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Improving IV Insulin Administration in a Community Hospital

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Published on: June 11, 2012

Siphon effects on continuous subcutaneous insulin infusion pump delivery performance.

Howard C Zisser¹, Wendy Bevier, Eyal Dassau

¹Sansum Diabetes Research Institute, Santa Barbara, California 93105, USA. hzisser@sansum.org

Journal of Diabetes Science and Technology

|February 20, 2010

Summary

Hydrostatic pressure significantly impacts continuous subcutaneous insulin infusion (CSII) pump accuracy, especially at low basal rates. Pump position relative to tubing causes variable insulin delivery, affecting glycemic control.

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Area of Science:

Endocrinology
Biomedical Engineering
Medical Devices

Background:

Continuous subcutaneous insulin infusion (CSII) is a cornerstone of modern diabetes management.
Accurate insulin delivery is critical for maintaining glycemic control.
Potential sources of error in CSII delivery require thorough investigation.

Purpose of the Study:

To quantify the hydrostatic effects on insulin delivery accuracy of various CSII pumps.
To assess the impact of pump orientation and tubing length on basal and bolus insulin delivery.
To compare the performance of different CSII pump systems under varying hydrostatic conditions.

Main Methods:

Tested Medtronic MiniMed 512/515, Smiths Deltec Cozmo 1700, and Insulet OmniPod CSII pumps.
Used insulin aspart (Novolog) and measured fluid level changes via a graduated glass pipette.
Evaluated pumps during 1 U and 5 U boluses and basal rates of 1.0 U/h and 1.5 U/h, considering pump position relative to the pipette.

Main Results:

Significant variations in insulin delivery were observed during basal rates (1.0-1.5 U/h) with tubing-based pumps.
Delivery accuracy ranged from 74.5% to 123.3% depending on pump position (below/above) and flow direction.
The OmniPod system demonstrated significantly less delivery variation compared to pumps with external tubing.

Conclusions:

The position of conventional CSII pumps relative to their tubing introduces significant variability in insulin delivery.
A siphon effect in the tubing can compromise insulin delivery accuracy, particularly at low basal rates.
This hydrostatic effect, previously noted with syringe pumps, is a relevant consideration for CSII pump performance.