Intravenous infusion devices - commonly known as infusion pumps - provide clinicians with mechanisms to automate the accurate dosing of potent fluid therapies to critically ill patients. In critical care applications, fluid dosing must be both accurate and safe since unwanted flow disturbance can cause physiological harm to the patient. This study consists of three discrete projects based on these vital themes of safe device design and accurate fluid delivery. The first project, commissioned by Medical Magnetics Ltd during the period 1998 onwards, proposed that the fail-safe design philosophy universally used in the design of infusion pumps, and implemented in embedded software, is lengthy and provides the manufacturer with difficulties in demonstrating the exhaustive fail-safe validation needed for an instrument to be released speedily for sale. An alternative and innovative strategy employing the design of hardware modules and using re-configurable VLSI, is proposed and shown to offer a significant reduction of the design and validation phase of development with consequent financial benefit to the manufacturer. The second project conducted as part of the Manukau Institute Research Programme for 2003 examined the manner in which dosing accuracy is assessed for infusion pumps. The International Standard used by clinicians to select apparatus suitable for treatment of 'critically-ill' patients is shown to be flawed and potentially misleading - a finding of international significance. An innovative mathematical simulation model is described that enables prediction of flow accuracy for various expected operating scenarios previously impossible to investigate using current laboratory measurement techniques. Use of this simulation model indicates that various mechanical design factors influencing system compliance and hence dosing accuracy have been previously ignored by designers and suggests that contemporary infusion pump designs are far from optimum. These findings offer an explanation for instances of dosing error previously reported in the clinical literature and are of international value. The third project of the study utilises the findings of, and is subsequent to, the second project. An innovative design is proposed for an infusion therapy device in which dosing accuracy may be maintained under operating conditions such as height change and patient venous pressure variation that cause unwanted errors in conventional equipment designs. This design is the subject of patent application, commercial exploitation and further development.

Thesis submitted in fulfilment of the requirements for the degree Master of Technology: Nursing In the Faculty of Health and Wellness Sciences At the Cape Peninsula University of Technology, 2013 / The syringe driver is a battery-operated device which accurately delivers a continuous subcutaneous infusion of a combination of medication to alleviate symptoms, such as pain, nausea and vomiting, noisy moist breathing and preterminal restlessness. The researcher who works in a palliative care unit in Cape Town noticed the ambivalence and negative attitudes from family members regarding the use of the syringe driver. This gave rise to distress, conflict and ambivalence in patients and between family members. This study aimed to gain insight into the understanding, perceptions and expectations of families of terminally ill patients commenced on a syringe driver in a palliative care unit. A descriptive, qualitative research method was employed using semi-structured interviews, diaries, observation and documentation as the data collection methods. Data was coded and arranged into themes. Thematic analysis and coding were used to analyse the data during this study. This study found that the lack of education and written information were the two major contributing factors towards negative attitudes causing ambivalence in family members whose relatives were on a syringe driver. This study also highlighted the need for quality improvement control when using the syringe driver in the palliative care unit. The need for continuous education and written information and support for the immediate and extendedfamily members was evident. KEY WORDS: Syringe driver, Symptom control, Family members, Terminally ill, Palliative care unit.

O presente estudo consiste em analisar se o sistema atual de calibração das bombas de um determinado fabricante, baseado na entrada de parâmetros externos e consequente readequação interna por software é adequado para a correção dos volumes infundidos. A literatura carece de estudos sobre bombas de infusão peristálticas lineares, principalmente estudos metrológicos relacionados aos volumes infundidos. Esta carência relaciona-se entre outros fatores, pelos elevados custos das bombas de infusão, bem como à grande quantidade de horas de ensaios necessárias. Para isso, foram analisados os volumes infundidos em taxas mínima, intermediária e máxima de três bombas de infusão peristálticas lineares retiradas aleatoriamente de um hospital no estado do Paraná, que não passavam por manutenção havia exatos doze meses e estavam em uso contínuo no estabelecimento. Foram realizados ensaios em taxa fixa de 25 ml/h em 5 volumes diferentes ao longo da faixa habitual de uso. Também foram feitos ensaios em volume fixo de 10 ml variando-se a taxa de infusão entre 1 ml/h, 25 ml/h e 100 ml/h. Para análise estatística dos resultados, foi feito um teste de normalidade de Anderson-Darling, como a maioria dos resultados não apresentaram características de normalidade, foi feito uma análise do intervalo de confiança das medianas para análise dos resultados. Também foi necessário fazer uma ANOVA para verificação da influência das bombas e das taxas no volume infundido, seguido por uma análise de curva de erros e uma planilha para o cálculo de incertezas das medições. Foi possível verificar que os volumes infundidos pelas bombas deste fabricante, em sua maioria apresentaram mudanças significativas após o processo de calibração, com diminuição na variância e melhora na exatidão dos volumes programados. / This study examined whether the current system calibration of the pumps from a particular manufacturer, based on the input of external parameters and consequent internal readjustment by software, is suitable for the correction of infused volumes. The literature lacks studies on linear peristaltic pump infusion, especially metrological studies related to the infused volume. This deficiency relates among other factors, the high costs of infusion pumps as well as the large amount of hours required for testing. Therefore, the volumes were analyzed by infusing at minimum, intermediate and maximum rates of three linear peristaltic infusion pumps randomly taken from a hospital in the state of Paraná, which had not have maintenance in the latest 12 months and were in continuous use at the hospital. Assays were performed in flat rate of 25 ml / h in 5 different volumes over the usual range of use. Tests at a fixed volume of 10 ml varying the infusion rate at 1 ml/h, 25 ml/h and 100 ml/h were also made. For statistical analysis, an Anderson-Darling normality test was done, as most of the results did not show normal characteristics, an analysis of the confidence interval of the median for analysis of results was done. It was also necessary to do an ANOVA to check the influence of pumps and rates of infused volume, followed by a curve error analysis and a spreadsheet to calculate the measurements uncertainties. It was possible to verify that the volumes infused by the bombs from this manufacturer, at most, showed significant changes after the calibration process, decreasing variance and improving the accuracy of programmed volumes.

O presente estudo consiste em analisar se o sistema atual de calibração das bombas de um determinado fabricante, baseado na entrada de parâmetros externos e consequente readequação interna por software é adequado para a correção dos volumes infundidos. A literatura carece de estudos sobre bombas de infusão peristálticas lineares, principalmente estudos metrológicos relacionados aos volumes infundidos. Esta carência relaciona-se entre outros fatores, pelos elevados custos das bombas de infusão, bem como à grande quantidade de horas de ensaios necessárias. Para isso, foram analisados os volumes infundidos em taxas mínima, intermediária e máxima de três bombas de infusão peristálticas lineares retiradas aleatoriamente de um hospital no estado do Paraná, que não passavam por manutenção havia exatos doze meses e estavam em uso contínuo no estabelecimento. Foram realizados ensaios em taxa fixa de 25 ml/h em 5 volumes diferentes ao longo da faixa habitual de uso. Também foram feitos ensaios em volume fixo de 10 ml variando-se a taxa de infusão entre 1 ml/h, 25 ml/h e 100 ml/h. Para análise estatística dos resultados, foi feito um teste de normalidade de Anderson-Darling, como a maioria dos resultados não apresentaram características de normalidade, foi feito uma análise do intervalo de confiança das medianas para análise dos resultados. Também foi necessário fazer uma ANOVA para verificação da influência das bombas e das taxas no volume infundido, seguido por uma análise de curva de erros e uma planilha para o cálculo de incertezas das medições. Foi possível verificar que os volumes infundidos pelas bombas deste fabricante, em sua maioria apresentaram mudanças significativas após o processo de calibração, com diminuição na variância e melhora na exatidão dos volumes programados. / This study examined whether the current system calibration of the pumps from a particular manufacturer, based on the input of external parameters and consequent internal readjustment by software, is suitable for the correction of infused volumes. The literature lacks studies on linear peristaltic pump infusion, especially metrological studies related to the infused volume. This deficiency relates among other factors, the high costs of infusion pumps as well as the large amount of hours required for testing. Therefore, the volumes were analyzed by infusing at minimum, intermediate and maximum rates of three linear peristaltic infusion pumps randomly taken from a hospital in the state of Paraná, which had not have maintenance in the latest 12 months and were in continuous use at the hospital. Assays were performed in flat rate of 25 ml / h in 5 different volumes over the usual range of use. Tests at a fixed volume of 10 ml varying the infusion rate at 1 ml/h, 25 ml/h and 100 ml/h were also made. For statistical analysis, an Anderson-Darling normality test was done, as most of the results did not show normal characteristics, an analysis of the confidence interval of the median for analysis of results was done. It was also necessary to do an ANOVA to check the influence of pumps and rates of infused volume, followed by a curve error analysis and a spreadsheet to calculate the measurements uncertainties. It was possible to verify that the volumes infused by the bombs from this manufacturer, at most, showed significant changes after the calibration process, decreasing variance and improving the accuracy of programmed volumes.