Application of Nano-Insulin Pump in Children with Diabetic Ketoacidosis

Type 1 diabetes is an insulin-dependent type of diabetes that is most common among children. Due to absolute deficiency of insulin in patients, diabetic ketoacidosis (DKA) can easily ensue. Insulin pump can simulate the physiological secretion of islet, but increases the risk of pain and infection in children due to its traumatic effect. This study aimed to analyze the application effect of nano-insulin pump in children with DKA. Children with DKA admitted to our hospital from May 2018 to May 2020 were included in this study and, according to the random number table method, they were divided into two groups, with each group containing 36 cases. The first group received traditional insulin pump infusion (IP), while the second group received nano-insulin pump infusion (NIP). It was found that the reduction of FBG and PBG in NIP group was greater than that in IP group. The recovery time of urine ketone, blood ketone, glucose, venous pH, and other clinical indicators in the NIP group were all lower than those in the IP group (P < 0.05). The length of hospital stay, insulin dosage, incidence of hypoglycemia, and infusion site infection rate in the NIP group were all lower than those in the IP group (P <0.05). The findings indicate that the application of nano-insulin pump in children with DKA had a significant effect and could quickly and obviously correct the levels of blood glucose and ketone body in children.

Advances in Insulin Pump Infusion Sets Symposium Report

Continuous subcutaneous insulin infusion (CSII) is becoming increasingly used for achieving target glycemic control as well as providing flexibility in lifestyle. In a widely used version of CSII, the insulin pump itself is attached to one end of an insulin infusion set (IIS), which delivers insulin via a thin flexible plastic tube to the patient’s body via a cannula or needle that is inserted under the skin at the other end of the IIS. Despite the increased use of CSII by patients with diabetes, there have been few recent advances in IIS technology, especially when compared to the many recent advances made in insulin pump technology and in insulin pharmacokinetics. To discuss recent developments in, and future plans for IIS development, Diabetes Technology Society virtually hosted the Advances in Insulin Pump Infusion Sets Symposium on December 1, 2020. This symposium featured experts in the field of IISs, including representatives from Medtronic and ConvaTec (which are two manufacturers that are currently developing IISs), Stanford University, Steno Diabetes Center Copenhagen, and Science Consulting in Diabetes. The webinar’s six speakers covered (1) patient burden, (2) extended wear technology, and (3) future directions in IIS development.

Direct Observational Study of Interfaced Smart-Pumps in Pediatric Intensive Care

Background Processes for delivery of high-risk infusions in pediatric intensive care units (PICUs) are complex. Standard concentration infusions (SCIs), smart-pumps, and electronic prescribing are recommended medication error reduction strategies. Implementation rates in Europe lag behind those in the United States. Since 2012, the PICU of an Irish tertiary pediatric hospital has been using a smart-pump SCI library, interfaced with electronic infusion orders (Philips ICCA). The incidence of infusion errors is unknown. Objectives To determine the frequency, severity, and distribution of smart-pump infusion errors in PICUs. Methods Programmed infusions were directly observed at the bedside. Parameters were compared against medication orders and autodocumented infusion data. Identified deviations were categorized as medication errors or discrepancies. Error rates (%) were calculated as infusions with errors and errors per opportunities for error (OEs). Predefined definitions, multidisciplinary consensus and grading processes were employed. Results A total of 1,023 infusions for 175 patients were directly observed over 27 days between February and September 2017. The drug library accommodated 96.5% of infusions. Compliance with the drug library was 98.9%. A total of 133 infusions had ≥1 error (13.0%); a further 58 (5.7%) had ≥1 discrepancy. From a total of 4,997 OEs, 153 errors (3.1%) and 107 discrepancies (2.1%) were observed. Undocumented bolus doses were most commonly identified (n = 81); this was the only deviation in 36.1% (n = 69) of infusions. Programming errors were rare (0.32% OE). Errors were minor, with just one requiring minimal intervention to prevent harm. Conclusion The error rates identified are low compared with similar studies, highlighting the benefits of smart-pumps and autodocumented infusion data in PICUs. A range of quality improvement opportunities has been identified.

Human Milk Fat Loss Is Strongly Affected by Syringe Position During Tube Feeding in the NICU Population

Objectives Human milk is the recommended feeding for preterm infants. It is a dynamic, non-homogenized fluid. The most variable component is the fat content, which rapidly separates out when milk is allowed to sit. Fat from human milk is thought to adhere to the plastic syringe and tubing products used to administer tube feedings. The objective of this study was to identify best practices for tube feeding preterm infants to minimize nutrient loss from human milk during administration in the Neonatal Intensive Care Unit (NICU). Methods A study was conducted to investigate the effect of different tube feeding methods on the macronutrient content of donated unpasteurized (raw) frozen human milk samples. Tube feeding scenarios tested were: (1) 30 min pump syringe tip horizontal; (2) 30 min pump syringe tip up; (3) 4 hr pump syringe tip horizontal; (4) 4 hr pump syringe tip up; (5) 15 min gravity syringe tip down; (6) 30 min gravity syringe tip down; and (7) controls. Fat loss was calculated using paired “pre” and “post” samples (n = 51 pairs). Percent fat loss was compared for each scenario versus control. Results More fat was lost with syringe tip horizontal or down than with tip pointed up. Another contributing factor was the pump infusion time. Greatest fat loss occurred with the 4 hr pump syringe tip horizontal (average fat loss 13.1%), followed by: 4 hr tip up (8.3%); 30 min tip horizontal (6.7%); and 30 min tip up (3.4%). Fat loss via gravity drip was similar for 15 min (6.6%) and 30 min (5.7%), so the two gravity scenarios were combined into one. Fat loss for controls was small (1.5%). Except for the 30 min pump tip up scenario (P = 0.16), all the other scenarios had higher fat loss when compared to control (P-values &lt;0.001). Conclusions These findings suggest that, for best delivery of fat, tube feedings of raw human milk given by pump should be run with the syringe tip pointed directly up and with the shortest infusion time that the infant will tolerate. In contrast to previous published studies, both 15 and 30 min gravity drip delivery resulted in more fat loss than 30 min pump infusion with syringe tip up. This difference may be due to the short gravity delivery times (&lt;5 min) reported in prior studies. In our study, 15 and 30 min times were tested for gravity delivery to more realistically mimic those observed in routine NICU care. Funding Sources N/A.

Manual versus Pump Infusion of Distending Media for Hysteroscopic Procedures: A Randomized Controlled Trial

Fluid overload is a potential complication of hysteroscopic procedures with the possibility of dangerous electrolyte changes. This prospective randomized controlled trial aimed to compare perioperative outcomes and changes in electrolytes after hysteroscopic procedures between the manual infusion (MI) and the pump infusion (PI) methods for distending media infusion. One hundred consecutive women who had hysteroscopic procedures between December 2013 and February 2017 were recruited and randomly allocated to either the MI or PI group. The PI group was associated with an increased volume of infused fluid and collected fluid compared with the volumes of the MI group. Almost all serum electrolyte levels differed significantly between the baseline and postoperative values in both groups; however, no significant differences were noted between the groups. The change in potassium level was positively correlated with the volume of fluid deficit (Spearman’s rho = 0.24, P = 0.03), whereas the change in calcium level was negatively correlated with the volume of fluid deficit (Spearman’s rho = −0.26, P = 0.046). With no between-group differences in the changes in the other perioperative parameters and electrolytes, the MI method can be a good alternative for delivering distending media for hysteroscopic procedures.