Pulmonary hypertension is a rare chronic disorder, but life-threatening condition associated with an increase in pulmonary pressure. If not treated, it may cause severe cardiac problem particularly right ventricular failure and can lead to death. Pulmonary pressure means an increase of blood pressure in arteries of the lungs. The measurement of the pressure involves Swan-Ganz catheter insertion at the right side of the heart. If the arteries pressure is ≥ 25mmHg is referred to as pulmonary hypertension. At present, there is no cure for this disease and the cause is unknown. The incidence rate of this disorder is defined as 15 cases per million patients.

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What is Implantable Pump for Pulmonary Hypertension?

The introduction of an implantable pump for pulmonary hypertension is one of the intriguing researches in medical field. The ultimate objective of this delivery system is to provide drugs to the target part and release drugs at a desired concentration. It is medication device approved by food and drug administration. It is placed under the skin in the abdomen part of the body. The device releases the drug into the vein at the superior caval-atrial intersection with the help of a catheter. The drug is stored inside the reservoir associated with the pump. The pump assists the drug to move from reservoir to vein via a catheter. Instead of oral drug delivery, this direct release in veins has several advantages in patents and minimize the unwanted side effects. Today, thousands of pulmonary hypertension patients are benefited because of this simple drug delivery systems. Generally, the device is well tolerable

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Advantages and Disadvantages of Implantable Pump

The most important advantage of this device is, if the drug volume runs low in the reservoir it can be refilled with the help of injection through the skin without removing the device from the abdomen. Recent days, several manufacturers with numerous improvement in the device have come up such as alarm if reservoir runs low drug volume, testing alarm, and silencing the alarm. Manufacturers have engineered the pump system to achieve 100% accurate performance in the release of the drug. The flow rate of the pump (1.2 to 2 ml/24 hr) varies with body temperature. It increases as the temperature increases above 37°C and decreases as the temperature decreases below 37°C. Flow rate also gradually decreases if the reservoir runs low volume. Pump longevity depends on the function of flow rate. Flow rates can affect the battery voltage and motor revolutions.

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The procedure for implanting the device along with the catheter in patient’s body is done with sedating medicine which is generally a risky process. Catheter kinking generally requires local anesthesia and the whole surgical procedure takes place in 60 to 90 minutes involve general anesthesia sedation. The process performed by expert team surgeons and sometimes may interrupt because of excess bleeding, inadequate anesthesia, lung injury, or blood clot. The patients must take appropriate steps to keep the device infection-free and must follow up regularly while refilling. Riociguat, treprostinil, and selexipag are some of the significant drugs for pulmonary hypertension patients. Some of these drugs are prostacyclin analog is the most widely used drug to treat pulmonary arterial hypertension.

Most of the pumps are made up of titanium reservoir with a capacity of 20 or 40 ml and silicone septum for easy refill process. Refill process is done by the experts every month (28 days once) by percutaneous injection into the septum of silicone port i.e. position on the top of the devices. The drugs should be stable at the 37°C is utmost very important for 60 days.

Catheter-related adverse side effects still occur even though several advancements made by the manufacturer. About 40% of the implanted patients have experienced catheter-related complications. Early identification of side effects and the prompt treatment for the symptoms can outweigh the risk associated with the implantable pump in patients.

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Pramod Kerkar

Written, Edited or Reviewed By:

, MD,FFARCSI

Pain Assist Inc.

Last Modified On: June 12, 2018

This article does not provide medical advice. See disclaimer

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