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Intrathecal Pump
Aka: Intrathecal Pump, Intrathecal Pump Insertion
- See Also
- Baclofen Pump
- Mechanism
- Intrathecal drug delivery for maximal pain relief with less adverse effects
- Avoids the sedation of antispasmodics such as Baclofen
- Avoids the Nausea, Pruritus and sedation of systemic Opioids
- Catheter inserted into intrathecal space cerebrospinal fluid
- Catheter tunneled around Abdomen and into the lower abdominal wall
- Insertion by interventional pain management specialists or Neurosurgeons
- Pump refills
- Pump is battery operated and is typically implanted into Abdomen
- Pump port is accessed via needle through the skin
- Preparations
- FDA approved agents to be used in Intrathecal Pumps
- Morphine
- Baclofen
- Ziconotide
- Off-Label medication uses within Intrathecal Pumps
- Hydromorphone
- Bupivicaine
- Fentanyl
- Clonidine
- Complications
- Clonidine Pump malfunction with Drug Withdrawal
- Clonide withdrawal results in hypertensive emergencies
- Baclofen Pump Malfunction with Drug Withdrawal
- See Baclofen Pump
- Overdose
- Less common
- May occur on attempted pump port refill, if the port site is missed
- Infection
- May occur immediately after implantation, however otherwise infections are uncommon
- Catheter granuloma
- May result in local mass effect with pressure on spinal cord and risk of injury
- Precautions
- Lumbar Puncture
- Interventionist may access side port of pump to withdraw CSF for analysis
- Do not perform blindly without identifying the course of the catheter
- XRay catheter region to determine involved levels
- Perform Lumbar Puncture under fluoroscopy if performing Lumbar Puncture in region of catheter
- MRI with implanted pump
- Consult specific pump guide or device consultant
- Precautions vary by pump
- Some pumps require medication to be withdrawn from reservoir before MRI due to risk of rapid infusion
- Anticoagulants and Thrombolytics
- Risk of intrathecal hematoma in perioperative period (insertion or removal)
- Anticoagulants and Thrombolytics should be avoided in the first 48 hours of catheter procedure
- Pump interrogation (e.g. flow rate settings)
- May be performed by device consultants as well as some hospital pharmacists
- Pump maintenance
- Pump should be refilled every 6-12 weeks (or based on amount used and type of agent)
- Pump should be replaced every 3-5 years
- References
- Mishler and Lovecchio (2017) Crit Dec Emerg Med 31(11): 15-20
- Lin, Coralic and Poree in Herbert (2015) EM:Rap 15(11):4-5