How do you manage aberrencies in people with IT pumps?

[kstarm]

In my hospital work I have run across a few patients that have intrathecal pumps but also have concerning behaviors. I have seen the same patient three times for alcohol withdrawal who is being managed with an intrathecal pump for chronic pain by an outside provider. One patient who tried to commit suicide by ingestion who also had an intrathecal pump in place. I would also imagine that there are some IT pump patients that have concerning urine tox screens for illicit substances. I do not manage pumps in my clinic population but if I did often wonder what would be the appropriate treatment regarding their pump (and thus what I should be recommending to their clinic that manages their pump). Taper them off and just continue to refill with saline? explant? I would be curious about thoughts from others.

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[Aether2000]

Perhaps adding alcohol to the pump would save them having to drink it....

 

[deleted472101]

Saline or explant

 

[DOctorJay]

Do people really show up for saline refills?


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[geauxg8rs]

Do people really show up for saline refills?


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What if they are allergic to saline?

 

[unchockey21]

Saline or explant

Do people really show up for saline refills?

Agree with offering saline vs. explant. Could maybe get someone to show up once for a saline fill to buy time if they really want to find someone else to take over filling it with actual meds. But in reality they probably just start trying to inject whatever into the pump themselves, then it gets infected, then explant. So I guess you're really offering explant now or explant later.

 

[deleted185747]

Put their drug of choice in the pump. I hear carfentayl is BOMB

 

[SeniorWrangler]

You can fill the pump with saline and put it in sleep mode so it runs very slowly, but you can't turn it off without destroying it. Every pump gets explanted eventually when the battery runs out, it's just a question of whether it gets replaced. I think the decision of no meds vs very low meds vs business as usual is a clinical one, probably depends on why the patient got it in the first place.

 

[Orin]

Sounds like some doctor made a bad decision somewhere, but not like that's the first time someone put hardware that wasn't indicated right?

If you're being kind, taper 20-25% per week until you get to saline and then explant. If not ready for explant, saline and minimum flow rate which buys you a bit over a year with a 20 mL Synchromed II pump, and then explant when the pump dies unless patient refuses in which case send a kill command so the beeping stops. You could also just send a kill command when it's ready for saline.

I don't think it's unreasonable to "destroy" it with the kill command in the scenarios described above to reduce the risk of the patient doing something stupid with it, but I would talk to the patient and some other providers with options. In this day and age, it's rare to find someone willing to take on an outside pump mess.

 

[Ducttape]

Put their drug of choice in the pump. I hear carfentayl is BOMB

um...
nowadays i hear its all about MOAB...