title: Aberrant intrathecal pump refill: ultrasound-guided aspiration of a substantial quantity of subcutaneous hydromorphone.
abstract: Intrathecal drug delivery systems are an effective and increasingly common pain treatment modality for certain patient populations. Pumps are surgically inserted in a subcutaneous abdominal pocket and refilled with highly concentrated medication at regular intervals. Inadvertent injection of medication outside the pump is a known complication of the refill procedure. We describe the injection of hydromorphone into the pump's surrounding subcutaneous pocket, subsequent opioid overdose, and the novel application of ultrasound to visualize and aspirate the subcutaneous drug. Ultrasonography can be used as an effective modality for rapid diagnosis and treatment of an accidental pocket fill.
authors.affiliation: From the *Department of Anesthesiology, Perioperative, and Pain Medicine, Brigham & Women's Hospital, Harvard Medical School; and †Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA.
authors.forename: Christian D
authors.initials: CD
authors.lastname: Peccora
authors.forename: Edgar L
authors.initials: EL
authors.lastname: Ross
authors.forename: George M
authors.initials: GM
authors.lastname: Hanna
mesh_terms: D000369:Aged, 80 and over; D000701:Analgesics, Opioid / Q000008:administration & dosage / Q000506:poisoning*; D062787:Drug Overdose / Q000000981:diagnostic imaging / Q000209:etiology / Q000628:therapy*; D004867:Equipment Design; D005260:Female; D006801:Humans; D004091:Hydromorphone / Q000008:administration & dosage / Q000506:poisoning*; D015918:Infusion Pumps, Implantable; D060186:Infusions, Spinal / Q000295:instrumentation*; D008508:Medication Errors; D009292:Narcotic Antagonists / Q000627:therapeutic use; D013396:Suction; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional
chemical_list: D000701:Analgesics, Opioid; D009292:Narcotic Antagonists; D004091:Hydromorphone