Smart infusion pump

Smart infusion pumps are smart devices that infusion pumps that collect data and then aggregate them into a database on central server. This includes records of the administration warnings and alerts that have fired and the administering clinicians responses to those alerts.

Overview

It is important to distinguish the different types of pumps by modality. The common modalities are (1) large volume parenteral infusions (LVPs), (2) syringe infusions, (3) epidural infusions and (4) patient-controlled analgesia infusions.

Some pumps are purpose-built exclusively to be used for only a single modality, whereas other pumps have been engineered to support multiple infusion modalities.

Klas recently (2008) reviewed several pump vendor products. The represented vendors were B. Braun, Baxter, Cardinal Health, Hospira, Sigma and Smiths Medical.

Some smart pumps have become network devices, connecting to wireless networks in hospitals and clinics using IEEE 802.11 standards for wireless local area network communications.

Management

The network distribution of new data set information wirelessly to widely distributed smart infusion pump devices is an area of particular concern. While it seems convenient to distribute drug library data set updates for new drugs, changes to standard concentrations and upper and lower infusion rate bounds to infusion pumps using a wireless network, one must consider that this type of distribution will NOT be completed quickly. Instead, the pump devices must be turned on and connected to the network to receive a data set update. Therefore it can take a period of days or longer to disseminate a new data set wirelessly. This lag time for data set updates could cause problems but it can be managed and diminished through policies and procedures that require locating each and every smart infusion device in circulation and validating data set downloads over a much shorter period of time, perhaps requiring only a few hours.

Smart Infusion Pump quality data

One fascinating advantage of smart infusion pump technology is the ability to capture information from the pump programming process for later review and analysis. Typically, smart infusion pumps include drug libraries or databases of drug-specific information. These drug libraries can include lower and upper bounds governing safe and appropriate infusion rates for standard infusions as they are defined by the hospital, health-system or clinic. These lower and upper infusion rate bounds are then used to provide administration decision support at the point-of-care. Overridable soft stops and rigid hard stops are both supported by some of the smart pump software.

Maddox et al. report some of these data in a paper on smart infusion devices for patient-controlled analgesia (PCA). In this study, the PCA pump system included a novel, integrated, continous capnographic quality of respiration monitoring system augmented by pulse-oximetry (see Am J Health-Syst Pharm Vol. 63: Jan 15, 2006). These authors present several cases where automated respiratory monitoring by the PCA smart pump system alerted clinicians early-on to potential narcotic-induced repiratory depression before life-saving measures were needed. The authors also report "examples of averted programming errors" from the smart PCA pump activity database.