European Journal of Underwater and Hyperbaric Medicine, ISSN: 1605-9204 Volume 7 No.

2, June 2006

Review Articles

MEDICAL EQUIPMENT FOR MULTIPLACE HYPERBARIC

CHAMBERS
Part III: Infusion pumps and syringes
Jacek Kot
National Centre for Hyperbaric Medicine, Institute of Maritime and Tropical Medicine, Gdynia,
Medical University of Gdansk, Poland
Kot J: Medical equipment for multiplace hyperbaric chambers. Part III: Infusion pums and syringes. Europ J Underwater Hyperbaric
Med 2006, 7(2): 29-31. All medical devices introduced into the hyperbaric chamber should be of an appropriate design and fit for use in
the hyperbaric environment and they should be certified by the manufacturer for hyperbaric conditions. However, until now only several
medical devices are CE marked for usage in hyperbaric chambers. Therefore users often need to perform themselves checking of the
medical equipment needed for continuation of intensive care during hyperbaric treatment. To make this task easier, this paper presents
review of reports of usage of medical devices under increased pressure. Part 1 concerned devices for monitoring and cardiac support.
Part 2 described mechanical ventilators and Part 3 devotes to infusion pumps and syringes.

Hyperbaric Oxygen Therapy, Medical Equipment, CE Marking

INTRODUCTION Therefore – theoretically – one can assume that pressure

The review concerning monitoring devices and cardiac should not influence the performance of such system.
support was presented in the Part 1 of this paper (1). Part However, there are some reports of reduction of fluid
2 of this paper reviewed the mechanical ventilators (2). delivery rate during changes of pressure (4, 7). In cases
Part 3 presentes a review of infusion pumps and electric where there is a reduction in infused volume during the
syringes. compression phase followed by an increased infused
volume after decompression, a non-equilibrated gas space
INFUSION PUMPS AND SYRINGES in the system should be suspected, space between the
The cheapest method of fluid delivery in multiplace sealing rings of the rubber cap of the syringe plunger
chamber is using a free fall system. The only pitfall is to being one possibility (4). If there is a reduction of the
regulate the volume of gas compartments in fluid bottle infused volumes in all phases of the HBO session other
and in a drip chamber of the fluid line during the HBO explanations are needed (4). One is “backlash” which is
session according to changing pressure. Using flexible due to delayed engagement of the drive system. The other
PVC pre-packed solutions allows avoiding of the hazards is “breakfree” force required to overcome the resistive
of too fast fluid application, blood draw-back into the line forces of the syringe. Both reasons are not related directly
and introducing gas into the blood vessel which are with the changes of pressure, but are responsible for
hazards of gas bubble entrapped in the rigid bottles being inaccuracy in flow control even at normobaric conditions.
exposed to changing pressure. Nevertheless due to
changes of gas volume in the drip chamber the user must Infusion pumps can deliver the fluid using different
constantly adjust the fluid flow. Therefore this method mechanisms. If the infusions pump is a vacuum-type
cannot be used for administration of fluids and drugs device (eg. Coopdeq, Osaka, Japan), in which there are
which need to be administered at the constant rate. Some two chambers divided by a partition and a vacuum is
electrical syringes and infusion pumps are needed inside produced in one chamber when the other one is filled with
hyperbaric chamber to accurate titrated delivery of drugs fluid, the influence of changing pressure on vacuum
as a part of intensive care, usually for inotropic agents and chamber is so large, that they are unsuitable for
sedatives. hyperbaric environment (8). Also all peristaltic pumps
controlled by a drip chamber are presumed to be
As all medical devices being introduced into the unsuitable for use inside the hyperbaric chamber, because
hyperbaric chamber, infusion and syringe pumps need to during compression the drip chamber fills with fluid and
be carefully checked for additional hazards created by the device stops working. This was confirmed for several
their usage in hyperbaric conditions. The important point different models (5). Other mechanisms (spring or
in the pre-compression checking is validation of balloon-type) can be generally used in the hyperbaric
performance under increased pressure (3), because there conditions (8), however their performance can be
are several reports of significant reduction in infused significantly influenced by the hyperbaric conditions and
volume during the HBO session for different models (4, therefore they must be checked before usage for critically
5, 6, 7). ill patients.

Knowledge of type of the infusion system and its Up to now only one syringe pump is CE marked for usage
construction helps to predict its behaviour under in hyperbaric environment. It is Pilot HYPERBARIC
hyperbaric conditions. Syringe pumps are delivering the (Fresenius Vial S.A.). This pump allows administering
fluid be a mechanical pushing of the piston syringe. fluids from the syringes of volumes 20, 50 or 60 ml with a

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 European Journal of Underwater and Hyperbaric Medicine, ISSN: 1605-9204 Volume 7 No.2, June 2006

preset rate in a range of 0.1 to 400 ml/hour with a Some other models – even if not CE marked for
possibility to program a bolus. The pump has a 6 V hyperbaric conditions - have been already tested in
battery to be located outside the hyperbaric chamber hyperbaric environment. The list of electrical syringes
ensuring 7 hours of autonomy at 5 ml/h flow. It has been and infusion pumps which have been tested under
tested at 7 ATA. hyperbaric conditions either with positive or negative
results is presented in the Table 1.

Table 1. Electrical syringes and infusion pumps used in multiplace hyperbaric chambers
Electrical syringe / infusion pump Testing conditions and comments Remarks References
Atom 235 (Atom Medical Corporation, Tested to 2.8 ATA. It is a syringe pump. Average reduction OK 4
Tokyo, Japan) in infused volume during the compression phase was 7% of
the pre-compression value.
Ballon Infuser (Baxter, USA) Tested to 2 ATA. It is a balloon-type infuser. The effect of OK 8
increased pressure was minimal.
Baxter Colleague CX (Baxter Tested to 6 ATA. It is a volumetric pump. The volume OK 9
International Inc., USA) error was within the limit of 10%.
Baxter PCA Infusor (Baxter Healthcare Tested to 2.3 ATA. It is a patient-controlled analgesia OK 10
Corporation, Deerfield, IL, USA) infusor. There was increased flow by up to 10% at
increased pressure.
CADD-PCA 5200 PXC (Pharmacia Tested to 1.9 ATA. At 2 ATA it stops functioning. It is a UNSUITABLE 11, 12
Deltec Inc., St Paul, MN, USA) PCA pump. In this case it was used for epidural analgesia.
Coopdeq (Osaka, Japan) Tested to 2 ATA. It is vacuum-type infuser. Pump output UNSUITABLE 8
was approx. doubled at 2 ATA.
DPS (Becton-Dickinson & Company, Tested to 2 ATA. The pump stopped between 2 and 2.1 UNSUITABLE 12, 13
Franklin Lakes, NJ, USA) ATA.
Easy-pump MZ-257 (Lemi-Op Ltd., Tested to 6 ATA. It is a peristaltic infusion pump UNSUITABLE 5
Bnei-Brak, Izrael) controlled by a drip chamber. It failed to function
completely beyond a chamber pressure of 1.4 ATA.
Graseby 3100 (SIMS Graseby, Watford, Tested to 1.6, 2.5 and 6 ATA. It is a syringe pump. It did UNSUITABLE 5, 6
UK) not respond to any of the control button under pressure of
2.5 ATA.
Imed 965 (Alaris Medical Systems, San Tested to 6 ATA. It is a volumetric infusion pump. For the OK 5, 6
Diego, CA, USA) most part a deviation was within 10% (20-40% at the low
infusion rates during compression).
IMED Gemini PC-1 (ALARIS Medical It is a volumetric pump. OK 15
Systems, Inc., USA)
IMED Gemini PC-2TX (ALARIS Tested to 6 ATA. It is a volumetric pump. The greatest OK 15
Medical Systems, Inc., USA) variation in the output was 21%.
Imed series (Life Care, Abbot) It is a volumetric pump. OK 16
Infusion Dynamics Power Infuser It is a volumetric pump. OK 17
(Infusion Dynamics, Inc., USA)
Infutec 520 (Infutec Medical Systems Tested to 6 ATA. It is a volumetric infusion pump. For the OK 5
2000 Ltd., Lod, Israel) most part a deviation was within 10%.
IVAC 770 (IVAC Corp., CA, USA) It is a volumetric pump. OK 16
IVAC Alaris Medsystem III (ALARIS Tested to 6 ATA. It is a volumetric pump. The greatest OK 14, 15
Medical Systems, Inc., USA) variation in the output was 17%.
IVAC P300 (Ivac Medical Systems, Tested to 2.5 ATA. Released flows were equal at different OK 12, 13
Basingstoke, UK) pressures.
MiniMed 506 Tested to 2.4 ATA and also to altitude of 10,000 feet. It is OK 17
an insulin pump. Functional without modification.
MTP military (Medical Technology It is a volumetric pump. OK 14
Products, Inc., USA)
Rateminder III (Criticon) It is a volumetric pump. OK 16
SE 200 (Vial Medical, France) It is a syringe pump. OK 16
SE 400B (Vial Medical, France) It is a syringe pump. OK 16
TE-171 (Terumo Inst., Tokyo, Japan) Tested to 2 ATA. It is peristaltic type pump. A deviation OK 18
was ±3.6%.
TE-311 (Terumo, Leuven, Belgium) Tested to 2.8 ATA. It is a syringe pump. The change in OK 19
delivery rate was 0.5%.
TE-312 (Terumo, Leuven, Belgium) Tested to 2.8 ATA. It is a syringe pump. The change in OK 19
delivery rate was 0.5%.
Terumo STC-3121 (Terumo Inst., Tested to 2 ATA. It is a syringe pump. The discrepancies OK 20
Tokyo, Japan) from the set rate were from -4% to +3%.
Terumotec (Terumo Inst., Tokyo, Japan) Tested to 2 ATA. It is a spring-type infuser. The effect of OK 8
increased pressure was minimal.
Top (Top Inst., Tokyo, Japan) Tested to 2.5 ATA. It is a syringe pump. The output of the OK 7
syringe was reduced by 10% during the compression.

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 European Journal of Underwater and Hyperbaric Medicine, ISSN: 1605-9204 Volume 7 No.2, June 2006

CONCLUSIONS hyperbaric conditions. Anaesthesia. 1994 Sep; 49(9): 796-

Regardless of the model of electric syringe or infusion 797.
pump used, the user should be aware of the hazard related 11. Sanchez-Guijo JJ, Benavente MA, Crespo A. Failure of a
to the use of such devices to minimize the risk of critical patient-controlled analgesia pump in a hyperbaric
environment. Anesthesiology. 1999 Nov; 91(5): 1540-
incidents for seriously ill patients receiving hyperbaric 1542.
treatment. This is of most importance for inotrope– 12. Levecque JP, Vincenti-Rouquette I, Rousseau JM. Electric
dependent patients. Such patients need accurate pumps and hyperbaric treatment. Anesthesiology. 2000
continuous haemodynamic monitoring and a preparedness Aug; 93(2): 586.
to rapidly titrate inotropes to physiologic endpoints (4). 13. Vincenti-Rouquette I, Lévecque JP, Schiano P, Rousseau
JM, Brinquin L. Ľ Evaluation du fonctionnement d’un
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Powstania Styczniowego 9B
Hyperbar Med 2003; 30(3): 261. Gdynia 81-519, POLAND
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disposable patient-controlled analgesia infusor under E-mail: [email protected]

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