An orchestra in need of a conductor:challenges and opportunities in multi-infusion therapy

Intravenous (IV) therapy is one of the most commonly used medical treatments worldwide. In hospitals IV therapy is commonly performed using an IV pump that administers drug solutions contained in an IV bag or syringe into the bloodstream of the patient. Despite its wide application there are various risks in all stages of the therapy. Multi-infusion, the administration of multiple different infusions simultaneously, is common in the intensive care unit (ICU). In the ICU more than twice the number of drugs are administered compared to other hospital departments, which also increases the risks of IV therapy in the ICU. In this thesis we explored the various challenges as well as opportunities of multi-infusion. One of these challenges is how to objectively identify phlebitis, a common complication of IV therapy. Using infrared (IR) thermography we were able to detect a temperature difference between the IV insertion site and a reference point that was related to early onset phlebitis. Another challenge is the incompatibility of IV drug solutions, where solutions react chemically when co-administered through the same IV tube. We developed a new protocol to determine which common IV drug solutions can safely be co-administered. We also developed a novel way to avoid drug incompatibilities called multiplex infusion. Using this technique incompatible drug solutions are separated within the same IV tube using a third solution that is compatible with both surrounding solutions. We found that this technique could reduce the number of IV access points required in multi-infusion and may also prevent the occurrence of phlebitis. We developed and tested a new user interface that allowed the simultaneous control and monitoring of multiple infusion pumps that could serve as a platform for multiplex infusion. Finally, we developed new algorithms that allowed for a quicker detection of occlusions (blockages) in the IV tube than traditional occlusion detection algorithms