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About Your Codman Implanted Liver Infusion Pump

This information describes your Codman® implanted liver infusion pump, including how it is placed, how it works, and how it is refilled.

Your chemotherapy will be given to you through a pump that is implanted in your liver. The pump is a small, disc-shaped device that is made of titanium metal. It is about 2 or 3 inches in diameter, about 1 inch thick, and weighs about 4 ounces. Using the pump will ensure that the medication flows directly to your liver.

How Your Pump Is Implanted

Your pump will be implanted during a surgery. You will be given general anesthesia (medication to make you sleep) during your surgery. Your nurse will give you more information about your surgery.

Your pump will be placed in a pocket that is made between the skin and muscle in your lower abdomen (belly). A catheter (small, flexible tube) that is attached to the pump will be placed into your hepatic artery. This is the main blood vessel that goes into your liver (see Figure 1).

Your surgery will take 90 minutes to 2 hours. You will then stay in the hospital for 4 or 5 days.

How Your Pump Works

Your pump is divided into an inner and outer chamber (see Figure 2). The medication is located in the inner chamber. It flows into your liver at a constant rate all day.

A chemical called a propellant is sealed inside the outer chamber. After the propellant is warmed by your body, it will cause the medication to flow out of the catheter and into your liver.

Your pump is refilled with medication through a raised area in the center called the septum (see Figure 2).

Your doctor or nurse will give you an identification card to carry with you while you have your pump. You must carry this card at all times while you have your pump.

How Medication Is Given Through Your Pump

Before you begin using your pump, you will have a procedure called a flow scan to make sure your pump is working properly. Your nurse will give you more information about this procedure before it is done.

After your flow scan, your pump will be filled with medication. Your nurse will give you information about your chemotherapy and possible side effects.

Medication can be given by the pump in two ways. With both methods, the medication goes straight into the catheter and into your hepatic artery. Most often, the medication is given at a constant rate all day. The other way is with a single, fast injection called a bolus. With the bolus method, the medication is not stored in the inner chamber of the pump.

Your pump will only hold enough medication for 14 days. It must be refilled on the 14th day. When you are not receiving chemotherapy, your pump will be filled with glycerol. It is a thick solution that lets you go 6 weeks between pump refills.

Some patients who have the pump develop stomach ulcers during treatment. You will be given antiulcer medications during treatment to help prevent this.

How Your Pump Is Refilled

The procedure to refill your pump will take 10 to 15 minutes.

Your nurse will clean your skin at the pump site and insert a needle into the septum. You may experience discomfort from the prick of the needle.

If any medication is still in your pump, it will be taken out with a syringe and measured by your nurse (see Figure 3). You will not experience any discomfort while the medication is being taken out of the pump.

If there is any question about the amount of medication left in your pump, your nurse will make sure that the catheter is not blocked. Otherwise, your pump will be refilled with medication through a syringe that is inserted into the inner chamber (see Figure 4). You will not experience any discomfort while the medication is being refilled.

Your pump will only hold enough medication for 14 days. It must be refilled on the 14th day. It is very important that you keep all of your refill appointments. Your pump can run dry if it is not refilled regularly. If that happens, it could become clotted and damaged. Call your doctor or nurse if you cannot keep a refill appointment. Tell your doctor if you will be out of town at any point while you have
your pump.

Activity

After you recover from your surgery, you can resume most of your usual activities. However, follow the guidelines below:

  • Avoid rough physical activity, such as contact sports, that can cause an injury to your pump site.
  • Avoid deep sea or scuba diving. You can swim or snorkel.
  • Avoid lifting heavy objects, which can cause your pump to move.
  • Check with your doctor if you plan to travel by airplane. Pressure changes in the cabin can cause your medication to flow faster.

Do not:

  • Place heating pads, electric blankets, or hot water bottles directly on your pump site
  • Take hot baths or showers
  • Go in a sauna or hot tub
  • Overexpose yourself to the sun

All of these activities can raise your body temperature and cause your medication to flow faster.

Call Your Doctor or Nurse if You:

  • Have a temperature of 100.4° F (38° C) or higher
  • Have any signs of infection at your pump site, such as tenderness, drainage, or redness
  • Have swelling over your pump site
  • Have plans to travel by airplane
  • Cannot keep a scheduled refill appointment
  • Have any unexplained or unusual reactions
  • Have any questions or concerns