A Case Report of Reticular Telangiectatic Erythema Following Intrathecal Drug Delivery System Reservoir Replacement

2020 ◽  
Vol 23 (7) ◽  
pp. 1054-1056
Author(s):  
Logan Kinch ◽  
Lynn Kohan
Keyword(s):  
Drug Delivery ◽  
Case Report ◽  
Drug Delivery System ◽  
Delivery System ◽  
Intrathecal Drug Delivery

scholarly journals Intrathecal Pump Exposure to Electromagnetic Interference: A Report of Device Interrogation following Multiple ECT Sessions

2019 ◽  
Vol 19 (2;2) ◽  
pp. E343-E345
Author(s):  
Mark Bicket
Keyword(s):  
Drug Delivery ◽  
Case Report ◽  
Drug Delivery System ◽  
Delivery System ◽  
Electroconvulsive Therapy ◽  
Electromagnetic Interference ◽  
Drug Delivery Systems ◽  
Safety Issue ◽  
Delivery Systems ◽  
Intrathecal Drug Delivery

Background: Intrathecal drug delivery systems represent an increasingly common treatment modality for patients with a variety of conditions, including chronic pain and spasticity. Pumps rely on electronic programming to properly control and administer highly concentrated medications. Electromagnetic interference (EMI) is a known exposure that may cause a potential patient safety issue stemming from direct patient injury, pump damage, or changes to pump operation or flow rate. Objectives: The objective of our case report was to describe an approach to evaluating a patient with a pump prior to and following exposure to EMI from electroconvulsive therapy (ECT), as well as to document findings from device interrogations associated with this event. Study Design: Case report. Setting: Academic university-based pain management center. Results: We present the case of a patient with an intrathecal pump who underwent multiple exposures to EMI in the form of 42 ECT sessions. Interrogation of the intrathecal drug delivery system revealed no safety issues following ECT sessions. At no time were error messages, unintentional changes in event logs, unintentional changes in pump settings, or evidence of pump stall or over-infusion noted. Conclusion: Communication with multiple entities (patient, family, consulting physicians, and device manufacturer) and maintaining vigilance through device interrogation both before and after EMI exposure are appropriate safeguards to mitigate the risk and detect potential adverse events of EMI with intrathecal drug delivery systems. Given the infrequent reports of device exposure to ECT, best practices may be derived from experience with EMI exposure from magnetic resonance imaging (MRI). Although routine EMI exposure to intrathecal drug delivery systems should be avoided, we describe one patient with repeated exposure to ECT without apparent complication. Key words: Baclofen, intrathecal drug delivery system, electromagnetic interference, electroconvulsive therapy, safety, pump interrogation, intrathecal pump, pump stall

scholarly journals Inadvertent Spinal Shock during an Intrathecal Drug Delivery System Refill – A Case Report and Troubleshooting Algorithm

2018 ◽  
pp. 227-234
Author(s):  
Gaurav Chauhan
Keyword(s):  
Drug Delivery ◽  
Case Report ◽  
Side Effects ◽  
Drug Delivery System ◽  
Delivery System ◽  
Chronic Back Pain ◽  
High Dose ◽  
Educational Objective ◽  
Spinal Shock ◽  
Intrathecal Drug Delivery

Intrathecal drug delivery systems (IDDS) are used to treat patients with chronic refractory pain syndromes and spasticity. IDDS offer an effective therapy to control pain while offering the advantage of a decrease in the incidence of side effects from high-dose systemic opioid therapy. Serious outcomes including death or permanent brain damage may occur from medication administration errors, primarily during maintenance of IDDS. The pump refill and reprogramming procedures, although elemental in theory, are not bereft of serious and fatal side effects .The importance of understanding the IDDS and competency in performing pump refills and programming is of critical importance. To reduce the risk of drug-related errors, particular attention should be paid to the proper functioning of pump hardware, drug reservoir volume discrepancies and overdose symptoms reported by patients. Furthermore, the clinician should be prepared for drug errors and follow the risk mitigation flowchart mentioned in the clinician refill reference card provided by the IDDS manufacturer. We present a case report of a 62-year old male with a history of post-laminectomy syndrome, associated with chronic back pain for the last 4 years. The patient developed inadvertent total spinal shock during a refill procedure of the IDDS reservoir. The educational objective of this case report is to highlight troubleshooting options, plus some of the risks and complications that can occur when managing an intrathecal pump delivery system. Clinicians involved in the ongoing care of patients with IDDS should undergo periodic competency validations. Imaging modalities are useful adjuncts for intrathecal pump refills when a patient has a more difficult entry or previous complications at the time of refill. A rapid recognition of evolving complications and implementation of appropriate treatment are the cornerstones of successfully managing complications associated with refilling of IDDS. Key words: Intrathecal drug delivery system, drug refill, total spinal shock, seroma, catheter port study, rotor study

scholarly journals Malfunctioning sufentanil intrathecal pain pump: a case report

2020 ◽  
Vol 14 (1) ◽  
Author(s):  
Lindsay Warner ◽  
Anna Branstad ◽  
Lindsay Hunter Guevara ◽  
Laura Matzke Bitterman ◽  
Matthew Pingree ◽  
...  
Keyword(s):  
Drug Delivery ◽  
Case Report ◽  
Drug Delivery System ◽  
Delivery System ◽  
Pump System ◽  
Context Sensitive ◽  
Intrathecal Drug Delivery ◽  
Pharmacokinetic Properties ◽  
Pain Pump ◽  
Clinically Significant

Abstract Background Sufentanil is a potent opioid uncommonly used to manage pain and is rarely administered via an intrathecal pain pump system. Case presentation This case illustrates the use of intrathecal sufentanil in a 50-year-old Caucasian man for the management of chronic pain; however, the intrathecal drug delivery system experienced a malfunction which led to 1/100th output of the correct dosage. Interesting aspects of this case report include the uncommon choice of sufentanil use for an intrathecal drug delivery system, as well as the unusual pharmacokinetics of this drug. Specifically, this patient did not experience the major withdrawal that would be expected given significant under dosing of opioid, and this may be explained by the lipophilicity and context-sensitive half-times of sufentanil. Conclusions Because of the absence of a clinically significant withdrawal in this case report, clinicians must be aware of relevant pharmacokinetic properties and unusual intrathecal drug delivery system technologies that influence a patient’s response when device malfunction occurs.

Multiple Fibrin Glue Use in a Complicated Case of Postdural Puncture Headache Following Intrathecal Drug Delivery System Placement: A Case Report

2019 ◽  
pp. 77-81
Author(s):  
Matthew Chung
Keyword(s):  
Drug Delivery ◽  
Cerebrospinal Fluid ◽  
Drug Delivery System ◽  
Fibrin Glue ◽  
Delivery System ◽  
Epidural Blood Patch ◽  
Csf Leak ◽  
Postdural Puncture Headache ◽  
Intrathecal Drug Delivery ◽  
Blood Patch

A postdural puncture headache (PDPH) is a well-described complication after implantation of an intrathecal drug delivery system (IDDS). Treatment is typically with supportive management with the occasional need for an epidural blood patch. We describe a case of a patient with refractory muscle spasticity secondary to cerebral palsy that required a baclofen IDDS implantation and subsequently developed a PDPH. After failing conservative therapy as well as an epidural blood patch, the decision was made to attempt an epidural fibrin patch, which transiently improved her headache. Upon return of the patient’s symptoms, computed tomography myelogram demonstrated an extensive cerebrospinal fluid leak with ventral spread into the retroperitoneal space. Using a novel technique, a second epidural fibrin glue patch was administered just adjacent to the IDDS catheter insertion point, which was then successful in resolving her symptoms. Key words: Intrathecal drug delivery system, postdural puncture headache, dural tear, cerebrospinal fluid (CSF) leak, fibrin glue, epidural blood patch

Pontine Hemorrhage Following a Recently Implanted Intrathecal Drug Delivery System

Pain Practice ◽  
2009 ◽  
Vol 9 (4) ◽  
pp. 312-316 ◽  
Author(s):  
David M. Rosenfeld ◽  
Terrence Trentman ◽  
Naresh P. Patel
Keyword(s):  
Drug Delivery ◽  
Drug Delivery System ◽  
Delivery System ◽  
Intrathecal Drug Delivery ◽  
Pontine Hemorrhage
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