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“智能”输液泵将是下一个COVID-19短缺设备

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【导读】智能输液泵是一种编程设备用来输送受控药物剂量可减少护士们接触COVID-19风险。 COVID-19重症患者需要通过输液泵输送多种药物。生产厂商和医院正在磋商如何避免输液泵及其配件的短缺。 MASSDEVICE网站截图 从美国ICU走廊视频可以看到走廊上都排放着医疗设备,这些医疗设备通常都是放在病房里的,在这些......
TAG标签: COVID-19 智能 输液泵 短缺设备

“智能”输液泵是一种编程设备用来输送受控药物剂量可减少护士们接触COVID-19风险。

COVID-19重症患者需要通过输液泵输送多种药物。生产厂商和医院正在磋商如何避免输液泵及其配件的短缺。

“智能”输液泵将是下一个COVID-19短缺设备

MASSDEVICE网站截图

从美国ICU走廊视频可以看到走廊上都排放着医疗设备,这些医疗设备通常都是放在病房里的,在这些设备中有“智能”输液泵——这是在任何一家医院都随处可见的设备。“智能”输液泵是一种编程设备,用来输送受控药物剂量的。COVID-19对患者器官的影响增加了对这些泵的需求。

输液泵的药物管理装置和加长的管路使其可以在走廊上操作,以减少护士们接触COVID-19的风险,一些患者因为需要多种药物甚至需要多个泵。

``院规在不久前被抛开''

据美国ECRI研究所和美国ISMP研究所称,随着COVID-19重症患者的数量开始增加,3月份的护士服务名单上开始出现输液泵短缺的记录。

“智能”输液泵将是下一个COVID-19短缺设备

ECRI网站截图

在ICU,这些智能泵可提供血管加压药、抗心律失常药、阿片类药物、麻醉药、神经肌肉阻断剂、抗血栓药物和胰岛素,其中的许多药物是COVID-19患者所需的。

ISMP的护士兼咨询服务总监Michelle Mandrack表示,病人的数量成为泵系统的负担。Mandrack在《医疗设计与外包》中表述,“当患者的需求超出医院设备的可供应量时,一些医院不得不抉择他们将去哪里寻找智能泵?我认为智能泵不会像呼吸机那么紧张,但是我们从交谈中了解到,生产厂家正设法厘清他们将如何作决定。”

“智能”输液泵将是下一个COVID-19短缺设备

ISMP网站截图

马萨诸塞州北安多佛市的智能输液泵生产企业Ivenix公司的首席护理官Susan Niemeier表示,护士必须小心滴定测量高浓度药物,并确保适当的剂量,并使提供这些药物的泵尽量地靠近患者。Niemeier说,三月初,她开始注意到护士们把输液泵放在了病房外面进行操作。

“用这种非常有创意的方式来适应这个充满挑战的局面并不是很理想,院规在不久前就被抛开了。如果需要输送高度敏感的药物,且要以非常低的速度给药,那么现在就要另外加长输管。”

除了材料短缺的可能性,使用加长输管还会引发感染控制和脚下绊倒危险等问题。如果输液管更换不定期,使用镇静用的异丙酚,其脂质含物会增加细菌污染的可能性。Niemeier指出,对于异丙酚,护理标准是每6至12小时更换一次输液管。

为短缺做好准备

随着病毒在全美和全世界的传播,医疗供应商,医院和输液泵的生产厂商全都面临着泵及其配件可能会出现更大范围的短缺。

数周以来,ECRI和ISMP为这种短缺一直在作计划,建议卫生系统如何最大限度地利用现有的输液泵。因为护理的重点对象是COVID-19患者,该建议连其他部门和诊所在内一起寻找未使用的泵。

据Mandrack称,医院使用智能输液泵已有20年了,他们倾向于与单一生产厂商合作,因为这种厂商能够针对不同药物的输注速率,编程输液泵的内置软件库,该软件还能拦截错误条目的编程,错误条目的编程是可能会危及患者健康的。

这些输注速率也存储在中心数据库中,供全医院参考。Mandrack说,如果医院需要更多的这种智能泵,而这些泵又不可用,那么切换到其他生产厂家的设备就不容易了。

该机构的健康设备部门工程经理Erin Sparnon表示,与呼吸机的短缺不同,ECRI并不希望研究人员或其他人感到有必要自己来动手制作输液泵。她补充道,一些供应商正着手把每一份订单从自动交付转向分配到受灾最严重的地区。

提前计划

输液泵生产厂商同样密切关注着态势。B. Braun公司、Baxter公司、ICU Medical公司和Ivenix公司各自向ECRI和ISMP报告了他们的监控和目标库存,以及为提高输液泵、给药装置和加长输管的产量所作的各种努力。

例如,总部位于德国的B. Braun公司的Melsungen报告ECRI,他们已经增加了关键项目的输液器的产量,并增加了加长输管套件的库存。为了把货物运送到最需要的地区,BD表示已停止了Alaris公司输液器的自动发货。没有一家公司报告输液泵、输液器或加长输管的短缺。

“智能”输液泵将是下一个COVID-19短缺设备

B.Braun公司网站截图

Baxter公司女发言人Colleen Weber在一封电子邮件中报告MDO:“尽管我们看到输液泵的需求空前增长,这与目前新兴的COVID-19热点相吻合,但我们已经能够通过可用库存和增加产量来满足客户的需求。我们是以客观的研究来源、政府数据报告和学术数据跟踪热点为依据的,如Johns Hopkins University & Medicine Coronavirus Resource Center的数据。”

Weber表示,总部位于伊利诺伊州迪尔菲尔德的Baxter公司,其加长输管套件的订单也大幅增加。为了确保患者的安全,该公司同时加强指导如何正确使用加长输管套件。

她补充说:“我们正在与制造工厂合作,提高这些产品代码的产量,与此同时,我们已经实施高于历史订货水平的保护性分配,以确保供应的公平分配。在大流行期间,我们还根据特定标准分配额外的产品,把我们的救生产品运输到最需要的地方。

公司医疗总监Dr. John Beard说,总部位于加利福尼亚州圣克莱门特的ICU Medical公司已审查了库存,包括来自COVID-19受影响国家的原材料,并确认其现有库存足以支持生产计划。

Beard指出,该计划包括全面增加IV泵、耗材和解决方案的制造,以满足预期的需求激增。他补充说,ICU Medical公司还增加了用于治疗COVID-19患者的关键输液器配件和组件的供应,包括长输液管套件。

Beard 在一封电子邮件中报告MDO:“我们会定期审查供应商的最新动态,来发现任何供应风险,并将采取适当措施来降低此类的任何风险。此外,我们对可能存在于次级供应商的限制条件所造成的潜在影响进行持续性审查。”

随着冠状病毒的继续传播,ECRI和ISMP也将密切关注供应情况,并继续提供指导医院和医疗系统的帮助。

Mandrack说:“有些地区并没有经历这种激增,但他们正在为此作着准备。这绝对是一个不断发展的过程。”

原文:

Severely ill COVID-19 patients may need multiple medications delivered by infusion pumps. Manufacturers and hospitals are planning on how to avoid shortages of these pumps and the associated tubing.

Youve likely seen the videos of ICU hallways lined with medical devices that would normally be in patient rooms.

Among them are machines that are ubiquitous throughout any hospital smart infusion pumps that are programmed to deliver controlled doses of medication. The effects of COVID-19 on patients organs heighten the need for these pumps made by companies including Becton Dickinson (NYSE:BDX), B.Braun,Baxter (NYSE:BAX), ICU Medical (NSDQ:ICUI) and Ivenix.

The pumps medication administration sets and the extended tubing allow them to operate in hallways to reduce nurses exposure to COVID-19. Some patients even need multiple pumps.

The rules were thrown out a while ago

Reports of pump shortages began popping up on nurses listservs in March as the volume of critically ill COVID-19 patients began to increase, according to the ECRI Institute and the Institute for Safe Medication Practices (ISMP). In acute-care settings, these smart pumps deliver vasopressors, antiarrhythmic agents, opioids, anesthetic agents, neuromuscular blocking agents, antithrombotics and insulin, many of which COVID-19 patients need.

The volume of patients is whats taxing the system in terms of the availability of pumps, according to Michelle Mandrack, a nurse and the director of consulting services at ISMP.

Some hospitals have to face choices in where they will use smart pumps when the patient need exceeds their available supply,” Mandrack told Medical Design & Outsourcing. I think the availability of smart pumps is not as stressed as probably the ventilators, but we are hearing conversations where organizations are trying to figure out how theyre going to make these kinds of decisions.

Nurses must carefully titrate highly concentrated drugs and, to ensure proper dosing, want the pumps supplying those medications to be as close to the patient as possible, according to Susan Niemeier, chief nursing officer for smart infusion pump manufacturer Ivenix (North Andover, Mass.). Niemeier said she started noticing nurses positioning the pumps outside patient rooms in early March.

It was a very creative way to accommodate a challenging situation. Its not ideal. The rules were thrown out a while ago, Niemeier said. If youre delivering a drug that is highly sensitive and to be delivered at a very low rate you now have extra feet of tubing.

The use of extended tubing also raises issues of infection control and tripping hazards, not to mention the possibility of shortages. The drug propofol, used for sedation, contains lipids that raise the possibility of bacterial contamination if the tubing is not changed regularly. For propofol, the standard of care is to change the tubing every 6 to 12 hours, Niemeier noted.

Bracing for shortages

Healthcare providers, hospitals and pump manufacturers are all bracing for the possibility that the pumps and their accessories may go into more widespread shortage as the virus spreads across the country and the world.

ECRI and ISMP have been planning for such a shortage for weeks and advising health systems on how to maximize the infusion pumps they already have. That advice includes scouring their other departments and clinics for unused pumps as care focuses on COVID-19 patients.

Hospitals have been using smart infusion pumps for about 20 years, according to Mandrack. They tend to stick with a single manufacturer because they can program the pumps built-in software library with infusion rates for different medications. The software can also potentially intercept the programming of a mistaken entry that could jeopardize a patients health, Mandrack said.

Those infusion rates are also stored in a central library for reference throughout the hospital. If the hospital needs more of those pumps and they are not available, its not easy to switch to another manufacturers device, Mandrack said.

But unlike the ventilator shortage, ECRI doesnt expect researchers and others to feel the need to make do-it-yourself infusion pumps, according to the organizations health devices group engineering manager, Erin Sparnon. Some suppliers are moving away from automatically delivering on every order to allocating supplies to the hardest-hit areas, she added.

Planning ahead

Infusion pump manufacturers are keeping a close eye on the situation as well. Becton Dickinson B. Braun,Baxter, ICU Medical and Ivenix each reported their various efforts to monitor and target inventory as well as boost production of pumps, administration sets and extended tubing to ECRI and ISMP.

Melsungen, Germany-based B. Braun, for instance, told ECRI it has increased infusion set production for critical items and added long extension sets to its inventory. BD said it has ceased automatic shipments of its Alaris infusion sets in order to target shipments to highest-need areas. None of the companies reported shortages of pumps or infusion sets or extended tubing.

“While we are seeing unprecedented increases in demand for pumps coinciding with existing and emerging COVID-19 hot spots, we have been able to meet customer needs through available inventory and by increasing production, Baxter spokeswoman Colleen Weber told MDO in an email. We track hot spots based on objective research sources, government data reporting and academic data, such as Johns Hopkins University & Medicine Coronavirus Resource Center.

Deerfield, Ill.based Baxter has also seen significant increases in orders for its extension sets, including sets with longer tubing. To ensure patient safety, the company simultaneously reinforced guidance on proper extension-set usage, according to Weber.

We are working with our manufacturing facilities to increase production of these product codes, and in the interim, have implemented a protective allocation above historical ordering levels to help ensure fair distribution of supply, she added. During the pandemic, we are also allocating additional product based on specific criteria that help deliver our life-saving products where they are needed most.

San Clemente, Calif.-based ICU Medical has reviewed its inventory, including the raw materials originating from COVID-19-affected countries, and confirmed that it has sufficient stock on hand to support its production plan, according to company medical director Dr. John Beard.

That plan includes an across-the-board increase in the manufacturing of IV pumps, consumables and solutions to meet the anticipated surge in demand, Beard noted. ICU Medical has also increased the supply of key infusion set configurations and components used in the treatment of COVID-19 patients, including long tubing sets, he added.

We review regular supplier updates to identify any supply risks and are taking appropriate measures to mitigate any such risks, Beard told MDO in an email. In addition, we conduct an ongoing review of potential impacts caused by constraints that may exist at sub-tier suppliers.

ECRI and ISMP will also keep an eye on supplies and continue to help guide hospitals and healthcare systems as the coronavirus continues its spread.

There are areas that are not experiencing that surge but they are preparing for it, Mandrack said. Its definitely an evolving process.

(本文来源:奥咨达)

(责任编辑:子豪)

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TAG标签: COVID-19 智能 输液泵 短缺设备
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