Design flaw can convert commercially available continuous syringe pumps to intermittent bolus injectors

To investigate if unexpected behaviour of neonatal and paediatric patients connected to syringe pumps could be explained by transient elevation of these devices.

Five different commercially available syringe-pumps were set at an infusion rate of 1 ml/h and then subjected to a vertical displacement manoeuvre (height 1 m). The actual delivered infusion volumes in association with the displacement manoeuvre were measured by a high precision weight scale connected to a computer.

A medical technology laboratory in a university hospital.

Elevation of the devices resulted in a rapid bolus injection of 0.19-2.28 ml. Returning the devices to their original positions resulted in an aspiration into the system of 0.06-0.34 ml. The times both for bolus injection and for aspiration into the system were less than 1 min in all cases. The updown manoeuvre was followed by a period with zero infusion ranging from 8 to 105 min.

Design flaws in the construction of syringe pumps can expose patients to substantial danger following vertical displacement if potent drugs are being infused. If potent drugs are infused, care should be taken not to change the vertical position of the syringe pump even for short periods of time. Before buying new equipment, the authors recommend that the delivery characteristics of these devices should not only be tested during ordinary bench testing but should also include the reaction to a vertical displacement manoeuvre.