title: Siphon effects on continuous subcutaneous insulin infusion pump delivery performance.
abstract: BACKGROUND
  The objective was to quantify hydrostatic effects on continuous subcutaneous insulin infusion (CSII) pumps during basal and bolus insulin delivery.
  
  
  METHODS
  We tested CSII pumps from Medtronic Diabetes (MiniMed 512 and 515), Smiths Medical (Deltec Cozmo 1700), and Insulet (OmniPod) using insulin aspart (Novolog, Novo Nordisk). Pumps were filled and primed per manufacturer's instructions. The fluid level change was measured using an inline graduated glass pipette (100 microl) when the pipette was moved in relation to the pump (80 cm Cosmo and 110 cm Medtronics) and when level. Pumps were compared during 1 and 5 U boluses and basal insulin delivery of 1.0 and 1.5 U/h.
  
  
  RESULTS
  Pronounced differences were seen during basal delivery in pumps using 80-100 cm tubing. For the 1 U/h rate, differences ranged from 74.5% of the expected delivery when the pumps were below the pipettes and pumping upward to 123.3% when the pumps were above the pipettes and pumping downward. For the 1.5 U/h rate, differences ranged from 86.7% to 117.0% when the pumps were below or above the pipettes, respectively. Compared to pumps with tubing, OmniPod performed with significantly less variation in insulin delivery.
  
  
  CONCLUSIONS
  Changing position of a conventional CSII pump in relation to its tubing results in significant changes in insulin delivery. The siphon effect in the tubing may affect the accuracy of insulin delivery, especially during low basal rates. This effect has been reported when syringe pumps were moved in relation to infusion sites but has not been reported with CSII pumps.
authors.affiliation: Sansum Diabetes Research Institute, Santa Barbara, California 93105, USA. hzisser@sansum.org
authors.forename: Howard C
authors.initials: HC
authors.lastname: Zisser
authors.forename: Wendy
authors.initials: W
authors.lastname: Bevier
authors.forename: Eyal
authors.initials: E
authors.lastname: Dassau
authors.forename: Lois
authors.initials: L
authors.lastname: Jovanovic
mesh_terms: D001786:Blood Glucose / Q000032:analysis; D002648:Child; D003920:Diabetes Mellitus / Q000097:blood / Q000188:drug therapy; D004526:Efficiency; D019544:Equipment Failure Analysis; D006801:Humans; D006874:Hydrostatic Pressure; D007004:Hypoglycemic Agents / Q000008:administration & dosage; D015918:Infusion Pumps, Implantable / Q000592:standards*; D007279:Injections, Subcutaneous; D007328:Insulin / Q000008:administration & dosage
chemical_list: D001786:Blood Glucose; D007004:Hypoglycemic Agents; D007328:Insulin