A programmable SynchroMed
II pump is surgically implanted just below the skin in
the abdomen and connected to a thin flexible catheter that
is tunnelled beneath the skin into the intrathecal space
where it continuously delivers precisely controlled doses
of a liquid formulation of baclofen. Since the drug is
delivered exactly to where the receptors are for it to
be effective, only small doses are needed and very little
circulates around the body minimising the possibilities
of unwanted side-effects.
II pump can be programmed using radio-waves by a physician
programmer to precisely deliver exactly the correct amount
of baclofen to manage spasticity and minimise or eliminate
unwanted side-effects. It can also be programmed to automatically
deliver different dosages at different times of the day
if the child's spasticity fluctuates. The medical team
is able to change the dosage an infinite number of times
as often as necessary using the programmer until the dosage
has been accurately titrated.
Prior to the implantation
of the pump the child will undertake a test-dose procedure
(screening phase) to ensure that they will benefit from
having the pump implanted. During this hospital-based test-dose,
a small quantity of ITB is injected into the intrathecal
space and the child is carefully monitored for up to 8
hours to assess the quality and degree of spasticity reduction.
Only one injection of a particular dose can be given in
a single day so it may require two or three days of repetitive
test-dose injections. If the test-dose is successful then
a decision to implant the pump is reached only through
a thorough discussion between the medical team, the child/carer
Once implanted, the pump
will need to be refilled periodically, usually at intervals
between 2-6 months, as the drug reservoir gradually empties.
Pump refill is usually achieved in an outpatients setting
by injecting fresh baclofen with a syringe through the
skin directly into the pump reservoir. During this refill
it is usual for the quality of spasticity management to
be reassessed and any adjustments to the dosage made by
reprogramming the pump. A date for the next refill is given
before leaving the hospital.