We do the PPM and service for Graseby Syringe pump in our equipment library. We use Metron infusion Pump Tester to test Occulsion level.

I find out that most the time, the 3100 occulsion pressure is below 476mmHg (9.20 psi) (Suggest level from Manual). Normally, they are around 7 to 8 psi before I service them. Therefore, I have to adjust them to 476 – 556 mmHg (9.20 – 10.75 psi) according to the manul.

However, recently, we brought few brand new Graseby 3100 pumps from Smith medical. I checked them, their occulsion level are below 9.20psi.

Can any one who work on Graseby 3000 pumps gives some advices here? Do I make some mistake here or you also experience the same problem?

Many thanks.

We used to use an IDA for testing occlusion on the graseby syringe drivers but found they varied so much. You could calibrate it and then when testing again, it may vary by more than 50 mmHg. We questioned this with graseby (Brian Lane in tech support VERY helpful) and they told us about using the Alaris spring force test gauge. Brian sent us a copy of the test procedure and BINGO spot on every time.

Try this if you have it.

Jerry,
Going back some years, we used to test syringe pump occlusion levels using a fluid filled syringe and an in line pressure meter as we still do on pumps with in line pressure sensors. The problem is that every admin set and syringe combination will have a different compliance and stiction level therefor giving you inconsistant occlusion readings.
For some time now, when setting/testing occlusion levels on syringe pumps, we too have been using a dynamometer (force gauge) as Jeff suggested, which eliminates the inconsistances.
I also agree with Jeff that should you require technical advice, Brian is your man at Graseby.
If you absolutely must use a fluid filled syringe, always use a new one.

Good luck,

Ivor

Totally agree with Jeff and Shins. The Alaris guage is the only way to go.

There is one thing to bear in mind. Brian told us that you have to add 1/2 kg to the expected force, eg if you want to set the occlusion to 5 kg then make sure the Alaris gauge reads 5.5 kg.

This we are told is due to the difference between the gauge and the "hung weight" method that Graseby suggest in their service manuals.

Thanks, every one.
Yes, I use a fluid filled syringe and infusion pump tester, which results in inconsistant occlusion reading.

There is a company called Force Measurement Systems Ltd that makes a digital force meter for syringe pumps. It is not as cheap as the Alaris Spring Gauge. It can also be used to do Graseby Omnifuse pumps.

Syringe Force Gauge:
http://ccgi.forcemeasurement.force9.co.uk/index.php?page=products/fmssyringe

Digital meter:
http://ccgi.forcemeasurement.force9.co.uk/index.php?page=products/gm74-564

A.M

I haven't had any problem with occlusion alarm limits.The area is quite large and it's quite easy to adjust the pressure.In my opinion when you test with Metron,syringe and distilled water you are closer to the real situation than with some kind of pressure gauge.

I mean is there any point to have occlusion alarm if it's not stable in real situation?

The occlusion pressure indicated at the end of the line represents the peak pressure that the pump is able to generate before the leadscrew/friction bearing starts to slip and the occlusion alarm is activated by the optical sensing circuitry. In use there is bound to be a pressure gradient along the line when there is a flow and any check valves or antisyphon devices will have pressure-drops across them. A certain amount of force will also be required to overcome stiction in the syringe. The force required to overcome these losses can be equated to a loss of pressure measured at the output of the system and the rest of the applied force produced by the syringe driver actually does work in delivering fluid and overcoming the opposing forces in the patient's circulation. This is the pressure measured at occlusion.

Putting it very simply: approaching occlusion then maximum syringe force = force to overcome losses + force opposing the occlusion pressure. Some of the losses in the system occur due to syringe stiction (sticking plunger) and friction in the mechanics, i.e. leadscrew, halfnut, plunger clamp, tube and motor/gearbox assembly. The less the friction in the mechanics, stiction in the syringe and pressure drops in the line then the greater the pressure indicated at occlusion alarm, measured at the cannula.

My point is the physical occlusion limit, i.e. mechanical adjustment of the occlusion setting nut, may be identical but if different lines and syringes are used for wet setup or there are fluctuations due to mechanical wear then the indicated occlusion pressure will change accordingly as the losses vary. The danger to the patient is the maximum force that the pump can generate, irrespective of the largely uncontrollable losses in the syringe/line and fluctuations in the patient (e.g. extension/flexion of limbs used for peripheral infusions).

The size of syringe, dimensions of the line, viscosity of the fluid and mechanical condition of the pump can influence the pressures obtained at occlusion in practice. Thus a wet setup performed at one hosptial maintenance department may produce different occlusion alarm thresholds, i.e. measured pressures, than those measured at other departments when testing the same syringe driver. The biggest influence is likely to be the syringe stiction, line length, delivery rate (causes pressure gradients) and the presence of inline valves.

Use different syringe types and sizes along with different length extension lines and you'll see that the occlusion alarm pressure using a wet setup will vary considerably. Even with a consitent setup and a repeatable method then you have to be careful to use a new syringe or a lubricated syringe where stiction is negligible. New syringes are lubricated for one pull, to draw up drugs and then a delivery, by the way.

It is clear in syringe manufacturing standards that the range of pressure required to overcome static and dynamic friction (read as losses, which translate to pressure variation at the output of the system) are very wide - not far off the limits for some pumps. 3300s using pre-filled BD 50 syringes have to be set to within a few Kgf of the upper limit to avoid nuisance occlusion alarms where I work. I've attributed the problem to the fact that the lubricant has been dispersed when the syringes have been drawn and sat with drug in them).

Removing these sources of pressure variations from the system, i.e. by not performing wet oclusion alarm setup with syringes and lines during calibration, removes uncertainties in the losses. This allows consistent, i.e. more repeatable plunger forces to be measured. Consistent alarm limits, based on these repeatable measurements, can be obtained every time the machine is calibrated.

Unfortunately, with the occlusion alarm's reliance on mechanics, the Graseby 3XXX range are susceptible to wear and need to be fitted correctly. Fit a new leadscrew and other components including a motor/gearbox, friction bearing, etc, etc and set the occlusion alarm limit. I can guarantee you that after a few hours working under load that the occlusion alarm limits will be significantly higher than they were at calibration. This is because of the reduction in frictional losses as the leadscrew mechanics "bed-in" during use.

We use the Cardinal Medical (ALARIS Products) force gauge to ensure that the basic calibration of the Graseby 3XXX occlusion alarm is repeatable, i.e. that we've run the pump under backpressure after changing components or calibrating to ensure variations in mechanical losses have worked their way out of the system and are therefore minimised. At least if the mechanics are calibrated reliably to within Graseby's specifications then when the variable parts of the system, that are beyond our control, are fitted, then the pumps should alarm, to indicate problems, whether they involve the syringe, lines or the infusion site, consistently.

Losses will still vary in use on the patient as will the conditions at the infusion site (thus the occlusion alarm pressure will vary) but the maximum force generated by the syringe driver, hence maximum theoretical occlusion pressure, is fixed to an acceptable absolute maximum force measured by removing unknown sources of error in the measurement. This accurate setting of the force by removing variables, is more effective in protecting the patient than assuming all syringes used for calibration have low stiction and other factors in wet setup are negligible.

Even using the force gauge we find that as the length of the plunger is varied then the occlusion force measured varies along the leadscrew. We test with the plunger clamp at three points along the leadscrew with the force gauge to ensure the occlusion alarms within the specification. I am certain that if replacement mechanical components have not been given time to "bed-in" that the force indicated at occlusion will he higher than when the machine was calibrated within a few hours from putting the device back into use.

This has been learned in practice since the courses I attended were in the late 80's/early 90's and this was not discussed then. We were using the ALARIS test gauges for Grasebys when ALARIS first made them available for welmed/PX000 calibration purposes. Prior to that on factory visits to Graseby I'd observed that the standard service method of checking/setting occlusion alarm limits was using weights on a piece of dowelling with the pumps up-ended.

One other thing that needs to be remembered is that the case needs to be torqued-up to the appropriate values - not just to ensure accurate syringe sizing and a good seal that prevents case-cracking but I have seen occlusion alarm-limit values change with how tightly the case is fastened together.

HI, Richard.
Thank you for such a good lesson.
^_^

My apologies if it came across as a lecture or a lesson, unfortunately that's the way it comes out - just some observatons off the top of my head based on fixing them and setting up occlusion alarms using wet setups and force gauges. I'd always recommend a manufacturers course as a starter, I'm just discussing what I've seen and measured in practice. If anyone can add any extra knowledge, opinions or information I'd be grateful since I'm open to any servicing tips or observations that people have. Thanks.

Just one correction:

Do you change DU washers and PAB bearing on service Jerry?

WE use Force Measurement Systems force gauge. However,although the was developed in conjunction with Graseby I have founf that it is not suitable for use with the 3000 series. We have reverted back to the Dial gauge method or hung weight. I believe that Graseby recommend the Force Measurement Systems unit for the Omnifuse.

What problems have you had with using force gauges with the 3X00 series Joe?

We find they are useful for checking consistency of force/occlusion threshold, limiting the maximum force produced by the syringe drivers, which is ultimately what has the potential to generate damaging pressures at the cannula when an occlusion occurs. We try to ensure consistency by running-in the mechanics to minimise losses in the mechanism and calibrate without syringe-induced losses hopefully, if anything, to give an overestmate rather than an underestimate of the equivalent occlusion pressure that could be attained when in use.

In syringe manfacturing standards the variation allowed in syringe stiction is something equivalent to 3kgf I think so I can't see how calibration using a syringe is reliable unless the syringe is well lubricated to reduce stiction to a negligible value and a standard extension line is used.

Without use of a force gauge we've found it very difficult to setup 3300's for use with pre-filled syringes - the operators suffer with nuisance alarms if we use wet setup since inconsistencies at calibration cause problems. I think Jim Lefever at the MHRA has suggested, as I have previously mentioned being described in a letter published in a journal, that increasing the force is a way reduce the incidence of nuisance alarms on these pumps.

We set to 5kgf (tolerance 4.5kgf to 5.5kgf in the Graseby manual) and our nuisance alarms due to occlusion disappeared. Anyhing lower than 4.7kgf caused occlusion alarms - I assumed/have established that variability in the syringe stiction was the predominant factor along with the relatively fixed characteristics in the line/anti-syphon valve. We couldn't have reliably measured/examined/set these maximum acceptable occlusion thresholds without the force gauge.

When measured, carefully, using wet setup and well lubricated BD50 syringe this force equates to pressure values that are within the equivalent Graseby specification at occlusion. If a "sticky" syringe is fitted then the pressure losses will be higher thus occlusion pressure measured at the cannula will tend to be lower. This is safer, in my view, than calibrating occlusion thresholds with a "typical", potentially "sticky", syringe, at a particular pressure value, given a particuar syringe characteristic, then when a "loose" syringe is fitted in use then there is the potential for higher occlusion pressures, above the maximum acceptable value, to be generated.

My thinking is that if the maximum force generated by the pump is consistent at a value that produces equivalent, acceptable, occlusion pressure thresholds (for a given syringe type/line) via calibration using a force measurements then it's better than setting occlusion alarms using a wetsetup that's inconsistent and unpredictable (using a syringe/line setup that gives unpredictable results). Worst thing that can happen is you get nuisance occlusion alarms - this is more acceptable than excessive occlusion pressures than could cause injury.

Repeatable wet setup calibration is only possible, in my view, if you measure stiction (a rough test can be done by releasing the syringe actuator under pressure and seeing what residual pressure is indicated on the test manometer, at rest, after the plunger is forced back out of the syringe body - and this is only a guide) or reduce it to a minimum by lubricating the syringe well. Either way the stiction then needs to be added to the pressure measured at occlusion to give an indication of the potential pressure that could be generated given an ideal stictionless syringe - however this still does not include the pressure gradient in the line (that is probably negligible as occlusion is approach and flow approaches zero, anyhow).

The problem is always going to be finding the occlusion pressure to force relationship for typical syringes used on these pumps and the pressure gradients in the line at different rates, with different viscosity of fluids and various check-valve/cannula-gauge/anti-syphon arrangements. A selection of sizes and manufacturers syringes may be used in different hospitals so this may complicate the issue. Perhaps I need to go on a 3X00 refresher course to se how it is done these days.