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Mark, are the users having problems with loss of delivery 0.1ml/hr, at startup, or is the pump delivery fluctuating excessively at this low rate and causing unwanted physiological effects - is it just that problems in maintaining the patient's condition are being observed at these rates and everything is Ok at higher delivery rates? Hence the reason you're suggesting higher delivery rates and dilution of the drug. It's just that I don't fully understand what John is getting at and I'd like to, if possible.

RL - in answer to your questions:
No - there is no loss of delivery at startup as they follow the correct priming procedures. From our tests the pump does not fluctuate excessively - we've run tests (over 3 days!!) but it is close to the limit of what we can measure reliably.
As far as I am aware there are no undesirable effects to the patient.

John's initial problem was a misunderstanding regarding KVO rates at the end of infusion. Generally these are to allow the pump to run at a lower rate than the initial infusion to keep the vein patent. But, due to this extremely low rate of infusion being below the KVO rate there was concern that the pump would actually INCREASE in rate when reverting to KVO mode.

My concern is that this rate is so low that all sorts of other problems may occur:
- slow start up if not primed.
- movement of line may cause bolus to be delivered
- how accurate is such a low rate? (actually in tests there is no problem)
- Time to alarm occlusion will be long
- if they are using this rate & want to go lower, they can't
- etc


I hope that this clarifies the issue.

(I shall see if I can clarify why the users are using such low rates).

Mark

RL - The books - thanks, either John or myself will see if we can get hold of them.

Right then, I've been talking to the users (a nurse consultant no less)

The 0.1ml/hr was not a typical rate for the inotrope infusion - although it was rate that had been used. The typical rate was around 1 to 2ml/hr.

However our concern was advantageous - the drug protocol has now been changed, so that the inotrope is further diluted. This means that it is infused now at a higher rate. This is better from a safety point of view, but also gives flexibility of treatment (easier to change rates of infusion without "shocking" the patient).

So, all is now well (until the next time). A learning experience.

Mark