SaulinoGailOn May 3, after both Dr. Caraway and Dr. Grigsby’s presentations, I re-visited the lecture hall to attend Dr. Michael Saulino’s presentation entitled, “Clinical and Economic Considerations of Intrathecal Baclofen Therapy.” This is a topic that has interested me for many years. He reviewed the five main medical conditions that are suitable for baclofen therapy: 1) spinal cord injury, 2) stroke, 3) cerebral palsy, 4) traumatic brain injury, and 5) multiple sclerosis. Dr. Saulino went on to discuss infusion rates and cited bolus dosing versus continuous infusion. He found that bolus dosing provided a better clinical effect and prolonged relief in some patients.

Immediately following Dr. Saulino’s presentation was one by Ms. Gail McGlothlen, APRN, MS, CNS, entitled, “Best Practices in Refilling and Management of IT Infusion Pumps.” She discussed new recommendations for best practices on implantation and pump refills. The key recommendations for implantation were: mandatory overnight stay, physician to program pump initially, eliminate systemic opioids, titrate dose cautiously and exert caution with administration of any central nervous systems drugs. She profiled a very critical adverse event of inadvertent pocket fills. For reference, a pocket fill is a situation in which a pump refill process does not go into the reservoir; however, the drug is deposited within the pocket surrounding the pump. As you can imagine, this error will deliver 30 to 60 days worth of pain medication directly into the patient.

Ms. McGlothlen cited a study between 1996 and 2010 in which 851 reports of pocket fills led to eight deaths. She considers this medical mishap to be unrecognized and probably under reported.  She believes that clinicians need to reevaluate their processes during which they perform pump refills. At her clinic, all pump refills are performed under ultrasound to clearly locate the pump and the refill port and to minimize the possibility of pocket fills.

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