intrathecal pumps thomas yeargin biomedical engineering bme 281 section 1

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Intrathecal Pumps Thomas Yeargin Biomedical Engineering BME 281 Section 1

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Intrathecal PumpsThomas Yeargin

Biomedical Engineering BME 281 Section 1

What is an Intrathecal Pump?

• Method of giving medication directly to the spine to cure intolerable pains

• Small pump surgically placed under skin of abdomen

• Delivers medication, usually morphine, through a catheter to intrathecal space of spine

• Can release medication slowly over period of time or can be programmed to release different amounts periodically

Reasons for Intrathecal Pumps

• If one is dependent on pain medication

• If one could not benefit from additional surgeries

• Cancer pains

• Lessen spasticity from cerebral palsy or multiple sclerosis

http://www.swarminteractive.com/images/thumbs/pumpimplant_300.jpg

Is it for you?

• Must go through complex trial to see if treatment decreases pain/spasticity

• Single injection through lumbar puncture

• Multiple injections over the course of days

• Continuous trial- catheter placed in correct area of the spine connected to external pump

• Dose is increased every two hours until patient feels pain relief

Types of Intrathecal Pumps

• Two major types of intrathecal pumps:

• Implanted pump with a constant flow rate

-dosage cannot be changed

• Fully implanted pump with programmable pump

-Programmed by computer so doctors can change dosages to meet patients needs

http://www.medgadget.com/2012/09/ascenda-a-stronger-catheter-for-medtronics-baclofen-synchromed-ii-pump.html

Medications

• First line of medication is morphine, provides good analgesia in patients

• Second line of medication is morphine with the addition of bupivacaine or clonidine

-better for patients with neuropathic symptoms

• Third line is the combination of both bupivacaine and clonidine with morphine

-Third line only used if line one and two fail

Surgery

• Takes about 3-4 hours

• Catheter is placed in intrathecal space of spine

• Pump is placed in between skin and muscle layers of the abdomen

• An extension catheter is passed under the skin from the spine to the abdomen to connect to the pump.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2080496/

Living With the Pump

• Must schedule medication refills on a regular basis

• Effectiveness of treatment will be assessed at the checkups

• Tell doctor if feeling unusual symptoms or drug overdose

• Withdrawal symptoms could happen and can possibly be very dangerous

Risks/Side Effects

• Infection or bleeding from the surgery

• It is very rare but the catheter could move out of place or the pump could stop working

• Accumulation of cerebrospinal fluid around the pump causes a watery discharge from incisions or headaches

• Side effects could include respiratory depression, twitching, muscle spasms and nausea

Results of Pump

• Depends on the severity of the condition of the patient

• Chronic patients experience a reduction of pain as well as overall improvement in everyday activities

• Spasticity patients experience a reduction in rigidity and muscle spasms

• Oral medications are reduced because of the direct delivery of medication to the spinal cord from the pump

Conclusion

• It has already surpassed oral medication and is proven more efficient

• Most patients find that this type of medication works well for them and there are not many risks or side effects that come with it

• If researchers can find a better design for the catheters then the future for this pump is very bright

Questions??

References

• [1] Mayfield Clinic and Spine Institute. " intrathecal Drug Pump." Pain Pump, Intrathecal Drug Delivery, Drug Pump. N.p., Mar. 2013. Web. 16 Oct. 2015. <http://www.mayfieldclinic.com/PE-PUMP.htm#.ViBO27RViko>.

• [2] Knight, Karen H. et al. “Implantable Intrathecal Pumps for Chronic Pain: Highlights and Updates.” Croatian medical journal 48.1 (2007): 22–34. Print.

• [3] Lee, Kung-Shing, Kowng-Shing Chu, Chia-Li Chung, Chiuh-Lung Lin, Shiuh-Ling Hwang, and Shen-Long Howng. "Review Article Intrathecal Drug Delivery System with Programmable Morphine Pump for Pain of Terminally Ill Cancer Patients." CiteSeerX. N.p., 2009. Web. 17 Oct. 2015. http://citeseerx.ist.psu.edu/viewdoc/summary?doi=10.1.1.537.7707&rank=27.