Implantable Pumps and Ports

Abstract

An implantable pump is a device that can be implanted within the body to deliver a drug or other substance to the same location or another site in the body. In addition to a reservoir and pumping mechanism, an implantable pump usually has a refill septum so that it can be refilled in situ and a catheter for remote delivery; an implantable port also has a refill septum and a delivery catheter but lacks a reservoir and an intrinsic pump.

Pumps and ports have been utilised for continuous heparin, chemotherapeutic agents, antibiotic, antispasmotic, analgesic and insulin infusions. The future use of this modality is only limited by the boundaries of imagination.

Key Concepts:

  • Implantable pumps and ports allow for intravenous, intrathecal and specific organ delivery of drugs and other agents.

  • They circumvent alimentary tract destruction or failure of absorption, and permit the bypassing of the blood–brain barrier.

  • These systems can provide constant circulating drug levels. Various continuous and programmable flow devices are available.

  • Pumps and ports have been utilised for continuous heparin, chemotherapeutic agents, antibiotic, antispasmotic, analgesic and insulin infusions.

  • The future use of this modality is only limited by the boundaries of imagination.

Keywords: implantable pump; implantable port; intravenous, intrathecal and specific organ delivery of drugs

Figure 1.

Typical patterns of delivery when a one‐day supply of a drug is administered by different means: (a) single dose, (b) multiple doses and (c) continuous single‐rate.

Figure 2.

Schematic showing an implantable port in cross‐section. The port provides a direct route to a vein or other body site for drug injection or for sampling of blood or other body fluids.

Figure 3.

Schematic of the Alzet® Osmotic pump.

Figure 4.

Schematic of a vapour pressure‐powered pump. (a) As the pump is filled by an injection through the skin and through a resealing septum into the pump's drug reservoir, the drug chamber expands, compressing the vapour in the liquid/gas chamber and converting the gas to liquid. (b) During normal operation, vapour from the liquid/gas chamber compresses the bellows and expels the drug into the body by means of a rubber (silicone) catheter.

Figure 5.

Schematic of a spring‐driven pump. (a) As the pump is filled by an injection through the skin and through a resealing septum into the pump's drug reservoir, the drug chamber expands, flexing the silicone rubber spring that also serves as one wall of the reservoir. (b) During normal operation, pressure from the flexed spring compresses the bellows and expels the drug into the body by means of a rubber (silicone) catheter.

Figure 6.

Schematic of a peristaltic pump. (a) Filling the pump by injection through the skin and a resealing septum into the pump's drug chamber with no fluid delivery taking place. (b) With the pump in operation, rollers move over a flexible tube in small steps, compressing the tube and squeezing a small quantity of fluid out of the pump. By controlling the interval between steps with the electronics of the device, flow rates can be varied and complex wave forms can be delivered.

Figure 7.

Schematic of programmable vapour pressure‐powered pump operations during (a) refilling, (b) filling the accumulator and (c) injecting the accumulator contents. Note in (b) that the inlet valve is open and the outlet valve is closed during the fill stroke and in (c) that the inlet valve is closed and the outlet valve open during the dispensing stroke.

Figure 8.

Schema of a solenoid‐driven pump. (a) Negative pressure draws the drug from the syringe into the pump. (b) The solenoid retracts, drawing a small amount of drug past the inlet valve into the dispensing chamber. (c) The solenoid advances closing the inlet valve, opening the outlet valve and expelling the drug from the pump.

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Further Reading

Buchwald H and Rohde TD (1987) Implantable Pumps. ASAIO Primers in Artificial Organs, No 2. Philadelphia: JB Lippincott.

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Selam J‐L and Charles MA (1990) Devices for insulin administration. Diabetes Care 13: 955–979.

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Buchwald, Henry, and Rohde, Thomas D(Jan 2013) Implantable Pumps and Ports. In: eLS. John Wiley & Sons Ltd, Chichester. http://www.els.net [doi: 10.1002/9780470015902.a0002301.pub3]