How much is the pump speed of the micro-injection pump without the need to continue pumping the liquid?-Henan Olsen Trading Co., Ltd

As a new type of instrument with small volume, simple operation and convenient use, the micro-injection pump (referred to as the syringe pump) has been widely used in clinical work. It can make the drug enter the human body more accurately, in small amounts, uniformly and continuously, and can adjust the drug concentration and speed at any time according to the disease condition, so that the drug can maintain the effective blood drug concentration in the body, and it plays an important role in the treatment of cardiovascular and cerebrovascular diseases and critically ill patients. great effect.

In clinical practice, when using micropumped drugs, isotonic fluid is usually instilled slowly in the same channel to keep the vein unobstructed, prevent the occurrence of blood return as much as possible, make the return blood flow into the blood vessels in time, and appropriately shorten the alarm delay time of the micropump , thereby reducing the occurrence of blockage and improving the safety of drug delivery. But for many critically ill patients, we need to control the amount and speed of fluids in consideration of patient safety and access. So when the pump speed of the syringe pump reaches how many milliliters can we keep the venous access unobstructed without using additional intravenous fluids?

At present, it is still in the exploratory stage to know how much the pump speed of the syringe pump can reach without continuous pumping. Zhou Chang'e et al. showed in their research that when the pump speed is ≥5 mL/h, the patency of the infusion needle can be basically guaranteed [1]. When the pump speed is less than or equal to 4 mL/h, it can be maintained by slow intravenous infusion of fluid, generally 8 to 10 drops/min [2]. In their research, Wang Xiaoli et al. showed that when the input speed of the micropump is lower than 5mL/h, it is easy to block the tube. It is necessary to input normal saline or glucose solution with infusion at the same time. Maintaining the speed of 5 drops/min will not cause adverse reactions. It will not increase the load on the heart, and can effectively prevent the return of blood [3]. Wang Jia'an et al. have shown in the study that in clinical work, when micro-pumping drugs, appropriate vascular volume should be given, preferably with micro-pump or infusion pump at a constant speed, but not all cases need to be given vascular volume. , only given when the pumping rate is less than 9 ml/h [4]. .

But do these different answers apply to all patients in the clinic? The following factors should also be considered when using continuous pump fluids:

①

Manufacturers are different.

Different manufacturers of different specifications of the syringe pump pressure alarm sensitivity is different.

②

Syringe pump and blocking pressure gear.

A syringe pump has different blocking pressure gears, and different gears have different blocking alarm pressure values, which are directly related to the set value of the flow rate.

③

Pressure alarm delay error.

JJF1259-2018 "Calibration Specifications for Medical Syringe Pumps and Infusion Pumps" stipulates that the maximum allowable error of the blocking alarm is ±13.33kPa (±100mmHg) or ±30% of the set value of the blocking alarm, and the set value and The alarm response time, however, the pressure value for the occlusion alarm is directly related to the flow rate setpoint.

④

Extension tube hardness.

The hardness of the pipeline has a great influence on the detection result of the blockage alarm pressure. Using the infusion extension tube with high hardness and low elasticity can more accurately detect the data of the micro-injection pump [5].

⑤

venous pressure.

In terms of clinical significance, the microinjection pump mainly injects the liquid medicine through the vein, and the pressure of the vein in different parts is different, and the pressure is lower as it is closer to the heart. Because the venous pressure is constantly changing, its resistance to the delivery of the microinjection pump is also different [6]. Therefore, the position of the venous catheter will also affect the patency of the infusion of the syringe pump. The same pump speed will also have different infusion patency due to different catheter placement or different venous pipelines.

⑥

Hypercoagulable state.

Vascular degeneration caused by high blood pressure, high blood sugar, and high blood lipids makes the blood sticky, and the adhesion of platelets and white blood cells increases, which is easy to cause blockage.

It can be seen that the pump speed achieved by the use of the syringe pump alone can not be uniformly pumped without continuous pumping. For example, for patients who strictly control the infusion volume, the use of continuous pumping liquid may increase the burden on the heart.

To sum up

For patients who strictly control the infusion volume, or the pump speed of the syringe pump has reached the reference index, it is not necessary to continue pumping the liquid. In order to reduce the venous blood return, reduce the incidence of alarm of the syringe pump, and ensure the safety of drug pumping, we should also pay attention to the following points:

(1)

保持整个静脉通路管道通畅。

发现针管堵塞或管道受压或打折, 不管是否有微泵阻塞报警, 解除堵塞前应分离针栓与连接管,排出连接管管腔内容量负荷的液体, 防止瞬间进入体内药物过多引起不良后果。

(2)

预防静脉回血。

采用抬高微量泵高于穿刺部位30.0cm或略高位置是预防静脉回血发生安全有效的方法^[7]。

(3)

尽可能的减少注射泵使用过程中垂直方向的移动。

垂直位移过程中输送管道中液体因地球引力作用发生的体积缺失，其缺失量在以高单位浓度、小单位、低流速输注时高警讯药物时，可导致病人诸如血压等生命体征的变化^[8]。

(4)

微泵注射药物尽可能稀释后增大泵速。

In order to prevent the blockage after the alarm time difference is too long and affect the treatment, the patient's condition changes suddenly (especially for those whose drug delivery rate is less than 3 ml), it is necessary to check whether the pipeline is blocked, so as to actively detect and deal with the problem early [9].

Huazhong University of Science Tongji Hospital, Tongji Medical College

(Mao Haiyan Xiao Huan Sun Tingting)

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