This information describes your Codman® implanted liver infusion pump, including how it is placed, how it works, and how it is refilled.
You will get your medication through a pump that is implanted in your liver. This is to make sure that the medication flows directly to 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.
You will have a surgery to implant the pump in your abdomen. It will be connected by a catheter (small, flexible tube) to your hepatic artery. This is the main blood vessel that goes into your liver.
Your nurse will give you more information about your surgery and tell you how to prepare.
How Your Pump Is Implanted
Your doctor will give you general anesthesia (medication to make you sleep). Once you are asleep, your doctor will make a pocket in your lower abdomen (belly) between the skin and muscle. He or she will place the pump in this pocket. Your doctor will attach the catheter on the pump to your hepatic artery (see Figure 1).
Figure 1. Placement of the pump
Your surgery will take 90 minutes to 2 hours. You will then stay in the hospital for 4 or 5 days. Your doctor or inpatient nurse will give you an identification card that says you have an implanted device. You must carry this card at all times while you have your pump.Back to top
How Your Pump Works
Your pump is divided into an inner and outer chamber (see Figure 2).
Figure 2. Parts of the pump
A chemical called a propellant is sealed inside the outer chamber. Your medication is located in the inner chamber.
When the propellant is warmed by your body, it will cause the medication to flow out of the catheter and into your liver.Back to top
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 nurse will fill your pump with medication through a raised area in the center called the septum (see Figure 2). Your nurse will give you information about your medication and possible side effects.
Medication can be given by the pump in 2 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 14thday. When you are not receiving medication, your pump will be filled with glycerol. It is a thick solution that lets you go 6 weeks between pump refills.
Some people may develop stomach ulcers during treatment with the pump. Your nurse will give you antiulcer medications during treatment to help prevent this.Back to top
How Your Pump Is Refilled
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, your nurse will remove it with a syringe and measure it (see Figure 3). You will not experience any discomfort while the medication is being taken out of the pump.
Figure 3. Taking medication out of the pump
Your nurse will make sure that the catheter is not blocked. He or she will refill your pump 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.
Figure 4. Refilling the pump with medication
The procedure to refill your pump will take 10 to 15 minutes.
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.Back to top
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.
- Avoid running or jogging. This can cause the catheter to move out of place.
- Check with your doctor if you plan to travel by airplane. Pressure changes in the cabin can cause your medication to flow faster.
- Avoid activities that can raise your body temperature because this can make your medication 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. If you are planning to be outdoors, make sure you use a broad-spectrum sunscreen with an SPF of at least 30. For more information about sunscreen, please read Understanding Sunscreen.
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