Care and Maintenance
Flolan has been shown to improve patients breathing, increasing their quality of life by relaxing and dilating blood vessels in the lungs. Unfortunately, flolan has a very brief half life and must be administered continuously by a computer controlled pump through a catheter that is permanently implanted in a central vein in the chest.
Flolan is administered using a small, light weight ambulatory infusion pump. The CADD-One pump and its related design, the CADD-Legacy pump, provide allow patients to walk and move freely during infusions so that normal daily life and travel can continue relatively uninterrupted.. Both pumps use disposable 9 volt or AA alkaline batteries and the pump consumes many batteries. While using Flolan, the patient must maintain two working pumps at all times because they need to be alternated every 24 hours to ensure the safety of the patient. Typically the pump is replaced every 6 months throughout the therapy for testing and maintenance. The FDA mandated this evaluation process which is designed to make sure the pumps are working properly. The pumps are usually sent by the provider and replaced via an arranged FedEx or express mail delivery.
The Infusion Pumps require minimal care, but the patient should note that:
1) The pumps are not waterproof and care must be taken when bathing, swimming or going into the rain.
2) The manufacturer warns to never clean the surface of the pump with abrasive cleaners which may damage the pump.
3) The patient needs to make sure the medication reservoir cassette is securely fastened before starting each infusion cycle.
4) Batteries are an issue. Make sure they work properly, Do not use non-alkaline batteries and never mix old and new batteries
5) In some cases the the Flolan is infused at lower temperatures and the use of ice packs and a special pump pouch are needed to maintain the medication at around 45 degrees. The ice packs which fit next to the medication cassette in special slots, need to be changed every 6 to 8 hours to keep the temperature constant.
Deltec Flolan Pump
The medical equipment company Deltec makes several pumps that may be used for flolan infusions including the CADD- PCA, CADD-Plus, CADD-1, CADD-Legacy 6400 and 6500.
Deltec pumps are compact and may be worn in a harness or belt so that patient can remain ambulatory during treatment. They are designed to deliver a continuous flow of flolan through the catheter into the bloodstream.
The pump must infuse Flolan continuously because the therapeutic effect of flolan dissipates quickly. This requires the pump's reservoir to be replenished at regular intervals. Generally, the pumps are complex and in addition to learning how to operate the pump patients are required to learn techniques of sterile preparation, and care of the intravenous catheter.
Patients receiving flolan treatment are given two pumps which they are advised to alternate every three days are so. Patients must also change the extension lines regularly (also every three days) and must visit the clinic approximately every five weeks to replace the catheter needle. Carefully cleaning the catheter is a crucial priority.
The pumps are calibrated by the treating physician doctor and should not be reprogrammed by the patient. Because the Flolan must always be kept cold, patient's planning to go on long trips are advised to buy a mobile refrigeration unit for their car.
In some cases this type of continuous infusion may create serious complications (e.g., sepsis, thromboembolism, or syncope) related to the use of an implanted central vein catheter.
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