Elastomeric Infusion Ball for IV Antibiotics
An elastomeric infusion ball (also called an elastomeric device or pump) is a portable, disposable mechanical device that delivers intravenous antibiotics continuously over a set period (typically 24 hours) without requiring electricity, gravity setup, or electronic pumps—making it ideal for outpatient parenteral antimicrobial therapy (OPAT).
How It Works
The device consists of a balloon-like elastomeric reservoir pre-filled with antibiotic solution that uses constant pressure from the elastic material to infuse medication through an IV catheter at a controlled rate 1. The pump is:
- Simple to use - requires minimal patient training
- Fully portable - allows complete patient mobility and independence
- Mechanical - no batteries, electricity, or gravity required
- Pre-programmed - delivers medication at a fixed rate based on the device configuration
Clinical Applications
Elastomeric devices are particularly valuable for:
- Time-dependent antibiotics requiring prolonged or continuous infusion (e.g., beta-lactams like piperacillin/tazobactam, which was the most commonly used antibiotic in 33.3% of cases) 2
- Home-based OPAT - enabling early hospital discharge
- Patients requiring 1-2 nurse visits daily rather than multiple daily infusions 1
- Treatment durations typically ranging from 10-15 days 3
Evidence of Safety and Efficacy
The evidence strongly supports elastomeric devices as safe and effective:
- High cure rates: 93.4% cure rate in one study of 91 patients receiving self-administered OPAT 4, and 85.2% good clinical outcomes in another cohort of 81 patients 2
- Low adverse event rates: Only 3-6% device-related complications across studies 3, 4
- Non-inferiority demonstrated: Two studies showed elastomeric delivery was non-inferior to conventional electronic pumps for cystic fibrosis patients 3
- Pediatric safety: 567 pediatric patients treated across 657 episodes with minimal adverse events 3
Important Caveats and Limitations
Insurance and Cost Considerations
Elastomeric devices may not be covered by all insurance carriers 1, which can be a significant barrier despite their cost-effectiveness (estimated savings of $2.4-3.5 million compared to inpatient therapy in one county hospital system) 4.
Drug Stability Requirements
You must carefully consider:
- Infusion duration compatibility with drug stability
- Concentration after dilution
- Diluent type (normal saline vs. D5W)
- Temperature control during infusion 5
Not all antibiotics are compatible with elastomeric delivery—14 different antibiotics plus aciclovir have been successfully used 3, but prescribers must verify stability data for each specific drug.
Patient Monitoring Needs
ED visits during therapy were relatively high (24.2%), with 14.3% presenting with PICC line concerns 4. This indicates the necessity of:
- Close patient monitoring through structured OPAT programs
- Clear protocols for troubleshooting line issues
- Accessible clinical support for patients at home
Patient Selection
Patients with certain comorbidities may have worse outcomes:
- Heart failure was associated with higher 30-day mortality (p=0.027) 2
- Recent neoplasia (within 5 years) was associated with unfavorable clinical evolution (p=0.012) 2
- However, age alone is not a contraindication—patients over 80 actually had better outcomes in one analysis 2
Practical Implementation
According to IDSA guidelines 1, elastomeric devices are most practical for:
- Once-daily dosing regimens (more frequent dosing is impractical for infusion center patients)
- Pediatric OPAT where more than 2-3 doses daily requiring adult assistance is impractical
- Patients who need mobility during treatment
The devices typically run to time in 96% of cases when properly implemented 6.