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| 22KS-015 |
MRI Induced IDD Malfunction
Department
of Anesthesiology and Pain Medicine, Eunpyeong St. Mary’s Hospital, College of
Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
Introduction
It is common clinical practice to perform magnetic resonance imaging (MRI) in patients with indwelling programmable intrathecal drug delivery (IDD) systems. It is known to be safe in most cases, but very scarce cases have been reported of a magnetic field which can temporarily stall the rotor of the pump motor. Normally, the rotor of the pump motor restarts automatically when the MRI terminates. However, it has been reported that there are cases where the motor gears are bound and the restart of the pump, which should be done automatically, is delayed because of the magnetic field.
Case
A 71-old male was hospitalized for pump replacement after 7 years of implantation. After the pump change, he complained of weakness on both legs which was not previously present. An L-MRI was done to check for any aggravations. After the MRI, we found an error message reporting that the pump had been stopped for more than 48 hours. Therefore, we restarted the pump and took a manual roller test. Through the test, we could confirm the pump worked properly. Manual roller test is executed as follows. 1) Take a C-arm or X-ray after setting daily dose to simple continuous & minimal dose. 2) Set 0.01ml/1minute through the priming bolus. 3) Taking the priming bolus time into account, the image is taken again after about 2 minutes of the 2 updates. 4) Check for any problems depending on whether the marker is rotated to about 60 degrees.
Conclusion
Intrathecal drug-delivery systems are susceptible to magnetic fields such as an MRI which can temporarily stall the rotor of the pump motor and suspend drug delivery. Physicians must check whether the IDD is operating properly after examinations or procedures that may affect the function of IDD. Manual roller test is useful to check IDD work properly.
References
1. De Andres J, Villanueva V, Palmisani S, Cerda-Olmedo G, Lopez-Alarcon MD, Monsalve V, . . . Martinez-Sanjuan V. The safety of magnetic resonance imaging in patients with programmable implanted intrathecal drug delivery systems: a 3-year prospective study. Anesth Analg. 2011 May;112(5):1124-9
2. Bicket MC, Hanna GM. Intrathecal Pump Exposure to Electromagnetic Interference: A Report of Device Interrogation following Multiple ECT Sessions. Pain Physician. 2016 Feb;19(2):E343-6.
It is common clinical practice to perform magnetic resonance imaging (MRI) in patients with indwelling programmable intrathecal drug delivery (IDD) systems. It is known to be safe in most cases, but very scarce cases have been reported of a magnetic field which can temporarily stall the rotor of the pump motor. Normally, the rotor of the pump motor restarts automatically when the MRI terminates. However, it has been reported that there are cases where the motor gears are bound and the restart of the pump, which should be done automatically, is delayed because of the magnetic field.
Case
A 71-old male was hospitalized for pump replacement after 7 years of implantation. After the pump change, he complained of weakness on both legs which was not previously present. An L-MRI was done to check for any aggravations. After the MRI, we found an error message reporting that the pump had been stopped for more than 48 hours. Therefore, we restarted the pump and took a manual roller test. Through the test, we could confirm the pump worked properly. Manual roller test is executed as follows. 1) Take a C-arm or X-ray after setting daily dose to simple continuous & minimal dose. 2) Set 0.01ml/1minute through the priming bolus. 3) Taking the priming bolus time into account, the image is taken again after about 2 minutes of the 2 updates. 4) Check for any problems depending on whether the marker is rotated to about 60 degrees.
Conclusion
Intrathecal drug-delivery systems are susceptible to magnetic fields such as an MRI which can temporarily stall the rotor of the pump motor and suspend drug delivery. Physicians must check whether the IDD is operating properly after examinations or procedures that may affect the function of IDD. Manual roller test is useful to check IDD work properly.
References
1. De Andres J, Villanueva V, Palmisani S, Cerda-Olmedo G, Lopez-Alarcon MD, Monsalve V, . . . Martinez-Sanjuan V. The safety of magnetic resonance imaging in patients with programmable implanted intrathecal drug delivery systems: a 3-year prospective study. Anesth Analg. 2011 May;112(5):1124-9
2. Bicket MC, Hanna GM. Intrathecal Pump Exposure to Electromagnetic Interference: A Report of Device Interrogation following Multiple ECT Sessions. Pain Physician. 2016 Feb;19(2):E343-6.