title: [Causes of failure and dangers in the use of motor driven infusion pumps. Accidental closure of the infusion system].
abstract: Syringe drivers are used in anaesthetics, intensive care and emergency medicine to deliver small volumes of highly potent drugs with continuous, constant and reproducible flow. For early recognition of interruptions of the drug delivery caused by occlusion of the infusion system, an alarm is triggered as soon as the system pressure exceeds a certain limit. The sensitivity of this alarm depends on the flow rate, type-specific cut-off pressure and the elastic parameters of the infusion system. The sudden release of pressure built up in the system after occlusion occurred can cause delivery of an uncontrolled drug bolus and hence an additional hazard.
  
  
  METHODS
  Six syringe drivers that are widely used in clinical practice were tested for alarm delay and bolus delivery in the event of an occlusion in the system. First, the alarm pressures at flow rates of 10, 50 and 100 ml/h were measured. Then the alarm delay time and bolus volumes post-occlusion were assessed, using a basic infusion system (syringe + single infusion set). Finally, several alterations to the system like extension, tap battery with germ filters or branching were made and their impact on alarm delay and bolus volume measured.
  
  
  RESULTS
  Because of the great differences in alarm pressures between the devices tested, there were marked differences in the alarm delay at same flow rates. Predictably, there was an indirect proportional link between alarm delay and flow rate. Using the basic infusion system, alarm delays between 23 s and 143 min were measured. In two of the tested syringe drivers, a pressure-release mechanism is activated with the pressure alarm, which prevented bolus application. In the other devices, release of the pressure in the occluded system caused boli of 0.5-7 ml. Variations in the actual syringe volume and insertion of a second connection tube had no impact on alarm delay and bolus volume. Tap batteries, parallel running syringe drivers or trapped air in the system, however, caused marked increase in both alarm delay (107%) and bolus volume (+147%).
  
  
  CONCLUSIONS
  Unidentified occlusions of the system cause grave malfunctioning of syringe drivers. While applying highly potent drugs, the discontinuation of drug delivery with subsequent bolus application can cause vital danger to the patient. As a result of the significant time delays in the pressure alarms, the devices tested do not provide sufficient protection against unrecognized system occlusion. Syringe drivers with adjustable alarm pressure can be set close to the actual infusion pressure. A further important point is that one should aim at a reduction in the elastic properties of the infusion set because of the great impact on alarm delay and bolus volume.
authors.affiliation: Zentrum Anästhesiologie, Rettungs- und Intensivmedizin, Georg-August-Universität Göttingen.
authors.forename: D
authors.initials: D
authors.lastname: Heise
authors.forename: J
authors.initials: J
authors.lastname: Rathgeber
authors.forename: D
authors.initials: D
authors.lastname: Kettler
mesh_terms: D004868:Equipment Failure; D005069:Evaluation Studies as Topic; D007260:Infusion Pumps; D013594:Syringes
vernacular_title: Fehlerquellen und Gefahren beim Einsatz von Motorspritzenpumpen. Akzidenteller Verschluss des Infusionssystems.