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Lag times to steady state drug delivery by continuous intravenous infusion: direct comparison of peristaltic and syringe pump performance identifies contributions from infusion system dead volume and pump startup characteristics

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A Correction to this article was published on 06 January 2022

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Abstract

Time lags between the initiation of a continuous drug infusion and achievement of a steady state delivery rate present an important safety concern. At least 3 factors contribute to these time lags: (1) dead volume size, (2) the ratio between total system flow and dead volume, and (3) startup delay. While clinicians employ both peristaltic pumps and syringe pumps to propel infusions, there has been no head-to-head comparison of drug delivery between commercially available infusion pumps with these distinct propulsion mechanisms. We quantified the delivery of a model drug by peristaltic and syringe pumps at clinically relevant flow rates using spectrophotometric absorbance. Delivery curves were modeled and compared, and the time required to reach 5% (T5), 50% (T50), and 95% (T95) of the intended delivery rate was reported. The ability to overcome the combined effects of startup delay and dead volume differed between syringe and peristaltic pumps. T5, T50, and T95 were shorter for the peristaltic pump at higher flow rates. T50 and T95 were shorter for the syringe pump at lower flow rates. The ability to overcome the effects of dead volume was overall similar between the syringe and peristaltic pumps, as was the response to consecutive changes in drug infusion rates. Startup delay and dead volume in carrier-based infusion systems cause substantial time lags to reaching intended delivery rates. Peristaltic and syringe pumps are similarly susceptible to dead volume effects. Startup performance differed between peristaltic and syringe pumps; their relative performance may be dependent on flow rate.

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Any raw data presented in this manuscript is available by written request to the corresponding author.

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Change history

Abbreviations

CI:

Confidence interval,

FDA:

Food and Drug Administration

MB:

Methylene blue

MFP:

Multivariable fractional polynomial

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Funding

This study was funded by a Development Grant from the Department of Anesthesia, Critical Care and Pain Medicine at Massachusetts General Hospital.

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Authors and Affiliations

  1. Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital, 55 Fruit Street, Boston, MA, USA

    Lauren E. Gibson, Hao Deng, Nathaniel M. Sims & Robert A. Peterfreund

  2. MD PnP Program, Massachusetts General Hospital, Boston, MA, USA

    Anders S. Knudsen & David Arney

Authors
  1. Lauren E. Gibson
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  2. Anders S. Knudsen
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  3. David Arney
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  4. Hao Deng
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  5. Nathaniel M. Sims
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  6. Robert A. Peterfreund
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Contributions

LEG: this author designed the experiments, performed data analysis, and wrote and reviewed the manuscript. AK: this author performed data collection, data analysis, and reviewed the manuscript. DA: this author designed the experiments and reviewed the manuscript. HD: this author performed statistical analyses and wrote and reviewed the manuscript. NMS: this author designed the experiments and wrote and reviewed the manuscript. RAP: this author designed the experiments, performed data analysis, and wrote and reviewed the manuscript.

Corresponding author

Correspondence to Lauren E. Gibson.

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Conflict of interest

Robert A. Peterfreund and Nathaniel M. Sims are co-inventors on US Patents 9,764,087 and 10,758,672, and European Patent EP-2575933 for infusion pump control technology.

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Waived for benchtop research not involving human or animal subjects.

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Gibson, L.E., Knudsen, A.S., Arney, D. et al. Lag times to steady state drug delivery by continuous intravenous infusion: direct comparison of peristaltic and syringe pump performance identifies contributions from infusion system dead volume and pump startup characteristics. J Clin Monit Comput 36, 1489–1498 (2022). https://doi.org/10.1007/s10877-021-00790-1

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  • DOI: https://doi.org/10.1007/s10877-021-00790-1

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