Significant time until catheter occlusion alerts in currently marketed insulin pumps at two basal rates

摘要

One of the most common problems of continuous subcutaneous insulin infusion (CSII) is occlusion of the infusion set. Frequencies up to 30% have been reported in literature, although objective assessment of occlusion is difficult. CSII devices feature an occlusion detection alert based on a sensor connected to an electronics system that measures pressure, compression, or displacement of the lead screw in the pump drive system. Above a certain threshold, an alert is given. A relatively large displacement of the lead screw may be needed to activate the alert; in other words, it may take quite some time before the occlusion alert is activated. Some CSII manufacturers provide information in the manual on the time needed to activate the alert after total occlusion. For example, the time until occlusion alert in the D-Tron~(TM) plus (Disetronic Medical Systems, Member of the Roche Group, Basel, Switzerland) is given as between 2 and 4h at a basal rate of 1.0IU/h. If the basal rate decreases, the occlusion alert will be activated later. As an illustration, the time until occlusion alert of the Accu-Chek~R Spirit Combo (Disetronic Medical Systems) is given as shorter than 5 h at a basal rate of 1.0IU/h, whereas at a basal rate of 0.1 IU/h, the alert will go off after up to 50 h. An occlusion alert is especially important during the night; therefore we examined the time until occlusion alert at basal rates.