Download Smart Infusion Pump: A boon to the Health Care Industry

International Journal of Engineering Trends and Technology (IJETT) – Volume 4 Issue 6- June 2013
Smart Infusion Pump: A boon to the Health Care
Industry
K.V. Padmaja#1, Apoorva M. Kalgal#2
1
2
Associate Dean and Professor, Department of Instrumentation Technology
Student, IV semester M. Tech, Bio-Medical Signal processing and Instrumentation
R.V. College of Engineering, Bangalore-560004
Abstract— Main motive of any hospital or clinic is to provide the
best patient care. Patient care can be drastically improved using
electronic medical record. An electronic medical record (EMR) is
a computerized medical record created in an organization that
delivers care, such as a hospital or physician's office. The costs of
storage media, such as paper and film, per unit of information
differ dramatically from that of electronic storage media. When
paper records are stored in different locations, collating them to
a single location for review by a health care provider is time
consuming and complicated, whereas the process can be
simplified with electronic records. When treating a patient
another major thing is to monitor the drug or fluid administered
to the patient. Better and safer drug delivery systems will be the
one with automatic or an intelligent infusion pump system. Thus
automatic intravenous infusion will efficiently reduce medication
and administration error.
Keywords— Infusion pump, barcode, automation.
I. INTRODUCTION
This Large-volume, syringe, and patient-controlled
analgesia infusion pumps are commonly used in healthcare
settings to deliver medications, fluids, and nutrients to patients
at precisely controlled rates. The infusion of solutions into a
patient’s venous system is central to today’s therapeutic
regimens and occurs in many settings: inpatient, outpatient,
physician offices and at home. Patients receive infusions
through a myriad of devices: peripheral venous catheters,
central venous catheters, PICCs (peripherally inserted central
catheters), implanted ports and epidural catheters, to name a
few. Each site, solution, medication, device and method of
delivery is chosen specifically for that patient and needs to be
evaluated on an ongoing basis (i.e., the patient’s therapy may
change, IV sites need to be rotated, sites may infiltrate, etc.).
In recent years, "smart" infusion pumps have become
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increasingly sophisticated and include such features as close
error reduction software, commonly referred to as drug
libraries. This technology allows infusion pumps to perform
functions that assist healthcare providers with programming
and calculating dose and delivery rates. When used properly,
these features help prevent I.V. medication errors and reduce
patient harm. It contributes to improve the patient care,
allowing a greater level of control, accuracy, and precision in
drug delivery, and thereby reducing medication errors.
An infusion pump infuses fluids, medication or nutrients
into a patient's circulatory system. It is generally used
intravenously, although subcutaneous, arterial and epidural
infusions are occasionally used. Infusion pumps can
administer fluids in ways that would be impractically
expensive or unreliable if performed manually by nursing staff.
For example, they can administer as little as 0.1 mL per hour
injections (too small for a drip), injections every minute,
injections with repeated boluses requested by the patient, up to
maximum number per hour (e.g. in patient-controlled
analgesia), or fluids whose volumes vary by the time of day.
This is because they can also produce quite high but
controlled pressures, they can inject controlled amounts of
fluids subcutaneously (beneath the skin), or epidurally (just
within the surface of the central nervous system- a very
popular local spinal anaesthesia for childbirth).
II. FACTORS AFFECT THE PHYSICS OF FLOW
An understanding of the physics of flow is helpful to safely
use all the available pump options, including selecting the
appropriate device; delivering the indicated therapy problem
free; evaluating and altering parameters; and assessing the
fluid pathway. Factors that affect the physics of flow are
comprised of the following: [2]
A. Rate
Flow rate (FR) impacts resistance and resistance impacts
the amount of pressure required to achieve the flow rate.
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B. Pressure
Pressure (P) is a measure of the force (F) applied to
overcome resistance in a system, across a given area (A).
The area is the internal fluid pathway or internal diameter
(tubing, add-ons and catheter). Pressure is the result of force
and is measured in either PSI (pounds per square inch) or
mmHg (millimetres of mercury).
Fig.1 Depiction of the vascular backpressure[2]
A pressure gradient between the IV solution container and
the venous pressure is necessary for flow to occur. The
gradient depends on static pressure (height of the solution
container in relation to the patient’s heart) and the patient’s
activity (blood pressure is lower when the patient is lying
down vs. standing and walking) and dynamic pressure
(resistance generated by the fluid flowing through the IV
system). The infusion pump is a source of constant force that
produces a constant flow rate, with the force exerted equal to
the rate times the amount of resistance existing within the
system.
C. Resistance
Resistance is anything that impedes flow. The greater the
resistance in the fluid pathway, the greater the force required
to move through it. Fluid viscosity, fluid pathway length
(tubing, extensions and the catheter) and internal diameter of
the administration set are the major resistors to flow.
D. Viscosity
Viscosity is defined as a fluid’s resistance to flow.
Temperature directly affects fluid viscosity. Colder fluids
exhibit greater resistance to flow than warm fluids. Principle:
Viscosity directly impacts resistance.
entire blood supply within a human body circulates within 60
seconds, substances introduced into the circulatory system are
distributed rapidly. An infusion device typically consists of
three major components: the fluid reservoir, a catheter system
for transferring fluids into the body and a device that
combines electronics with a mechanism to generate and
regulate flow. Regulated drug concentration in the body is
needed to achieve and maintain a desired result, especially if
prolonged under-infusion or over-infusion takes place.
Examples of such fluids include blood, plasma, antibiotics,
narcotics for pain relief, chemotherapy drugs and extend in
range to less obtrusive residential administered insulin for
diabetics. Two basic types of infusion pumps exist. The first
type is a syringe displacement, whereby the plunger is slowly
depressed by electromechanical means at a controlled rate.
These are often used for Patient Controlled Analgesia (PCA)
treatments. Pain relievers are self-administrated by the patient
under maximum dosage limits controlled by the device and
programmed by medical staff. Types of infusion pump and
there application in healthcare:
A. Large volume pump
These pumps are mainly used for intravenous (IV), epidural
routes and is used for multipurpose such as delivery of
medication, anesthesia, in chemotherapy, etc. These allow
high flow rates of about 0.1 t0 999mL/hr. with an accuracy of
+/- 5%.
Fig. 2 Large volume pump [1]
B. Syringe Pumps
They are used for IV, enteral infusions and have different
syringe types with an accuracy of +/- 2% to 3%. Typical flow
rates: 0.01 – 10 ml/hr. [1]
E. Length:
Length directly impacts resistance. Doubling the length
reduces the flow rate by half.
Many other factors like tube’s internal diameter, infiltration
affect the flow.
III. BASICS OF INFUSION PUMP
Infusion pumps are an effective pathway to deliver fluid,
blood, and medication to a patient's vital organs. Since the
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Fig. 3 Syringe pump [1]
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International Journal of Engineering Trends and Technology (IJETT) – Volume 4 Issue 6- June 2013
C. PCA Pump
They are used for IV, subcutaneous, epidural delivery with
patient controlled bolus delivery. They can hold up to 20-500
cc syringes/bags with a high flow rates: 0.1- 999 mL/hr. They
are mostly used for narcotics delivery.
errors and increased data accuracy and completeness. It must
mainly adapt to the general workflow followed in most of the
hospitals, like the one shown in figure 5 below.
D. Insulin Pumps
They are used for subcutaneous delivery with an accuracy
of +/- 5%. Reservoir of 3 ml of solution, infusion rate
controller, and catheter are the main components [1].
E. Enteral Pumps
They are used mainly for enteral (digestive tract) for
milk/formula delivery with an accuracy of +/- 10% and flow
rate: 1-300 ml/hr[1].
F. Implantable Pump
These are intra-thecal with volume of reservoir of 10 ml
and 18 ml. Pump, catheter are well programmed and can be
reprogramed via radio frequency with catheter access and
refill options and most importantly these are battery
powered[1].
Fig. 4 Implantable pump [1]
While smart pump technology helps reduce medication
errors and prevent patient injury, it's not intended to replace
clinical practices, institutional policies, and vigilant patient
monitoring. However, these smart pumps can't prevent all
programming and administration errors. According to a 2006
report from the Institute of Medicine of the National
Academies (IMNA), out of all medical errors, medication
administration mistakes have ranked among the most common,
harming at least 1.5 million people every year,. On average, at
least one medication error per hospital patient occurs each day,
which equals 400,000 errors each year, according to IMNA.
The extra medical cost of treating drug-related injuries
occurring in hospitals alone conservatively amounts to $3.5
billion annually, taking all these into account automation of
these infusion pumps are necessary.
IV. AUTOMATION OF INFUSION PUMPS
The basic idea or the motivation behind the infusion pump
automation is to avoid/ reduce the administration errors.
Automation mainly involves integration with Electronic
Medical Record Systems (EMR) with streamlined reporting
and caregiver workflow in order to reduced transcription
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Fig. 5 Wireless communication between the infusion pump
and hospital network [2]
Other main motivation behind automation is to use infusion
pump for the wireless application as well such as the remote
monitoring, maintenance, allow software upgrades etc. One of
the main automation involved or adapted is the barcode
scanning. Nowadays most of the infusion pump allows bar
code scanning for all infusions (bags and syringes) and
provide patient, clinician and drug recognition at the point of
care.
Fig. 6 Barcode facility in the infusion pumps to identify the
fluid bag [2]
Since barcode scanning is adapted into the infusion pump
technology knowledge about the barcode is necessary to
decode them. Barcode encodes data on parallel lines of
different widths. The most universally used barcode is the
UPC, Universal Product Code. The most common form of the
UPC is the UPC-A, which has 12 numerical digits encoded
through varying width of black and white parallel lines. [5]
The UPC-A barcode is an optical pattern of bars and spaces
that format and encode the UPC digit string. Each digit is
represented by a unique pattern of two bars and two spaces.
The bars and spaces are variable width; they may be 1, 2, 3, or
4 units wide. The total width for a digit is always 7 units.
Since there are 12 numbers, the barcode has starting lines,
middle separator, and ending lines. A complete UPC-A
includes 95 units: the 84 for the left and right digits combined
and 11 for the start, middle, and end patterns. Thus decoding
of the barcode is pretty straight forward. [5]
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V. CONCLUSIONS
Infusion pumps are an effective pathway to deliver fluid,
blood, and medication into a patient’s body in a controlled
manner. It contributes to improvements in patient care,
allowing for a greater level of control, accuracy, and precision
in drug delivery, and thereby reducing medication errors,
hence referred to as “smart pumps”. There are two important
things to keep in mind, first is to ensure that any infusion is
given correctly and safely by the most appropriate method and
second is to ensure that the pumps and their associated
consumable items are managed to ensure their optimum
performance. Automation is seen to improve the performance
of the infusion pump. The end result for the clinicians is a safe,
fast and reliable medication administration and documentation
process. While infusion pumps are quite intelligent, they can
only achieve their full potential when operated by a clinician
who understands the full range of available options and uses
them in accordance with prescribed recommendations.
REFERENCES
[1]
[2]
[3]
[4]
[5]
Izabella Gieras, “Innovative Infusion Pump Technologies”,
Engineering in Medicine & Biology Society (EMBS) IEEE Long
Island Chapter June 15, 2010.
Denise Macklin, “Infusion Pump Therapy- A Guide for Clinicians and
Educators”, Illinois: Hospira, Inc., June 2008
Abbott Park, “Fluid Dynamics: The Relationship between Fluid
Dynamics and Infusion Therapy” (Self Study Module), Illinois: Abbott
Laboratories, 2002.
Percival J., McGregor C., Percival N., Kamaleswaran R., Tuuha S., “A
framework for nursing documentation enabling integration with HER
and real-time patient monitoring”, Computer-Based Medical Systems
(CBMS), 2010 IEEE 23rd International Symposium on October 2010.
Kunmo Kim and Yiwei Cheng, “Real-Time Barcode Recognition”.
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