Pump, Intrathecal

Intrathecal pumps are instrumental in delivering medications directly into the intrathecal space, where they can intermix with the CSF and exert their effects directly on the spinal cord. In cases where pump malfunction is suspected, X-ray interrogation serves a diagnostic tool to investigate potential radiographic causes and ensure proper device functionality (Case 1).

Cases

1

Step-by-Step Tutorial: Intrathecal Pump Interrogation Under Fluorosocpy

Step 1: Placement of the Needle
(A): Position the needle inside the catheter access port, as depicted in the PA view (cyan arrow).
(B): Verify the correct placement of the needle tip within the port through the lateral view (red arrow).

Step 2: Test Occlusion
Aspirate to withdraw CSF.

• If clear back-flow of CSF is observed, aspirate as least 1 mL to clear the catheter of medication before proceeding to Step 3.
• Absence of CSF return suggests an occlusion distal to the access port, necessitating a revision. Terminate the procedure.

Step 3: Contrast Injection
(C): Delicately inject 1-2 mL of contrast into the port and monitor flow within the catheter (black arrow) using real-time fluoroscopy. Identify any contrast extravasation, indicative of catheter breakage.
(D): Detection of free-floating contrast within the intrathecal space (green arrow) confirms a patent catheter system. The blue arrow indicates the intrathecal catheter tip.

Step 4: Device Check
(E) and (F): Program the device to administer a small amount of the medication and verify its functionality on pre- (E) and post- (F) fluoroscopies, noting the counter-clockwise 60° rotation of the peristaltic pump.

*It is recommended to have a medical representative from the pump company present to assist with programming the device.