I recently returned from the INS 11th World Congress Meeting in Berlin Germany, which I felt very fortunate to attend and assembled an abundance of new information. Previously, I had attended the 10th World Congress Meeting in London, and I strongly believe that these conferences are educational opportunities that enable me to expand my knowledge and skills to effectively enhance my practice. The knowledge gained allows Hartley to evolve with the changing technologies and methodologies, thus increasing operational efficiencies and providing optimal customer service, dosing consultations, and maintaining an unwavering focus on patient safety. This conference featured some of the world’s greatest medical minds, and I am honored to have been a part of it once again.
During the meeting, I had the pleasure of attending an outstanding lecture by Dr. Michael Saulino from the Moss Rehab Center in Pennsylvania entitled, “Can CSF Pressure Signals Distinguish Catheter Complications from Normal Catheter Function in Subjects Who Experience Loss of Intrathecal Baclofen Therapy?” This was a very interesting topic considering previous presentations by Dr. Saulino that I have witnessed as it relates to catheter malfunction during baclofen infusions.
Dr. Saulino presented a study in which he wanted to collect and characterize data to be compared with physician-confirmed diagnoses of patients who were receiving baclofen therapy and experiencing possible catheter problems. The study was a prospective, non-randomized study examining new techniques and procedures to determine catheter patency. The CSF pressure data was recorded via an external sensor attached to a needle – which was inserted into the catheter access port of the pump. In the process of the study, an algorithm calculated the energy of the CSF pressure variation caused by respiration and heartbeat within the intrathecal space. The output of this data was a statistical measure representing variations in the CSF pressure waveforms. This data was then compared against a threshold to distinguish normal catheters from those with complications.
Dr. Saulino proposed a certain rationale as it relates to this study:
- CSF pressure has a pulsatile quality;
- Current technology now can detect CSF pulse; and
- There was a determination that CSF pressure can be compared to physician diagnosis as this relates to catheter malfunction.
This study consisted of 37 subjects and the mean CSF pressure energy was higher for subjects diagnosed with normal catheters versus catheters with suspected complications. The CSF pressure algorithm correctly identified catheters with physician-confirmed complications in nearly ninety percent of the subjects studied. And, more specifically, results yielded six out of six catheter occlusion, three out of four fractured catheters, and 100 percent catheters that possessed a micro-leak. In conclusion, Dr. Saulino stated that the procedure in this study was safe and cost-effective.
For me, this was a very innovative and informative study. Catheter complications have plagued practitioners for years, and new technologies help determine and/or confirm physician diagnoses of catheter malfunction during intrathecal infusion.
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