacturer recommendations regarding the management of implanted neurological devices before, during, and after HBOT to inform future decision-making in this setting. Among these recommendations, we highlight that neurostimulators should be switched off for the duration of HBOT and implanted pumps should be refilled prior to each treatment session to minimize empty reservoir space.

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“…IDDSs should be refilled prior to high-pressure exposure to prevent deformation of the device. Draulans et al reported a case of irreversible loss of drug reservoir capacity due to collapse of the bottom shield after scuba diving 4. It is possible that the first case of indentation of IDDS could possibly be prevented if the above protocol was followed.…”

Section: Discussionmentioning

confidence: 99%

“…This has been described in the case of stuck bellows and indentation of the IDDS after scuba diving 4. No return product analysis was available.…”

Section: Discussionmentioning

confidence: 99%

Indented intrathecal drug delivery system with loss of reservoir volume

Goel

Patwardhan

Ibrahim

et al. 2019

Reg Anesth Pain Med

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ObjectivesWe report two patients who underwent elective revision surgery were found to have reduced reservoir volumes and indented bottom shield of intrathecal drug delivery system (IDDS).Case reportsCase #1: A 59-year-old man stable on IDDS medications for chronic neck and upper back pain was found to have an irreversible reduction in reservoir volume from 40 to 28 cc on routine refill appointment. Despite having stable pain control, the reservoir volume decreased from 40 to 22 cc and subsequently to 17 cc when the patient had inadequate pain control. During replacement surgery, the posterior shield of the IDDS was found to be collapsed. The patient had exposure to hyperbaric oxygen treatments for chronic non-healing wounds of the lower extremities. Case #2: A 68-year-old woman had an IDDS implanted for chronic low back pain secondary to failed back surgery syndrome. The reservoir volume was found to be reduced to 15 cc of medication from 20 cc during the seventh year of therapy. There was a report of a fall. Routine reservoir exchange at the end of battery life revealed that the bottom shield of the reservoir was indented.ConclusionsInability to refill the medication to full capacity should be an indication to investigate device deformation. Information about exposure to hyperbaric therapy or local trauma should be obtained.

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Permanent mechanical deformation of an intrathecal baclofen pump secondary to scuba diving: a case report

Cited by 6 publications

References 3 publications

Best Practices for Intrathecal Baclofen Therapy: Troubleshooting

Best Practices for Intrathecal Baclofen Therapy: Troubleshooting

Clinical Considerations for Implanted Neurological Devices in Patients Undergoing Hyperbaric Oxygen Therapy: A Case Report and Review of Manufacturer Guidelines

Indented intrathecal drug delivery system with loss of reservoir volume

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