University of Washington, Seattle, WA, USA.
Pain Med. 2011 Apr;12(4):607-11. doi: 10.1111/j.1526-4637.2011.01090.x. Epub 2011 Apr 11.
Intrathecal pump drug refill may result in significant adverse outcome and complications. Thus far, 351 reports from around the world have been received by Medtronic Inc. related to occurrence of pocket fill, including eight lethal events. Ultrasound-assisted pump port access has been previously described, but did not result in wide acceptance in routine practice due to cumbersome and unreliable setup. This study outlines the methodology of real-time ultrasound-guided pump refill.
Preclinical feasibility study.
University of Washington Body Willed Program laboratory.
Using unembalmed cadaver model clinical scenarios of either inverted or deeply implanted pump were replicated. Sonographic images of those conditions were studied and an ultrasound-guided technique for accessing the pump injection port was developed. The ability to correctly identify pump versus pocket fill using ultrasonography was evaluated.
Positive and negative predictive value of correct needle placement, assessment of learning curve for inexperienced user, description of ultrasonography of inverted pump.
Both positive and negative predictive values reached 100%. Mastering the technique easy and uneventful. Inverted pump has a distinctive sonographic appearance.
Ultrasound-guided intrathecal pump access is a feasible and simple technique that may improve maintenance, routine device care, and prevent serious complications related to erroneous subcutaneous injections of concentrated medications. Clinical validation will be necessary in the future.
鞘内泵药物再填充可能导致严重的不良后果和并发症。迄今为止，美敦力公司已收到来自世界各地的 351 份与口袋填充相关的报告，包括 8 起致命事件。超声辅助泵端口接入此前已有描述，但由于设置繁琐且不可靠，并未在常规实践中广泛接受。本研究概述了实时超声引导泵再填充的方法。
临床前可行性研究。
华盛顿大学遗体捐赠计划实验室。
复制了倒置或深度植入泵的临床情况的非防腐尸体模型。研究了这些条件的超声图像，并开发了一种用于进入泵注射端口的超声引导技术。评估了使用超声正确识别泵与口袋填充的能力。
正确放置针头的阳性和阴性预测值，评估无经验用户的学习曲线，描述倒置泵的超声。
超声引导鞘内泵进入是一种可行且简单的技术，它可以提高维护、常规设备护理，并防止与错误的皮下注射浓缩药物相关的严重并发症。未来还需要进行临床验证。
