Objetivo: Este estudo objetivou avaliar a precisão de infusões de medicamentos em dois modelos de Bomba de Infusão (BI), de equipo específico do fabricante e de equipo universal, a concordância entre estes dois modelos e sua relação de custo e efetividade. Método: Foi realizado um ensaio clínico randomizado em pacientes internados em um hospital geral universitário de 740 leitos. As unidades de internação foram randomizadas através de sorteio simples para cada modelo de equipamento e os pacientes foram incluídos de acordo com indicação de uso de BI, conforme protocolo institucional. Os tipos de erros e reações adversas foram classificados por meio de algoritmos. Foi calculado o custo de cada sistema de bomba de infusão, pela vida útil da tecnologia. Resultados: Em 55 pacientes foram acompanhadas 310 infusões, 117 no grupo da bomba de infusão de equipo universal e 193 na bomba de infusão de equipo especifico. Houve semelhança (p=0,40) entre o tempo programado e o observado nas infusões por meio da bomba de equipo específico (-2,1 ± 19 min) e universal (0,08 ± 23 min). Percentualmente, também não foi observada diferença (p=0,70) entre a infusão por bomba de equipo específico (-0,15±3,8%) e universal (0,1±6,3%). Foram observados 14 (4,5%) erros de medicação, semelhantes (p=0,58) entre os tipos de BI. Os custos cumulativos entre os dois sistemas de bombas se equivaleram em 30 meses, sendo que após 11 anos, foram significativamente maiores para bomba de equipo específico em 184,29%. Conclusão: Ambos modelos de BI avaliadas mostraram-se igualmente seguras para administração EV de fármacos, sendo o modelo de equipo universal mais vantajoso economicamente ao longo da vida útil dos equipamentos. / Objective: This study aimed to evaluate the accuracy of drug infusion in two models of infusion pumps (IP), one with a specific IV set and other with universal IV set, the correlation between these two models and their relation of cost and effectiveness. Method: A randomized clinical trial was conducted in hospitalized patients in a university general hospital of 740 beds. The ward units were randomly chosen for each type of equipment, and patients were included according to indication for use of IP, based on institutional protocol. The types of errors and adverse reactions were classified by means of algorithms. The costs of each system for IP, was calculated considering the useful life of the technology. Results: 310 infusions were monitored: 117 in the universal infusion pump group and 193 in the specific equipment group, in 55 patients. The average difference between the scheduled time and the actual one in the infusions was -2.1 ± 19 min. and 0.08 ± 23 min. (p = 0.40) for the universal equipment and specific equipment, respectively, which means an average error of -0.15% ± 3.8% for the universal equipment and 0.10% ± 6.3% for the specific equipment, with no difference between the two types of pump. Fourteen (4.5%) medication errors were observed during the administration of medication, similar between the two types of IP. The cumulative costs between the two pump systems were equivalent in 30 months, and after 11 years the costs were meaningfully higher for the specific equipment pumps in 184,29 %. Conclusion: The infusion pumps do not show meaningful difference in accuracy between scheduled time and the actual one qualifying them as safe for the drugs observed. Cumulative costs were significantly distinct between both pieces of equipment.

Objetivo: Este estudo objetivou avaliar a precisão de infusões de medicamentos em dois modelos de Bomba de Infusão (BI), de equipo específico do fabricante e de equipo universal, a concordância entre estes dois modelos e sua relação de custo e efetividade. Método: Foi realizado um ensaio clínico randomizado em pacientes internados em um hospital geral universitário de 740 leitos. As unidades de internação foram randomizadas através de sorteio simples para cada modelo de equipamento e os pacientes foram incluídos de acordo com indicação de uso de BI, conforme protocolo institucional. Os tipos de erros e reações adversas foram classificados por meio de algoritmos. Foi calculado o custo de cada sistema de bomba de infusão, pela vida útil da tecnologia. Resultados: Em 55 pacientes foram acompanhadas 310 infusões, 117 no grupo da bomba de infusão de equipo universal e 193 na bomba de infusão de equipo especifico. Houve semelhança (p=0,40) entre o tempo programado e o observado nas infusões por meio da bomba de equipo específico (-2,1 ± 19 min) e universal (0,08 ± 23 min). Percentualmente, também não foi observada diferença (p=0,70) entre a infusão por bomba de equipo específico (-0,15±3,8%) e universal (0,1±6,3%). Foram observados 14 (4,5%) erros de medicação, semelhantes (p=0,58) entre os tipos de BI. Os custos cumulativos entre os dois sistemas de bombas se equivaleram em 30 meses, sendo que após 11 anos, foram significativamente maiores para bomba de equipo específico em 184,29%. Conclusão: Ambos modelos de BI avaliadas mostraram-se igualmente seguras para administração EV de fármacos, sendo o modelo de equipo universal mais vantajoso economicamente ao longo da vida útil dos equipamentos. / Objective: This study aimed to evaluate the accuracy of drug infusion in two models of infusion pumps (IP), one with a specific IV set and other with universal IV set, the correlation between these two models and their relation of cost and effectiveness. Method: A randomized clinical trial was conducted in hospitalized patients in a university general hospital of 740 beds. The ward units were randomly chosen for each type of equipment, and patients were included according to indication for use of IP, based on institutional protocol. The types of errors and adverse reactions were classified by means of algorithms. The costs of each system for IP, was calculated considering the useful life of the technology. Results: 310 infusions were monitored: 117 in the universal infusion pump group and 193 in the specific equipment group, in 55 patients. The average difference between the scheduled time and the actual one in the infusions was -2.1 ± 19 min. and 0.08 ± 23 min. (p = 0.40) for the universal equipment and specific equipment, respectively, which means an average error of -0.15% ± 3.8% for the universal equipment and 0.10% ± 6.3% for the specific equipment, with no difference between the two types of pump. Fourteen (4.5%) medication errors were observed during the administration of medication, similar between the two types of IP. The cumulative costs between the two pump systems were equivalent in 30 months, and after 11 years the costs were meaningfully higher for the specific equipment pumps in 184,29 %. Conclusion: The infusion pumps do not show meaningful difference in accuracy between scheduled time and the actual one qualifying them as safe for the drugs observed. Cumulative costs were significantly distinct between both pieces of equipment.

A stationary or portable infusion pump can be used to administer home parenteral nutrition (HPN). The stationary pump (SP) must be fasten to the infusion stand, so patients administer infusions in night mode to maintain their quality of life and mobility in the daytime. However, administering the HPN at nighttime can cause complications. Conversely, the portable pump (PP) does not have to be fasten to the infusion stand and the infusions can be administered in day mode during activities, as the PP can be placed in a special backpack. The aim of this diploma thesis is to evaluate the administration of HPN in day mode in patients with a PP and further to evaluate and compare the results of quality of life and liver function tests results in patients with a PP and a SP. HPN patients with a PP and a SP completed the HPN-QOL questionnaire in the nutritional clinic at the 4th internal clinic of the General University Hospital in Prague during outpatient visits. In addition to that, patients with a PP completed a questionnaire focused on the administration of HPN in day mode. Liver function tests results (total bilirubin, ALT, AST, GGT, ALP, cholinesterase and albumin) were obtained from patients' medical records. A total of 14 respondents with a PP and 14 respondents with a SP were included in the...

Infusion pumps are used in all departments of a hospital, in the emergency care unit as well as in pediatrics. The pumps administer intravenous medications for the purpose of helping patients to manage pain and are unfortunately not spared from emerging errors. Due to the complexity of the process involved in infusion pumps, errors regarding delay in administration are encountered. Especially vulnerable to errors are pediatric patients, due to the high risk of over- or under-dosing. This study aims to investigate the effects on administration delay by analysing the medical supply and system utilized for the infusion pumps. This is accomplished through implementation of Compartmental Modeling in Pharmacokinetics in combination with a self developed mathematical model for estimating the administration delay. Simulations were performed for analysing how various sizes of medical supply effected delay time. The result from the computed mathematical model indicates that increased volumes on utilized equipment will increase delay time. The combined use of a decreased flow rate and smaller equipment sizes will have the greatest affects on the delay in administration. The result obtained from the computed compartmental model can be useful for medical staff to be able to estimate the delay in administration. However, further validation is required before the utilization of the model can be applied in hospitals. / Infusionspumpar används på alla avdelningar på ett sjukhus, inom akutvården samt inom pediatrik. Pumparna administrerar olika mediciner i syfte att hjälpa patienten att hantera smärta och är tyvärr inte förskonade från att fel kan förekomma. På grund av komplexiteten i processen, involverad i infusionspumpar, uppstår fel gällande förseningar i administrering av medicin. Speciellt sårbara för dessa typer av förseninigar är pediatriska patienter, på grund av den förhöjda risker gällande över- eller underdosering. Denna studie syftar till att undersöka effekterna gällande administreringsfördröjning genom att analysera det medicinska utrustningen och systemet som används för infusionspumparna. Detta uppnås genom implementering av kompartmentmodellering i farmakokinetik i kombination med en egenutvecklad matematisk modell för att uppskatta administreringsfördröjningen. Simuleringar utfördes för att analysera effekterna av olika storlekar på medicinsk utrustning i förhållande till fördröjningen av administreringe. Resultatet från den beräknade matematiska modellen indikerar att ökade volymer gällande den medicinska utrustningen kommer att öka fördröjningstiden. Den kombinerade användningen av en minskad flödeshastighet och mindre utrustningsstorlekar kommer att ha störst inverkan på förseningen i administreringen. Resultatet som erhålls från den beräknade kompartmentmodellen kan vara användbar för sjukvårdspersonal för att kunna uppskatta förseningen i administrationen. Ytterligare validering krävs dock innan användningen av modellen kan tillämpas på sjukhus.

Volym- och sprutpumpar används inom neonatalvården tillsammans med en specialanpassad kateter. De prematurfödda barnen är mycket känsliga för feldoseringar men det finns minimalt med dokumenterade projekt som undersöker hur väl den distribuerade dosen stämmer överens med den angivna på infusionspumpen. Målet med denna studie var att kontrollera om det fettbaserade läkemedlet Clinoleic flyter tillbaka i det gemensamma blocket, avgöra tiden det tar för läkemedel att flyta fram samt mäta mängden av läkemedel som kommer till mynningen av katetern. Antalet pumpar begränsades till startuppsättningen inom intensivvården på neonatalavdelningen, vilket är fyra pumpar. Mängden av läkemedlet för fem olika flöden undersöktes endast för läkemedlet Peyona med koffeinbas. Projektet genomfördes på Karolinska Universitetssjukhuset och i samarbete med Nya Karolinska Solna förbättrades förståelse för uppsättningens användning. Samtliga sjuksköterskor och ingenjörer vi kom i kontakt med på sjukhusen ansåg att fler studier behöver göras inom distribution av läkemedlen. Tydliga kopplingar kan ses mellan resultat som presenteras i arbetet och misstankar och förväntningar efter samtal med de som jobbar med pumpar. Möjliga framtida experiment som kan ge tydligare riktlinjer inom neonatalvården diskuteras. Det är några anmärkningsvärda resultat som redovisas i studien. De är att Clinoleic flyter bakåt i blocket och att fylla backventilen tar mellan 16 och 25 minuter för de undersökta flödena. Dessutom framgår det att distributionen av Peyona avviker minst för de högre flödena. / Volume and syringe pumps are used in neonatal care together with a customized catheter. The premature born children are extremely sensitive to incorrect dosage, but there are only a short number of documented projects that investigate how well the distributed dose corresponds to that indicated on the infusion pump. The aim of this study was to check whether the fat-based drug Clinoleic flows back into the common block, determine the time it takes for drug to flow and measure the amount of drug that comes to the orifice of the catheter. The number of pumps and drugs was limited to the initial set that is used in intensive care in the neonatal department. The setup consists of four pumps and the drugs Peyona, Clinoleic, Glucos and Sodium Chloride solution. The amount of medicine distributed for five different flows was investigated only for the caffeine-based drug Peyona. The project was implemented at Karolinska Universitetssjukhuset and with help of Nya Karolinska Solna the understanding for the used setup was improved. All nurses and engineers we came into contact with at the hospitals felt that more studies should be done in the subject of the distribution of the drugs. Obvious connections are seen between results that are presented and suspicions and expectations after consultation with those who work with pumps daily. Possible future experiments that provide clearer guidelines for neonatal care are discussed. There are some notable results reported in the study. They are that Clinoleic is flowing back into the block and filling the check valve takes between 16 and 25 minutes for the investigated flows. for the investigated flows and that that the smallest distribution deviation of Peyona is observed in higher flows.

Infusion pumps administer medications like morphine to pediatric patients in order to manage pain. Drug delivery delays can be the result of flow rate variabilities in the infusion pump system. Due to the risk of over-or underdosing, this could have a high impact on the pediatric population. This study’s aim is to investigate the effect of drug dilution and dosing delays by investigating which factors affect the morphine concentration in the patient. Implementation of a previously developed population pharmacokinetic model was performed in MATLAB. Then combining it with a self-developed model of the infusion pump system, a model which included the infusion pump and the system between the pump and the patient. Simulations were performed to investigate the contributing factors. The results show that dosing delays decrease with an increasing patient’s age. There are larger morphine concentration variations with lower syringe flow rates. A decrease in dosage and a smaller syringe volume result in a shorter time of reaching a steady state concentration. Using the wrong syringe which is not compatible with the machine will lead to an increasing morphine concentration in the patient that does not reach a steady state. A limitation of the study was that no clinical data was used for the simulations. These results are useful for clinicians when making decisions regarding intravenous administration of morphine, potentially leading to fewer medication errors. / Infusionspumpar administrerar läkemedel som morfin till pediatriska patienter för smärtlindring. Fördröjning av läkemedelstillförsel kan vara resultatet av flödeshastighetsvariationer i infusionspumpsystemet. På grund av risken för över- eller underdosering kan detta ha en stor inverkan på den pediatriska populationen. Denna studies syfte är att undersöka effekten av läkemedels- utspädning och -fördröjning genom att undersöka vilka faktorer som påverkar koncentrationen av morfin i patienten. Implementering av en tidigare utvecklad populationsfarmakokinetisk modell gjordes i MATLAB . För att sedan kombinera den med en egenutvecklad modell av infusionspumpsystemet, en modell som inkluderade infusionspumpen och systemet mellan pumpen och patienten. Simuleringar utfördes för att undersöka de bidragande faktorerna. Resultaten visar att doseringsfördröjningar minskar med patientens stigande ålder. Det finns större koncentrationsvariationer med lägre sprutflödeshastig- heter. En minskning av dosen och en mindre sprutvolym resulterar i en kortare tid för att uppnå en steady state-koncentration. Användning av fel spruta som inte är kompatibel med maskinen kommer att leda till en ökad morfinkon- centration hos patienten som inte når ett stabilt tillstånd. En begränsning med studien var att inga klinisk data användes för simuleringarna. Dessa resultat är användbara för läkare när de fattar beslut om intravenös administrering av morfin, vilket potentiellt kan leda till färre medicineringsfel.

In November 2016 a brand new and highly technological hospital called New Karolinska Solna opened in Stockholm. In connection with the planning of the hospital, new medical devices were procured, including a new infusion system that is now in use. Previously, each ward at the hospital had their own pumps and was responsible for updates and maintenance. Now, the hospital will instead have a floating pump system, which means that the hospital will own the pumps. The infusion pumps will be floating between the wards without being linked to a specific ward or department. The updates that were previously done when the need arose at the ward will now be a common process for the entire hospital. The aim of the project was to develop new guidelines for how the update process should be done on New Karolinska Solna's new infusion pump system. Through interviews with key personnel during the procurement process, the medical technicians department and caseworkers, new guidelines have been written, given the already existing technical conditions. During the course of the project it has been found that there are major shortcomings of information and communication within the hospital. The guidelines presented in the result are an important part to ensure that information related to the update comes to the caregivers at New Karolinska Solna, thus simplifying and streamlining the update of the infusion pumps.