Medical device complications

Insulin Infusion Devices

• External pump visible on the abdomen with subcutaneous catheter placed under a dressing nearby
• Insulin pumps are easily removed by pulling the catheter out from under the dressing removing it from the subcutaneous insertion site

Complications:

1. Hyper/Hypoglycemia
2. DKA
3. Local Infection

Intrathecal Drug Delivery Systems

• used for delivery of short or long acting pain medications into the theca space

Most common Intrathecal medications

1. Clonidine
2. Bupivacaine
3. Morphine
4. Hydromorphone
5. Fentanyl
6. Baclofen
7. Ziconotide

Complications:

1. Respiratory depression from medication overdose
2. Infection

• The device is not removed in an overdose but should be turned off.
• Insertion of a 22-guage needle into the pump reservoir can remove all medication in case device cannot be turned off
• Consider naloxone to reverse effects taking into account patients chronicity of treatment if they withdrawal

Vagal Nerve Stimulators

• Used to treat refractory epilepsy
• Implanted in the chest with a single lead stimulating the left vagus nerve. It does not stimulate the right vagus nerve which innervates the heart

Complications:

1. Hoarseness
2. Shortness of Breath
3. Pharyngitis
4. Infection
5. Parasthesias
6. Insomnia
7. Excessive Pain

Bladder/Sacral Nerve Stimulators

• Single wire system inserted into the S3 sacral foramen to stimulate sacral nerve and treat urinary incontinence

Complications

1. Infection (early or late complication)
2. Lead Migration
3. Stimulator misfiring

Deep Brain Stimulators

• Implanted to treat Parkinson's disease and dystonia.
• Single lead systems implanted into the thalamus

Complications

1. Infection (usually early after placement)
2. Over or Under stimulation
3. Lead Migration

Gastric Pacemakers

• Inserted into the gastric musculature for gastroparesis management

Complications

1. Perforation
2. Infection
3. Lead Migration

Phrenic Nerve/Diaphragmatic Stimulators

• Implanted into bilateral phrenic nerves to treat rerspiratory insufficiency from poor diaphragmatic motion

Complications

1. Pneumothorax (early after implantation)
2. Infection
3. Wire Migration
4. Drive malfunction (causing diaphragmatic paralysis)

Sources

• Venkatraghavan L, Chinnapa V, Peng P, et al. Non-cardiac implantable electrical devices: brief review and implications for anesthesiologists. Can J Anaesth. 2009;56:320-326.