Effect of central venous pressure on back-flow and bolus events during vasopressor syringe changeover. Comment on Br J Anaesth 2020; 125: 622–628

Russotto, Vincenzo; Elli, Stefano; Rona, Roberto; Lucchini, Alberto

doi:10.1016/j.bja.2020.09.005

Cited by 5 publications

(6 citation statements)

References 5 publications

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“…Recent clinical data demonstrates that, independent of the syringe pump changeover strategy used, at least 25% of critical hemodynamic events in all three approaches tested occurred around changeover when administrating norepinephrine to critically ill adult patients 21 . As an explanation to these clinical findings, Russotto and coworkers argued that central venous pressure may have caused backflow and bolus events during vasopressor syringe changeover independently of the strategy used 24,25 . So far, the CVP level has not been included in studies investigating predictors of hemodynamic instability during changeovers of norepinephrine infusion pumps and certainly needs further alertness and research 26 …”

Section: Discussionmentioning

confidence: 99%

“…21 As an explanation to these clinical findings, Russotto and coworkers argued that central venous pressure may have caused backflow and bolus events during vasopressor syringe changeover independently of the strategy used. 24,25 So far, the CVP level has not been included in studies investigating predictors of hemodynamic instability during changeovers of norepinephrine infusion pumps and certainly needs further alertness and research. 26 Some limitations of this study must be acknowledged.…”

Section: Setup Cvp Infusion Volume Delivered (μL) [Ratio Delivered Ve...mentioning

confidence: 99%

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Effect of central venous pressure on fluid delivery during start‐up of syringe infusion pumps for microinfusion

Weiß

Wendel‐Garcia

Cannizzaro

et al. 2023

Pediatric Anesthesia

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BackgroundIntravenous administration of highly concentrated and potent drugs at low flow rates is common practice, particularly in critically ill children. Drug delivery during infusion start‐up can be considerably delayed by intrinsic factors of syringe infusion pump assemblies. The impact of central venous pressures on the course of start‐up fluid delivery of such microinfusions remains unknown.MethodsInfusion volumes delivered after activation of the start button in a conventional 50 mL syringe infusion pump assembly equilibrated (representing classical in vitro testing) and not equilibrated (representing real clinical conditions) to central venous pressure levels of 0, 10 and 20 mmHg at a set infusion flow rate of 1 mL/h were measured using a fluidic flow sensor.ResultsThe experimental setup mimicking real life conditions demonstrated considerable differences in fluid delivery during pump start‐up depending on central venous pressure. A central venous pressure of 0 mmHg resulted in massive fluid delivery at infusion start‐up, while central venous pressure levels of 10 and 20 mmHg resulted in retrograde flows with related mean (95% CI) zero‐drug delivery times of 3.22 (2.98–3.46) min and 4.51 (4.33–4.69) min, respectively (p < .0001).ConclusionDepending on central venous pressure level, connection and starting a new syringe pump can result in significant antegrade or retrograde fluid volumes. In clinical practice, this can lead to hemodynamic instability and hence requires clinical alertness. Further research and methods to improve start‐up performance in syringe infusion pump systems are desirable.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Setup Cvp Infusion Volume Delivered (μL) [Ratio Delivered Ve...mentioning

confidence: 99%

Effect of central venous pressure on fluid delivery during start‐up of syringe infusion pumps for microinfusion

Weiß

Wendel‐Garcia

Cannizzaro

et al. 2023

Pediatric Anesthesia

View full text Add to dashboard Cite

show abstract

“…Our findings may help to explain why none of the well-established syringe infusion pump changeover techniques presented and tested in the past effectively avoided fluid irregularities when using microinfusions. 6,13 The fact that only a single syringe infusion pump setup was used, can be regarded as a limitation of the study. In clinical practice, often multi-infusion setups are in use, representing a system with several communicating lines and pumps, where retro-and antegrade infusion volumes may have different effects on intravenous drug delivery.…”

Section: Discussionmentioning

confidence: 99%

“…5 This can result in bolus events or in prolonged lag times of intravenous drug delivery being particularly relevant when administering inotropic drugs in critically ill patients using microinfusion. 6 The vertical level of syringe pump position has also been reported to affect pressure gradients between the central venous line and the syringe infusion pump assembly and thereby drug delivery when connecting and starting a new infusion pump. 7 In the past, researchers have demonstrated that vertical displacement of a running syringe infusion pump assembly results in fluid shifts, that is, emptying of fluid from the pump assembly into the patient circulation (when elevating the pump) or vice versa pooling of fluid from the patient infusion line into the infusion system (when lowering the pump).…”

Section: Backg Rou N Dmentioning

confidence: 99%

“…A recent study revealed that the connection and opening a new syringe infusion pump assembly to a central venous catheter can lead to rapid anterograde or retrograde fluid shifts depending on the level of central venous pressure 5 . This can result in bolus events or in prolonged lag times of intravenous drug delivery being particularly relevant when administering inotropic drugs in critically ill patients using microinfusion 6 …”

Section: Introductionmentioning

confidence: 99%

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Effect of vertical pump position on start‐up fluid delivery of syringe pumps used for microinfusion

Weiss,

Wendel‐Garcia,

Grass

et al. 2023

Pediatric Anesthesia

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BackgroundConnection and opening a syringe infusion pump to a central venous line can lead to acute anterograde or retrograde fluid shifts depending on the level of central venous pressure. This may lead to bolus events or to prolonged lag times of intravenous drug delivery, being particularly relevant when administering vasoactive or inotropic drugs in critically ill patients using microinfusion. The aim of this study was to assess the effect of syringe pump positioning at different vertical heights on start‐up fluid delivery before versus after purging and connection the pump to the central venous catheter.MethodsThis in vitro study measured ante‐ and retrograde infusion volumes delivered to the central venous line after starting the syringe pump at a set infusion rate of 1 mL/h. In setup one, the pump was first positioned to vertical levels of +43 cm or –43 cm and then purged and connected to a central venous catheter. In setup two, the pump was first purged and connected at zero level and secondarily positioned to a vertical level of +43 cm or –43 cm. Central venous pressure was adjusted to 10 mmHg in both setups.ResultsPositioning of the pump prior to purging and connection to the central venous catheter resulted in a better start‐up performance with delivered fluid closer to programmed and expected infusion volumes when compared to the pump first purged, connected, and then positioned. Significant backflow volumes were observed with the pump purged and connected first and then positioned below zero level. No backflow was measured with the pump positioned first below zero level and then purged and connected.ConclusionsSyringe infusion pump assemblies should be positioned prior to purging and connection to a central venous catheter line when starting a new drug, particularly when administering highly concentrated vasoactive or inotropic drugs delivered at low flow rates.

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Evaluation of the venting principle to reduce start-up delays in syringe infusion pumps used for microinfusions

Weiss,

Wendel-Garcia,

Cannizzaro

et al. 2023

J Clin Monit Comput

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Effect of central venous pressure on back-flow and bolus events during vasopressor syringe changeover. Comment on Br J Anaesth 2020; 125: 622–628

Cited by 5 publications

References 5 publications

Effect of central venous pressure on fluid delivery during start‐up of syringe infusion pumps for microinfusion

Effect of central venous pressure on fluid delivery during start‐up of syringe infusion pumps for microinfusion

Effect of vertical pump position on start‐up fluid delivery of syringe pumps used for microinfusion

Evaluation of the venting principle to reduce start-up delays in syringe infusion pumps used for microinfusions

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