Intrathecal Drug Delivery

Patient Management

Long-Term Patient Management

Follow-up care for intrathecal drug delivery is critical to ongoing patient management. Some patient management considerations continue throughout the course of the patient's treatment.

Patient management considerations include:

• Refilling the pump and programming dose adjustments
• Monitoring for adverse events
• Managing system complications

Refill Appointments

The refill procedure involves a specific set of steps that must be followed precisely to help ensure patient safety. Before clinicians perform refills, they must be trained in the correct procedures.

A refill appointment usually includes:

• An assessment of the patient's general condition and response to the therapy
• Identify the need for dose titration
• Confirming system performance
• Refilling the pump
• Determining the interval to the next refill
• Programming the pump
• Documenting patient care and prescribing information
• Conducting ongoing patient education
• Scheduling the next refill appointment

Pump Refill and Refill Intervals

A typical refill appointment takes about 30 minutes. The pump is refilled by inserting a needle through the skin into the pump septum.

SynchroMed Pump Alarms

Medtronic recommends that clinicians refrain from depending solely on the pump alarm to determine refill intervals or remaining battery life. Some hearing-impaired patients may not hear the alarm or the pump may be implanted too deep to adequately hear the alarm. Always use the programmer to verify the battery life of the pump and the reservoir alarm status.

For reference, here are the SynchroMed II pump alarms:

Dosage Adjustment

The goal of intrathecal drug delivery for pain is to determine for each patient the drug dose that achieves optimal pain control without intolerable adverse effects. It is important to observe patients for symptoms of drug overdose, tolerance, and ineffective dosing.

Drug dosage will vary with each patient. Encourage patients to notify their clinicians of unusual symptoms, drug overdose, or loss of drug effect. If drug tolerance, disease progression, or psychosocial issues that may impact therapeutic effect are ruled out, evaluate the infusion system for malfunction.

Some patients may require supplemental drugs for ongoing pain management and/or for episodic breakthough pain. Intraspinal preservative-free morphine sulfate and intraspinal preservative-free ziconotide sterile solution are indicated for use with the SynchroMed Infusion System for chronic pain management.

Manuals

Technical Resources