External infusion pumps

Comparison of Infusion Devices with Different Driving Mechanisms 

Device Volume range (ml) Flow rate range (ml/hr) Accuracy Flow consistency Piice(%) 

Baneijee, P. S., Hosny, E. A., and Robinson, J. R., 1991, Parenteral delivery of peptide and protein, in Peptide and Protein Drug Delivery (V. H. L. Lee, ed.), Marcel DeWcer, New York, p. 487-543. 

Champion, M. C., Shepherd, G. A., Rodger, N. W., and Dupre J., 1980. Continuous subcutaneous infusion of insulin in the management of diabetes mellitus. Diabetes 29 206-212. 

Parenteral drug delivery and delivery systems, in Novel Drug Delivery Systems, 2nd ed. (J. Swarbrick, ed.), Marcel Dekker, New York, p. 381-528. 

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INSULIN GLULISINE Give within 15 minutes before a meal or within 20 minutes after starting a meal. Insulin glulisine is intended for subcutaneous administration and for use by external infusion pump. 

Insulin aspart Because insulin aspart has a more rapid onset and a shorter duration of action than human regular insulin, insulin aspart normally should be used in regimens together with an intermediate or long-acting insulin. NovoLog may be infused subcutaneously by external insulin pumps. 

Insulin aspart If insulin aspart is mixed with NPH human insulin, draw insulin aspart into the syringe first. Do not mix insulin aspart with crystalline zinc insulin preparations. When used in external subcutaneous infusion pumps for insulin, do not mix with any other insulins or diluent. 

II.f.1.3. Insulin delivery. Traditionally insulin was given intramuscularly and later subcutaneously. New technology has provided devices for insulin administrations including pen-devices, air powered injectors, external insulin infusion pumps (or continuous subcutaneous insulin infusion, CSII), and implantable insulin infusion pumps. Some novel forms of insulin delivery have been introduced, for example intranasal insulin gives peak insulin concentrations at 10-20 minutes after administration, but most insulin is still administered subcutaneously. 

In drug delivery, infusion pumps have achieved remarkable success in recent years. As of 1983, there were 18 different models of external pumps available (6). These battery-powered portable pumps are used to infuse insulin into diabetic patients. Although capable of variable delivery rates, they have a reservoir volume of less than 6 ml, which is unsuitable for fluid replenishment. Further, the cost of these small pumps is very high which limits the affordability to a few selected individuals. 

Mechanically driven pumps are common tools for the intravenous administration of drags in the hospital setting. They allow physicians and patients to precisely control the infusion rate of a drag. Externally programmable pumps can facilitate ... 

In addition to needles and syo inges, alternative techniques for insulin administration have been developed, some availing themselves of the kinetics of insulin insulin pens (supplied preloaded or with replaceable cartridges), external infusions and implantable pumps. These latter are convenient for cm accurately controlled continuously functioning biofeedback system, but pose difficulties for routine replacement in insulin deficiency. Therefore sustained-release (depot) formulations are used to provide an approach reasonably near to natural function and compatible with the convenience of daily living. An even closer approach is provided by the development of (at present inevitably expensive) miniaturised infusion pumps which can be used by reliable patients. 

Regional HAI can be accomplished using a hepatic arterial port, a totally implantable pump, or a percutaneously placed catheter into the hepatic artery that is connected to an external pump. The volume of drug required to administer floxuridine can be contained within an implantable pump, whereas fluorouracil administration generally requires use of an external pump. Implanted infusion pumps are typically loaded with a 2-week volume of chemotherapy that is followed by an infusion of heparinized saline for 2 weeks. Candidates are selected carefully based on documentation of hepatic-only disease, good performance status, and no significant comorbidities or liver anatomic variants. 

Which type of insulin is commonly used for insulin therapy in patients who wear external SC insulin infusion pumps ... 

The very first microfluidic-MS applications have involved sample infusion analysis from chips with a flat spraying surface or with inserted ESI capillary emitters. These relatively simple devices were fabricated from glass or polymeric substrates and were interfaced to IT, TOP, or hybrid Q-TOF instruments, and sample infusion was accomplished by connecting syringe pumps, N2 cylinders, or external EOF pumping capillaries to the chip. Alternatively, infusion experiments have... 

There are various ways to classify today s infusion devices based upon their functionality, driving mechanism, size, or ability to be disconnected periodically from the infusion apparatus. In order to simplify the classification, we have chosen to differentiate only between stationary and portable devices. Stationary devices are used for patients who remain in bed during the treatment, either at home or in a hospital environment. In general, these devices are large, programmable systems that remain near the bedside and require close supervision by medical personnel. Portable infusion pumps, on the other hand, are used by patients who can freely move during then-therapy. They include implantable and externally worn pumps, which range from somewhat bulky forms to small and concealable devices as shown in Fig.l. 

If the catheter is not radio-opaque, 0.5 ml of water soluble contrast material should be injected into the catheter. After correct catheter placement has been confirmed, the hypertonic solution is continuously and finitely delivered to the infant by means of a constant infusion pump. If metabolic balance studies are to be done, the infant should be maintained on a metabolic bed to facilitate accurate collection of all external secretions. 

Graham A, Holohan T (1994) External and implantable infusion pumps. Agency for Health Care Policy and Research, Rockville... 

A number of external or internal pumps have been developed as insulin infusion pumps, or an artificial pancreas, which gives a more precise control over the body s insulin level. These devices normally inject the insulin solution directly into the patient s blood. Many of these "artificial pancreas devices are able to vary the rate of insulin administration, and much progress has been made to couple these pumps with a microprocessor controlled glucose sensor which would closely approximate normal pancreatic activity. Most of these infusion pumps utilize poly-(dimethylsiloxane). 0,41... 

Fig. 7. Systemic (a) human insulin concentration and (b) glucose response following infusion of human insulin from external pump, 5 months postimplantation (Dziubla et ai, 2002).

Insulin pump - Approximately 50% of the total dose is given as meal-related boluses and the remainder as basal infusion. Higher basal rates in external... 

Jeandidier N, Boullu S, Busch-Brafin MS, Chabrier G, Sapin R, Gasser F, Pinget M. Comparison of antigenicity of Hoechst 21PH insulin using either implantable intraper-itoneal pump or subcutaneous external pump infusion in type 1 diabetic patients. Diabetes Care 2002 25(l) 84-8. 

The SynchroMed implantable pump was the first externally programmable implant pump to be introduced in the United States (in 1988). The major components are a miniature peristaltic pump, a drag reservoir (18 ml), a battery, an antenna, a microprocessor and a catheter through which infusate is delivered to a specific site. 

Continuous infusion may also be a mode of administration if the same mode administration is planned for clinical use or if the solubility is too low to achieve blood levels after single day injections. Infusions can be conducted either by external pumps connected to the animals vein or by internal pumps implanted subcutaneously. This mode of administration requires special equipments and great experience by the technicians. A major concern is to avoid infections of the implantation site. These types of studies should be confined to special laboratories with the necessary equipment and experience because under certain circumstances the time of infusion is 24 hours per day. 

Another remotely activated device has been described by Groning et al. (57). They demonstrated in a model the remote control of a device to delivery insulin (Fig. 7). This possibility of external programming and monitoring of insulin pumps is possible for continuous subcutaneous infusion. The use of SMS allows immediate transfer of commands to the pump. There are many pitfalls to overcome the ethics of taking control away from the patients and their carer is but one, and there are safety issues, should the GPS system fad, and presumably if in error the pump is activated by the physician or indeed by individuals accidentally. But there is no doubt that telepharmacy wiU impact on future medicine, whether personalized or not. The personal element could come simply as a result of automated reminders to patients to take their medications also discussed above, but the more sophisticated systems described by Groning et al. wiU also have their place. 

The ReviveFlow system (ReviveFlow, Inc., Quincy, MA) is a novel method of cerebral flow reversal in which a balloon guide catheter is placed in the cervical internal carotid arteries and jugular veins on one or both sides of the neck. The balloons are subsequently inflated and blood is aspirated via an external pump system from the proximal 1C A and infused in the distal internal jugular vein. The end result is total reversal of the cerebral circulation and perfusion of the venous system with arterial blood into the capillary bed, which is now physiologically proximal to the occluded artery. This device is currently undergoing precliifical smdies. 

If a patient is unable to produce sufficient quantities of GnRH, then replacement therapy is available. To mimic normal secretion patterns, this hormone is delivered by infusion every 90 minutes via an external pump worn by the patient (95). 

Following preclinical animal experiments, a Phase I clinical experiment should be performed to assess the dose and effects of continuous administration of the protein. These clinical experiments are particularly useful for analysis of proteins that are already approved for human use (e.g., insulin or growth hormone) or that have been previously observed to be very toxic (e.g., cytokines). Patients are administered a continuous infusion of the protein from either implanted or external pumps. This infusion should mimic the expected rate of delivery from the microsphere formulation. The... 

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