What is the management approach for a malfunctioning electrical pain pump (EPP)?

Management of a Malfunctioning Electrical Pain Pump

When faced with a malfunctioning electrical pain pump, the first step is to check power connections and battery status, followed by controller exchange if the problem persists, with immediate contact to the implanting center for any critical alarms or signs of pump stoppage. 1

Initial Assessment Algorithm

Step 1: Power Supply Verification

• Check all power connections to ensure they are intact and properly connected 1
• Verify battery status - if batteries are low, replace them or switch to alternating-current power 1
• Ensure both power supplies are connected (pumps typically require two power sources) 1

Step 2: Alarm Assessment

• Determine if the alarm is critical (continuous alarm with red warning light) or advisory (intermittent alarm with yellow warning light) 1
• Critical alarms require immediate attention as they indicate impending loss of hemodynamic support 1
• Advisory alarms can be addressed in a non-emergent fashion as they have little effect on pump function 1

Step 3: Controller Management

• If power supply is confirmed but pump function is absent, exchange the controller for the backup controller 1
• The caregiver or conscious patient may perform this exchange if they have received training 1

Emergency Management for Pump Stoppage

Pump stoppage is a serious complication that requires immediate intervention:

• Contact the pump implanting center immediately 1
• Verify pump function by placing a stethoscope over the pump location to listen for mechanical hum 1
• Assess for signs of inadequate circulation: altered mental status, cyanosis, signs of heart failure 1
• Be aware that restarting a pump after prolonged stoppage can result in stroke or other thromboembolic complications 1
• For intrathecal drug delivery systems, be vigilant for signs of withdrawal syndrome which can be life-threatening (high fever, altered mental status, rebound spasticity) 2

Transport Considerations

For patients requiring transport due to pump malfunction:

• Patients with controller or pump malfunction require immediate evaluation at the nearest center with experience in managing these devices 1
• Unstable patients should be transported to the nearest hospital for stabilization 1
• Avoid excessive tension on the percutaneous lead during transport 1
• Avoid kinking or cutting the percutaneous lead if clothing needs to be removed 1
• Transport all peripheral equipment with the patient (backup batteries, backup controller, battery charger, power charger) 1

Special Considerations

Intrathecal Drug Delivery Systems

• Abrupt cessation of intrathecal medications (particularly baclofen) can lead to life-threatening withdrawal syndrome 2
• For intrathecal pump malfunction, immediate contact with the implanting center is crucial 1
• Intrathecal pumps may malfunction due to electromagnetic interference, though this is rare 3
• Motor stall is a known complication with certain devices, with a reported prevalence of 9.03% in one study 4

Potential Causes of Malfunction

• Power failure is the most common cause of pump stoppage 1
• Damage to the percutaneous lead can compromise power supply 1
• Electrical corruption of the pump's program has been identified as a cause of overdose in some cases 5
• Cold solution instillation into the pump reservoir may trigger internal alarms 6
• Exposure to electromagnetic interference may affect pump function 3

Common Pitfalls to Avoid

• Delaying contact with the implanting center when critical alarms occur 1
• Failing to recognize signs of drug withdrawal, especially with intrathecal baclofen 2
• Neglecting to transport backup equipment with the patient 1
• Restarting a pump after prolonged stoppage without consulting specialists 1
• Exposing pumps to screening radiological procedures (CT, MRI) without appropriate precautions 1

By following this systematic approach to managing a malfunctioning electrical pain pump, clinicians can minimize risks to patient morbidity and mortality while ensuring appropriate intervention for this potentially serious medical device issue.