Pump refills and reprogramming are performed percutaneously and transcutaneously, respectively. Pumps are interrogated with a remote control and then accessed with a 22-gauge Huber needle under sterile conditions included in the refill kit. Unused medication is removed, and the reservoir is refilled with new medication. Discrepancies between the expected and the actual residual volume can be indicative of a problem with the system. After removal of old medication, 5 cc of the new medication is injected, aspirated back as a confirmatory step, and then the full volume can be slowly instilled. After refill, the pump is reprogrammed to the new reservoir volume and the new refill date is calculated. Errors in medications, concentrations, rates, and boluses as well as pump access and sterility can be life threatening. All reprogramming and drug changes should be confirmed with another experienced provider.
Infusion rates may be adjusted for increases in pain. Panel guidelines suggest dose increases for nonmalignant pain of up to 30% and increases of up to 50% for malignancy pain
(Deer et al. 2007). Magnetic resonance imaging will cause the pump to stall, and interrogation should be performed after each study. If functioning normally, it will restart within 15 min.
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