> Hello Mary, > > I'm surprised your email isn't getting more discussion. I think it's a > brilliant idea as it's the only physical way to make sure that the critical > antibiotic that drives the whole EGDT benefit even gets delivered and saves > the patient. Physically, a ballon pump (better known in Home Health as an > Elastomeric) is the only way I can see to overcome a yet unsaid contradiction > I see within the protocol. > > Here's the problem: > > 2 Liters of bolus solution to restore fluid levels STAT > AND > 50 ml of controlled antibiotic delivery over 1/2 hour without interruption. > > Cannot be delivered through the same IV site UNLESS; > > 1). The primary bolus fluid is gravity infused from a single 2L bag hung (on > a hanger) BELOW the slowly infusing antibiotic. > > Or > > 2). Both bolus and controlled antibiotic are gravity infused at the same > height and the peripheral they share has a higher flow capacity (minimum 14 > gauge) than the bolus fluid line to prevent bottle necking. > > If not done either way above, the initial antibiotic delivery (the whole > point of EGDT) will either be delivered; > > 1). Too quickly - blunting it's efficacy (red man syndrome) > > 2). Too slowly (or interrupted) - blunting it's designed initial impact. > > For those that haven't heard of these 'balloon', 'elastomeric', 'grenade' > devices, > > The elastomeric is whatever antibiotic you want in a pre-loaded, self > pressurized, error proof, disposable 'balloon', you can connect to any line > to make sure the antibiotic infuses as intended without even having to hang > it. They were designed so that home health patients self administering > intermittent antibiotics wouldn't be tethered to an IV pole or instructed on > how to program an IV pump. Just lure connect one to the line and throw the > clamp. Really no wrong way to do it. They only cost around $5.00 and are > already in most hospital pharmacies. They've been used for decades and have > evolved to frozen storage and microwave thawed as needed. > > I'm excited to see any discussion about these devices if anyone is willing to > consider them. Again I'm not a clinician and can't give you any examples of > anyone using these devices as I'm describing for the initial treatment of > sepsis. But I can provide numerous examples of how these same devices are > used in exactly the manner above for sepsis recovery in the home health > setting. So I'm not suggesting anything new here, just suggesting that an > existing sepsis treatment device be used Earlier in the process. > > I welcome any additional thoughts to my engineer's perspective about this > issue and apologize in advance for stepping on any clinical toes within my > outsider's perspective. > > Very humbly submitted, > > Matt Reavill > > 815-483-5712 > 2200 Pebble Beach Drive; Plainfield, IL 60586 > [email protected]
On Oct 10, 2012, at 7:52 AM, "Drake, Mary" <[email protected]> wrote: > Good Morning Colleagues, > > Has anyone used balloon pump therapy with patients in septic shock? If you > have a protocol and/or algorithm relative to this, I would be most interested > in obtaining that. > Thanks in advance for your assistance. > Best- > Mary > > Mary Drake > Manager, Quality & Operations Improvement > The Ohio State University Wexner Medical Center > Hawthorne House, Room 113 > 1492 East Broad Street > Columbus, OH 43205 > Phone: 614-257-2821 > Pager: 614-346-3267 > Fax: 614-257-2234 > E-mail: [email protected] > <Picture (Metafile) 1.jpg> > P Please consider the environment before printing this e-mail > This information is confidential per Ohio Revised Code Sec 2305.25 and may > not be shared discussed, or distributed outside of the quality process. If > the reader of this communication is not an intended recipient, you are hereby > notified that any dissemination, distribution or copying of this > communication is strictly prohibited. > > > <Picture (Metafile) 1.jpg> > _______________________________________________ > Sepsisgroups mailing list > [email protected] > http://lists.sepsisgroups.org/listinfo.cgi/sepsisgroups-sepsisgroups.org
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