Flow rate accuracy of ambulatory elastomeric and electronic infusion pumps when exposed to height and back pressures experienced during home infusion therapy

Hobbs, Jodie G; Ryan, Melissa; Mohtar, Aaron; Sluggett, Andrew J.; Sluggett, Janet K.; Ritchie, Brett; Reynolds, Karen

doi:10.1080/17434440.2019.1632187

Cited by 9 publications

(16 citation statements)

References 25 publications

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“…47 In addition, the elevation of the pump reservoir and back pressure from the infusion may affect the accuracy of the infusions in elastomeric pumps. 48,49 Technologically, elastomeric pumps do not have alarms for kinking or malfunctioning, cannot detect air in the infusion, nor accurately identify volume remaining in the pump. 47 While limited in some functions, there is also a potential benefit to their simplicity.…”

Section: Elastomeric Pumpsmentioning

confidence: 99%

Advances in regional anesthesia for ambulatory surgery

Kinjo,

Chernin,

Siegmueller

et al. 2023

International Anesthesiology Clinics

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Section: Elastomeric Pumpsmentioning

confidence: 99%

Advances in regional anesthesia for ambulatory surgery

Kinjo,

Chernin,

Siegmueller

et al. 2023

International Anesthesiology Clinics

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“…While electronic infusion systems might improve the accuracy of drug delivery, they carry the risks of false programming and free flow. They are also more labour-and cost-intensive [46,47]. But most importantly, the electronic devices are less convenient and reassuring for the patient than the "connect and forget" elastomeric pumps.…”

Section: -Fu Tdm: Practical Considerationsmentioning

confidence: 99%

“…<8Repeat the previous dose to exclude possible pre-analytical errors. If repeated AUC <8, dose adjustment: 30% higher 5-FU = 5-fluorouracil; AUC = area under curve; TDM = therapeutic drug monitoring This dosing scheme is adaptated from Kaldate et al[46] …”

mentioning

confidence: 99%

Fluoropyrimidine chemotherapy: recommendations for DPYD genotyping and therapeutic drug monitoring of the Swiss Group of Pharmacogenomics and Personalised Therapy

Hamzic¹,

Aebi²,

Joerger³

et al. 2020

Swiss Med Wkly

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Fluoropyrimidines (FPs), mainly 5-fluorouracil (5-FU) and its oral prodrug capecitabine (Cap), remain the backbone of the treatment of many different solid tumors. Despite their broad use in clinical routine, 10-40% of patients experience severe, and in rare cases (0.2-0.5%) even lethal, FP-related toxicity in early chemotherapy cycles. Today, there is a plethora of evidence that genetic variants in the gene encoding for the 5-FU catabolising enzyme dihydropyrimidine dehydrogenase (DPD, encoded by DPYD) are predictive of severe FP-related toxicities, and international clinical practice recommendations for DPYD genotype-guided FP dosing and therapeutic drug monitoring (TDM) are available. In spite of this strong evidence and DPYD genotyping becoming standard practice in other countries, it is has not been widely adopted in Switzerland to date. Here, we discuss current guidelines on genotypeguided FP dosing and TDM, and propose recommendations tailored to the situation in Switzerland to facilitate their clinical uptake for the further individualisation of FP chemotherapy.We recommend preemptive testing of four DPYD variants (c.1905+1G>A (rs3918290), c.1679T>G (rs55886062), c.2846A>T (rs67376798) and c.1129-5923C>G (rs75017182, c.1236G>A/HapB3)) in patients with an indication for FP-based chemotherapy, with the costs reimbursed through the compulsory health insurance in Switzerland. Carriers of these variants (6.5% in the Swiss population) have a 40-50% risk of developing severe early-onset toxicity when treated with standard FP doses. In these patients, we therefore recommend the use of a reduced starting dose, based on a dose adjustment scheme provided herein. Furthermore, we recommend the use of infusional 5-FU in patients with a DPYD risk genotype in order to enable TDM-based dose escalation. Only if the use of an infusional 5-FU regimen is not feasible should a slow titration of Cap, starting with the recommended reduced dose and basing further doses on monitoring of toxicity, be considered. Given that several studies have shown that TDM in 5-FU treatment improves not only the therapy's safety, but potentially also its efficacy, we also include detailed TDM-based dosing guidelines and discuss the pre-analytical aspects of 5-FU TDM.

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“…e refill mechanism of the bolus reservoir is based on an elastic balloon; however, this does not prevent the patient to administer a bolus continuously, which needs to be considered concerning the concentration when preparing the drug. As the reliability of elastomeric pumps is debated [20,21], new developments for such disposable pumps include electronic monitoring systems which can be attached to the device [22].…”

Section: Technology: Safety As Itsmentioning

confidence: 99%

Quo Vadis PCA? A Review on Current Concepts, Economic Considerations, Patient-Related Aspects, and Future Development with respect to Patient-Controlled Analgesia

Nardi-Hiebl

Eberhart

Gehling

et al. 2020

Anesthesiology Research and Practice

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This review assesses four interrelating aspects of patient-controlled analgesia (PCA), a long-standing and still widely used concept for postoperative pain management. Over the years, anaesthesiologists and patients have appreciated the benefits of PCA alike. The market has seen new technologies leveraging noninvasive routes of administration and, thus, further increasing patient and staff satisfaction as well as promoting safety aspects. Pharmaceutical research focuses on the reduction or avoidance of opioids, side effects, and adverse events although influence of these aspects appears to be minor. The importance of education is still eminent, and new educational formats are tested to train healthcare professionals and patients likewise. New PCA technology can support the implementation of efficient processes to reduce workload and human errors; however, these new products come with a cost, which is not necessarily reflected through beneficial budget impact or significant improvements in patient outcome. Although first steps have been taken to better recognize the importance of postoperative pain management through the introduction of value-based reimbursement, in most western countries, PCA is not specifically compensated. PCA is still an effective and valued technique for postoperative pain management. Although there is identifiable potential for future developments in various aspects, this potential has not materialized in new products.

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Flow rate accuracy of ambulatory elastomeric and electronic infusion pumps when exposed to height and back pressures experienced during home infusion therapy

Cited by 9 publications

References 25 publications

Advances in regional anesthesia for ambulatory surgery

Advances in regional anesthesia for ambulatory surgery

Fluoropyrimidine chemotherapy: recommendations for DPYD genotyping and therapeutic drug monitoring of the Swiss Group of Pharmacogenomics and Personalised Therapy

Quo Vadis PCA? A Review on Current Concepts, Economic Considerations, Patient-Related Aspects, and Future Development with respect to Patient-Controlled Analgesia

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