SARASOTA MEMORIAL HOSPITAL NURSING PROCEDURE DATE: 02/91 REVIEWED: 3/13 PAGES: 1 of 4 RESPONSIBILITY:
To provide information on the Medtronic SynchroMed Infusion
Medtronic SynchroMed infusion system – an implantable
system designed to contain and to administer parenteral drugs intrathecally. The system consists of an implantable programmable pump, a spinal catheter and an external programmer. Intrathecal – the subarachnoid space of the spinal canal.
1. The SynchroMed pump is a round metal dish about one (1)
inch thick, three (3) inches in diameter and weighs about six (6) ounces. The pump contains a collapsible 18ml refillable drug reservoir which stores and releases prescribed amounts of medication. The pump is also available in a 10 mL and 30 mL size. The most common size used is the 18 mL. The reservoir is refilled by percutaneous insertion of a 22-gauge Huber needle through the self-sealing septum. The septum can be punctured 500 times without losing its critical resealing characteristics. At SMH, this is done only by a Board Certified Pain Management Physician.
2. The pump has a side port that can only be accessed by a
Pain Management Physician. This allows the physician to check the internal mechanisms of the pump and the catheter location. This may be (can be) done without fluoroscopy done under fluoroscopy.
3. The pump is a battery-powered device. Its life is
dependent on the amount of medication it must deliver. The expected longevity of the device is four (4) to five (5) years.
4. The pump uses an audible alarm system that alerts the
patient and physician to low battery power, low reservoir volume or a memory error. The device can deliver a range of infusion rates from 0.025ml/hour to 0.9 ml/hour.
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5. The pump is programmed via a programming
communication between the pump and the programmer, which is accomplished by a radio wave telemetry link. Two security codes are exchanged between the implanted electronics and the programmer system to verify that proper and appropriate transfer of information has taken place. The rate, mode and pattern of infusion can be selected and altered whenever necessary. At SMH, programming will be done by a Chronic Pain Board- Certified Physician.
6. The pump dispenses the prescribed medication via the
spinal catheter that is inserted intrathecally.
7. The Medtronic SynchroMed Infusion System is indicated
for use when patient therapy requires: a. Intraspinal (intrathecal) infusion of preservative-free morphine sulfate for the treatment of chronic intractable pain. b. Intrathecal infusion of Lioresal Intrathecal (Baclofen) for the treatment of spasticity. *Currently, this is the only narcotic FDA approved for use in the Medtronic SynchroMed Infusion System.
1. The SynchroMed infusion pump is surgically implanted in a
subcutaneous pocket. The usual site is in the abdominal wall. The pump medication will be instilled into the pump in surgery. The catheter attached to the pump will be threaded to the intrathecal space.
Postoperative Care: a.
Observe for signs of infection. Report to MD a
temperature elevation over (101 degrees), redness, swelling or purulent drainage at the incision site. b. Perform patient assessment (level of sedation, respiratory rate and pain scale) every one hour for 12 hours; then every two hours for a total of 24 hours. After 24 hours (post-initiation of therapy) perform patient assessment with vital signs every four hours. c. If any bolus doses are administered by the MD, or the infusion rate is increased or the solution changed, check vital signs with level of sedation, respiratory rate and pain scale every 30 minutes x2, then as above. d.
Check dressing every shift noting any bleeding or
Dressings are usually applied to the operative site in
surgery. Dressing changes start per physician’s order, using sterile technique.
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f. Programming the pump is done ONLY by the physician who is either surgically implanting the pump or changing the prescription. A white paper print-out is then generated from the programmer while the patient is in the OR or the PACU. The print-out contains
the prescription information including drug name, concentration, priming volume, bolus dose (if any) and rate of infusion. This print-out should be placed in the patient’s chart. e. If an MRI is ordered for a patient with a pump, alert Radiology about the pump so they can check to see if there are contraindications.
PROCEDURE (cont’d): Emergency Situations:
a. Patients receiving narcotic infusions or Lioresal
(Baclofen) must be observed for signs of respiratory distress or depression and change in level of consciousness.
b. In an emergency situation, call the Physician who either
surgically implanted the pump or is changing the prescription STAT. Only the physician can stop the infusion using the Medtronic Programmer. One type of Medtronic programmer is located at the Main Surgery Desk in a labeled cabinet (programmer is in a black case). In any event, stabilization of the patient by the Rapid Response team may be indicated. A Narcan drip on intubation may be needed. Because of the long acting nature of the medication (Morphine or Baclofen) turning off the infusion is a not the first priority; patient stabilization is first priority.
c. In the event that the Physician reduces the medication
dosage, the nurse needs to observe the patient for systemic opiate withdrawal symptoms including lacrimation, diaphoreses, piloerection, elevated blood pressure and pulse, abdominal pain, diarrhea, emesis, anxiety, restless, yawning, muscle and joint pain.
d. If the patient’s respirations decrease less than 8 per
minute, notify the Physician. e. A refill kit is available in Material Management in Surgery for emergency withdrawal replacement.
Nursing Reassessment: Document the nursing care, patient
teaching, patient responses and any other pertinent data.
Medtronic Corporation. (1999). Patient Management for
Intraspinal Applications. Minneapolis, MN: Author. SMH Policy. Rapid Response Team. (01.PAT.83). SMH: Author.
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REVIEWING AUTHOR (S):
Tina Sweeney, RN, BSN, CM, Orthopedics Tonia Spenard, RN, Orthopedics Unit Jan Hurst-Lichter, RN, Clinical Manager, Surgery Diane Scheb, MSN, RN-BC, Acute Pain Coordinator Lyn Wakeman, RN, Risk Management Department
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