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Implantation of Intrathecal Catheters and Infusion Pumps

What is an intrathecal programmable pump placement?

The intrathecal programmable pump is an implanted medical device which is used to deliver medication directly into the spinal fluid. The system consists of an infusion pump, a spinal catheter, and an external programmer. This treatment has brought relief to many patients who suffer from chronic, severe pain from multiple causes and also from chronic, severe spasticity of spinal cord origin. The pump is programmed immediately upon placement, before leaving the surgical suite.

The effect of the medication occurs within minutes to hours, depending on the choice of medication placed in the pump.

How the Pump Works

Intrathecal Drug DeliveryThe pump has three sealed chambers. One contains an electronic module and battery; another contains a peristaltic pump and drug reservoir; and the third contains an inert gas. The gas provides the pressure that is used to force the medication into the peristaltic pump. An example of Intrathecal Drug Delivery Device image coutesy of Medtronic, Inc. is included below.

To fill the pump, medication is injected through the reservoir fill port, and into the expandable reservoir. An inert gas puts pressure on the reservoir. The pressure forces the medication through a bacterial-retentive filter and into the pump chamber. From the pump chamber, the medication is pumped out of the device and into the catheter.

A microprocessor controls the rate at which the pump delivers medication. Your doctor may program the pump to deliver different amounts of medication at different times of the day, depending on your individual needs.

How should I prepare for the procedure?

The intrathecal programmable pump is a safe medical procedure; but, as with any procedure, it has risks as well as benefits.

The pump placement is a relatively minor surgery preformed under general anesthesia or sedation. To minimize the chance of complication, we ask that you follow a few simple guidelines:

Do not eat or drink anything for (8) eight hours prior to the procedure.

We will require that you be accompanied to and from hospital by a responsible adult driver. Following the procedure, you will be admitted to the hospital for 1 or 2 nights for observation.

What happens during the procedure?

First, an intravenous line will be placed, generally in your hand. We will then bring you to the operating room and place several monitors on you, such as a heart, blood pressure and a pulse. These will enable us to monitor your vital signs throughout the procedure. Following placement of the monitors we will begin to give you some intravenous medication in order to decrease anxiety, as well as provide you with some pain relief.

You will be asked to lie on your side in the surgical suite. An x-ray is used to help guide the intrathecal catheter to the correct position.

After cleaning your skin, the skin is anesthetized with local anesthetic to decrease any pain associated with performance of the procedure. By this point, you will already have received sedation by the anesthesiologist, as well. The intrathecal catheter is placed through a small incision in your back.

The programmable pump is placed under the skin in the right or left abdomen where there is sufficient skin and soft tissue to support the pump. A pocket is created underneath the skin to contain the pump. The catheter is tunneled from the back, underneath the skin to the abdomen where it is connected to the programmable pump.

Both incisions are then closed with sutures. The pump is filled with the medication while you are in the surgical suite, and the programming is initiated. It will be functioning before you leave the recovery Room.

What happens afterwards?

We will assess that the pump is functioning correctly by observing for signs of pain relief from the medications, as well as development of numbness from the local anesthetic. You will be monitored for 20 to 40 minutes by a Recovery Room nurse and a Pain Management physician.

If there are no signs of problems, you will be ready to leave the recovery area and be transferred to your room for observation overnight. You will be monitored for correct functioning of the newly placed intrathecal pump, as well as for any complications related to the procedure and the anesthesia. If there are no signs of problems, you will be ready to leave by the next day or the following day.

You will need to return to the Pain Management Center for refills of the pump approximately every 30 days. Also, your pump can be reprogrammed at anytime by the Pain Management physicians using an external programmer. You will also be taught how to turn the pump on and off yourself while at home, using a magnet.

Will my insurance cover the procedure?

The intrathecal programmable pump placement is a well established medical procedure, and is reimbursed by most insurance companies. Any need for pre-authorization of services or co-payments, depends on your insurance carrier. Our office staff will assist you in obtaining pre-authorization whenever possible.

What should I expect from this procedure?

You will require a short period of recovery from this minor surgical procedure. You may notice soreness in the abdominal wall where the intrathecal pump is placed, and some soreness in the back where the catheter is inserted; this is usually quite minimal. There will be some bruising which may last up to a week, but will resolve. Your home nursing agency will assist in monitoring the two sites for any evidence of infection. Signs to monitor are redness and/or increased pain or swelling of the two incision sites. The stitches will be removed at the Pain Management Center in approximately one week, provided that the incisions are well healed.

What possible side effects might I see?

The intrathecal pump placement is a safe surgical procedure but, as with any procedure, it has risks as well as benefits. The major risks of an in dwelling foreign device is infection and/or local bleeding. Usage of such a device over the long term requires vigilance to maintaining clean technique and decrease the likelihood of infection.

The intrathecal pump accesses the intrathecal space. The medications delivered there may cause numbness and/or weakness and/or sedation depending on which medication is used and what dose is administered. These side effects are normally reversible. You may have some local tenderness at the pump insertion site once the numbing medicine has worn off.

Post procedure instructions:

These will be provided for you, in further detail, by the nurse, prior to your discharge from the hospital.

Signs to monitor are redness and/or increased pain or swelling of the two incision sites. The stitches will be removed at the Pain Management Center in approximately one week, provided that the incisions are well healed.

What should I do if any problems develop after I leave the hospital?

If you have any questions after your procedure, the medical staff of the Pain Management Clinic is on call 24 hours a day, seven days a week.

During normal business hours, you can reach either the nurse or physician by calling (312) 942-6631. After hours, the Pain Fellow on call can be reached by calling the page operator at (312) 942-5000 – Pager #7926.

Additional information/sources regarding this procedure:

Medtronic, Inc. info on Intrathecal Drug Delivery