Managing a National Intrathecal Pump Service During the COVID-19 Pandemic

Patel, Anil K.; Dowling, Mairéad; Purcell, Andrew; O'Brien, Joanne; Moore, David

doi:10.1111/ner.13225

Cited by 5 publications

(5 citation statements)

References 10 publications

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“…It poses a great risk for patients on ITB due to increased occurrence of infection, as well as the possibility of missing the pump supplementation with the drug. In some cases, this can be life-threatening [21].…”

Section: Discussionmentioning

confidence: 99%

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Intrathecal baclofen therapy and Covid-19 infection - report of three cases

Nikolić

Nestorovic²,

Repac

et al. 2022

Srp Arh Celok Lek

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Introduction. Patients with severe spasticity are effectively treated with intrathecal baclofen therapy (ITB), but because of their invalidity, in case of infection, prognosis is poor. Case outline. We present three cases (two men and one woman) of patients treated with baclofen intrathecal therapy due to spasticity of all four extremities who underwent SARS-CoV2 virus infection. Two of them have multiple sclerosis, and one has trauma of the cervical segment of the spinal cord. In all three patients, the clinical presentation of Covid-19 infection occurred within six months of implantation of the pump for ITB. They were successfully treated in hospital with same dose of the drug and without exacerbation of neurological status. Barthel index and modified Rankin score were same before and after Covid-19 infection. In two cases Barthel index (BI) was 20, and in one 69; and modified Rankin score (mRS) was 3 in one case, and 5 in two cases. Conclusion. Patients with severe spasticity who require intrathecal baclofen therapy can be safely treated regardless of the pandemic.

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Section: Discussionmentioning

confidence: 99%

“…Recent Corona virus pandemic caused major turbulence in majority of services, including health care. Patients with ITB are prone to poor prognosis in case of infection [5].…”

Section: Introductionmentioning

confidence: 99%

Intrathecal baclofen therapy and Covid-19 infection - report of three cases

Nikolić

Nestorovic²,

Repac

et al. 2022

Srp Arh Celok Lek

View full text Add to dashboard Cite

show abstract

“…This involves the implantation of an intrathecal catheter which is connected to a subcutaneous pump [ 20 ]. Children who have been implanted with an intrathecal (IT) pump need to come to the hospital for regular evaluation and a refill approximately every 3–6 months, depending on the exact dose [ 21 ]. Successful ITB pump therapy thus requires continuous input from specialist services to maintain an effective and safe therapy.…”

Section: Introductionmentioning

confidence: 99%

“…Successful ITB pump therapy thus requires continuous input from specialist services to maintain an effective and safe therapy. During the refill, the physician places a needle directly into the reservoir to refill the pump (i.e., refill through a transcutaneous needle) [ 21 ]. To alleviate the pain and fear with these refill procedures, it is hypothesized that VR could alleviate pain and make these regular refills more feasible.…”

Section: Introductionmentioning

confidence: 99%

Virtual Reality during Intrathecal Pump Refills in Children: A Case Series

Goudman

Jansen

Smedt

et al. 2022

JCM

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Virtual reality has proven to be an effective approach to decrease pain in acute settings, both in adults and children. The aim of this study is to evaluate whether virtual reality (VR) could reduce pain during an intrathecal pump refill procedure in children receiving intrathecal drug delivery, compared to a standard refill procedure. This is a three-arm crossover randomized controlled trial, evaluating the effect of VR on pain in children with cerebral palsy undergoing an intrathecal pump refill compared to a standard refill and a refill with distraction (watching a video). Pain was evaluated using the Wong–Baker Faces Scale. Secondary outcomes were procedural pain, fear, state anxiety, the incidence of adverse events and satisfaction. Six children participated in this study, whereby all children underwent the three conditions. Five children indicated an equal of lower pain score during VR, compared to a standard refill. This finding of an equal or lower pain intensity score for the VR condition compared to the control condition was also revealed by the ratings of the parents, physician and the researcher. The influence of VR on anxiety and fear seem to be in line with the influence of watching a video. In terms of satisfaction, all children and parents agreed with the statement that they would like to use VR again for a next refill. Due to the lack of adverse events, the high degree of satisfaction of children with VR and the decreased pain levels after a refill with VR, physicians may aim to explore the implementation of VR during intrathecal pump refill procedures in children in a daily clinical routine care setting.

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“…After pump implantation, the most commonly performed postoperative "maintenance" procedure is the drug refill, consisting of an aseptic access to the pump reservoir, emptying residual volume, and filling the reservoir with new medication [13]. Successful therapy thus requires continuous input from specialists; in particular, pump refills need to be performed at regular time intervals [14]. Delayed pump refill can cause serious withdrawal syndrome and in the case of baclofen lifethreatening events may occur such as rhabdomyolysis, seizure, coma and even death [15].…”

Section: Introductionmentioning

confidence: 99%

Hospital at Home for Intrathecal Pump Refills: A Prospective Effectiveness, Safety and Feasibility Study

Goudman

Smedt

Huygens

et al. 2021

JCM

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Continuous Intrathecal Drug Delivery through an implanted pump is a well-known therapeutic option for the management of chronic pain and severe disabling spasticity. To have a successful therapy, pump refills need to be performed at regular time intervals after implantation. In line with the increased applications of Hospital at Home, these refill procedures might be performed at the patient’s home. The aim of this pilot study is to evaluate the feasibility, safety, and effectiveness of intrathecal pump refill procedures at home. Twenty patients were included whereby pump refill procedures were conducted at the patient’s home. To enable contact with the hospital, a video connection was set-up. Tele-ultrasound was used as post-refill verification. All procedures were successfully performed with complete patient satisfaction. Ninety-five percent of the patients felt safe during the procedure, and 95% of the procedures felt safe according to the physician. All patients indicated that they preferred their next refill at home. The median time consumption for the physician/nurse at the patient’s home was 26 min and for the researcher at the hospital 15 min. In light of quality enhancement programs and personalized care, it is important to continue urgent pain management procedures in a safe way, even during a pandemic.

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Managing a National Intrathecal Pump Service During the COVID-19 Pandemic

Cited by 5 publications

References 10 publications

Intrathecal baclofen therapy and Covid-19 infection - report of three cases

Intrathecal baclofen therapy and Covid-19 infection - report of three cases

Virtual Reality during Intrathecal Pump Refills in Children: A Case Series

Hospital at Home for Intrathecal Pump Refills: A Prospective Effectiveness, Safety and Feasibility Study

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