Two-Needle Approach to Replenish an Empty Intrathecal Pump

Intrathecal pumps are devices developed for targeted central nervous system drug delivery in patients with severe, intractable pain who have failed traditional management, and in patients with secondary spasticity from an underlying condition refractory to oral medications. Typically, providers attempt to replenish the medication(s) of the reservoir before it is empty, with the residual volume being emptied prior to the refilling process. This is done in order to ensure verification of needle placement, since an empty reservoir can hamper needle placement verification. The inaccurate delivery of analgesic medication into the tissue surrounding an intrathecal pump, or "pocket fill," is a potentially life-threatening complication of pump management. This case report introduces a simple technique of using a second confirmatory needle along with the original refill needle in a patient whose pump reservoir has been empty for an extended period.