Introduction to Therapy Maintenance
Pump Refill and Refill Intervals
Programming
Practice Components

Therapy maintenance refers to the follow-up care that is critical to ongoing patient management. It includes refilling the pump and adjusting dosages as needed (see Pain Assessment Strategies). Patients must schedule and return for refills at their prescribed time. Patients may return to the hospital or clinic for follow-up care; in some cases, home health care is also an option.

• Need for dose titration/therapeutic response
• Presence of unusual signs or symptoms
• Refill schedule (which is a function of drug dosage and concentration)
• Physician’s preference
• Drug stability

Morphine remains stable in the pump for up to 90 days following refill. Maintenance therapy involves the following:

• Pump refill
• Dosage adjustment
• Continued patient education

The refill procedure involves a specific set of tasks that must be followed precisely to help ensure patient safety. Before clinicians perform refills, they must be well trained in the correct procedures.

• An assessment of the patientís general condition and response to therapy
• Programming the pump
• Refilling the pump
• Determining the interval to the next refill
• Scheduling the next refill appointment

SynchroMed Pump Alarms

Medtronic recommends that clinicians refrain from depending solely on the pump alarm to determine refill intervals or remaining battery life. Some hearing-impaired patients may not hear the alarm, or the pump may be implanted too deep to adequately hear the alarm. Always use the programmer to verify battery life of the pump or the reservoir alarm status.

The goal of intrathecal drug delivery for pain is to establish for each patient the drug dose that achieves optimal pain control without intolerable adverse effects. It is important to observe patients for symptoms of drug overdose, tolerance, and ineffective dosing.

Drug dosage will vary with each patient. Encourage patients to notify their clinician of unusual symptoms, drug overdose, or loss of drug effect. If drug tolerance, disease progression, or psychosocial issues that may impact therapeutic effect are ruled out, the infusion system should be evaluated.

Some patients may require supplemental drugs for ongoing pain management and/or for episodic breakthrough pain. Adjuvant drugs include analgesics, nonsteroidal anti-inflammatory agents, and antidepressants (Krames, 1993). Only intraspinal preservative-free morphine sulfate is FDA approved for use with the SynchroMed Infusion System for chronic pain management.

Introduction to Therapy Maintenance
Pump Refill and Refill Intervals
Programming
Practice Components