Selecting infusion devices for use in ambulatory care.

Intravenous infusion devices commonly used in home care and ambulatory care settings are reviewed and factors to consider in selecting a device are suggested. The type of therapy to be administered, the patient or caregiver's ability to understand and carry out instructions, staff time required for patient teaching and drug and device preparation, drug stability, frequency of doses, reservoir volume, control of flow rate, type of venous access, cost and availability of devices and supplies, and reimbursement should be considered. Cost-effectiveness of a device can be evaluated only by analyzing all of the costs associated with administering a medication. Decisions must be based on an individual agency's needs, but usually one type of single-dose infuser and one brand of electronic ambulatory-care infusion pump can meet the needs of most of an agency's patients. For patients self-administering up to four doses per day, appropriate methods may include slow intravenous injection (i.v. push), infusion from minibags and tubing, and the use of elastomeric infusers, electronic or mechanical syringe pumps, or a new device based on infusion across a bioelectric membrane. Some of these types of infusers can also be used for continuous infusion. Syringe pumps are reliable and affordable and control infusion rates well, but infusion volume is limited and these devices must be recovered, cleaned, and tested between patients. Although elastomeric pumps may have higher price tags than other devices, they are simple for patients to use and dispose of. While elastomeric devices have tubing permanently attached, the disposable tubing of some other devices is detachable and can be reused if institutional policy permits. Electronic ambulatory-care infusion pumps can meet a wide range of infusion requirements. They vary in size, weight, ability to detect occlusions, features, and reliability. All use proprietary infusion sets, but the costs of sets and disposable supplies vary. Some pumps can be used for a single infusion mode, such as patient-controlled analgesia (PCA); others offer two or more modes (for example, continuous, intermittent, and PCA). "Multichannel" pumps can be used for simultaneous infusion of up to four medications; the rate of each infusion is programmed separately, and some multichannel devices offer multiple infusion modes. Some can be programmed remotely by telephone. Before an agency decides on a pump, it can investigate current users' and rental firms' experiences with the device. Also, all relevant personnel should try programming the device. Determining which devices to use requires a comparison of features that are pertinent to the particular agency or institution and a cost analysis that considers acquisition, reimbursement, patient training time, and the cost of disposable supplies.