How to perform the baclofen pump refill?
Baclofen medication for intrathecal use is difficult to find in Brazil. The functional neurosurgeon has access to obtain the medication along with the patient, this can be combined between patient and physician.
The refill should be performed before the end of the medication. After the medication is finished, air may enter the pump system and may even spoil its operation. The surgeon should be aware of the material used in the puncture to avoid damaging the pump. There are specific refill kits for this procedure.
The procedure is performed by a physician or nurse practitioner, in a sterile environment, with sterile manipulation of medications and materials. No anesthesia is required, puncture of the reservoir chamber at the pump is similar to puncture of a vein for collection of exams. The patient is usually discharged shortly after the procedure.
What is the risk of intrathecal infusion pump refill?
The main risks are:
1) Infection - by non-sterile manipulation of materials or even by immunity of the patient
2) Infusion of the medication outside the puncture chamber - this can be very serious because the medication that should be applied over six months is absorbed by the body in an extremely fast way that can lead the patient to coma or even death. It is important that the person performing this procedure is familiar with the materials and the technique.
3) Error in medication, concentration, titulation or doses amount: principally when changing medication concentration into the pump reservoir. It's important to remeber that medication at catheter is the old one, so, changing medication or concentration demands a bridge bolus.
When should the refill be done?
Medtronic's Synchromed 2 Infusion Pump is an electronic pump that allows the surgeon to see by telemetry how much medication is still in the pump, how much of the medication is being dispensed per day for the patient, and how long the stock is in its reservoir .
Thus, the exchanges can be programmed without urgency. As the volumes infused are usually very low, the pump can last for weeks even with 1mL in its reservoir.
An alarm can be set on the pump to be triggered if the tank volume reaches a critical volume. When the pump triggers the alarm (which looks like a digital clock alarm clock, at relatively low volume), the patient should immediately seek his doctor.
In general, manufacturers recommend that the medication be changed at the most every 6 months. More than this period its pharmacological function is not evidently kept inside the pump reservoir (that is at the same temperature as the body, that is, around 37 degrees Celsius). Read more about Intrathecal Baclofen Infusion.
