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26th Napa Pain Conference

NPC26-F7-B - Intraspinal Drug Delivery Safety & Standardization


Aug 16, 2019 3:45pm ‐ Aug 16, 2019 5:30pm


Description


Intraspinal Drug Delivery

Safety & Standardization


Target Audience: Clinicians supervising or providing direct care for patients with intrathecal drug delivery systems, and providers considering the use of IIDs


Learning Objectives

As a result of participating in this activity, learners will be better able to:

  • Implement strategies to prevent the two clinician-related factors that contribute to the most serious adverse events
  • Triage inflammatory catheter tip granulomas

Presentations

Pharmacodynamics & Pharmacokinetics of Approved & Off-label IDDS Medications

Michael Saulino, MD, PhD

A Standardized Refill Protocol for Intrathecal Drug Delivery Systems

Lawrence Poree, MD, PhD, MPH



Description

Intraspinal drug delivery (IDD) is a safe and efficacious method used to deliver medications for the treatment of chronic neurological disease that requires periodic reservoir refills that can place patients at risk for a rare, accidental but potentially life-threatening pocket fill. After clinicians have been refilling pump reservoirs for 5 years, 18% report at least one of these serious adverse events.


Additional Reading

  • Mcglothlen G & Rodriguez L. Training for the intraspinal drug delivery system reservoir refill procedure highly variable: A nationwide survey of health care professionals. Neuromodulation. 2017; 20(7):727-732.
  • Fitzgibbon, D. R., Stephens, L. S., Posner, K. L., Michna, E., Rathmell, J. P., Pollak, K. A., & Domino, K. B. (2016). Injury and liability associated with implantable devices for chronic pain. The Journal of the American Society of Anesthesiologists, 124(6), 1384-1393.
  • Deer, T. R., Pope, J. E., Hayek, S. M., Lamer, T. J., Veizi, I. E., Erdek, M., ... & Rosen, S. M. (2017). The Polyanalgesic Consensus Conference (PACC): recommendations for intrathecal drug delivery: guidance for improving safety and mitigating risks. Neuromodulation: Technology at the Neural Interface, 20(2), 155-176.
  • Deer, T. R., Pope, J. E., Hayek, S. M., Bux, A., Buchser, E., Eldabe, S., ... & Doleys, D. M. (2017). The polyanalgesic consensus conference (pacc): recommendations on intrathecal drug infusion systems best practices and guidelines. Neuromodulation: Technology at the Neural Interface, 20(2), 96-132.
  • McGlothlen, Gail, “Intraspinal Drug Delivery Reservoir Refill Procedure by Non-Physician Clinicians: A Nation-Wide Survey of Training, Pocket Fill Experience, and Life-Long Learning Behaviors” (2016). Doctoral Projects. 39.
  • American Society of Health-System Pharmacists Guidelines on Preventing Medication Errors in Hospitals
  • Pharmaceutical Compounding—Sterile Preparations (general information chapter 797). In: The United States Pharmacopeia, 36th rev., and the National Formulary, 31 ed. Rockville, MD: The United States Pharmacopeial Convention; 2013: 361–98
  • Adler, J. A., & Lotz, N. M. (2017). Intrathecal pain management: a team-based approach. Journal of Pain Research, 10, 2565.
  • McGivern, J. G. (2007). Ziconotide: a review of its pharmacology and use in the treatment of pain. Neuropsychiatric disease and treatment, 3(1), 69.
  • Hanna, M. H., Peat, S. J., Woodham, M., Knibb, A., & Fung, C. (1990). Analgesic efficacy and CSF pharmacokinetics of intrathecal morphine-6-glucuronide: comparison with morphine. British Journal of Anaesthesia, 64(5), 547-550.

Speaker(s):

  • Dr. Michael Saulino, MD, PhD, Clinical Director, Intrathecal Therapy Services, MossRehab
  • Dr. Lawrence Poree, MD, PhD. MPH, Clinical Professor, Department of Anesthesia, University of California at San Francisco (UCSF)

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