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Intrathecal Pump

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Intrathecal Pump, Intrathecal Pump Insertion

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 Some pumps require medication to be withdrawn from reservoir before MRI due to risk of rapid infusion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