Patent Application
20230010290
Any and all applications for which a foreign or domestic priority claim is identified in the Application Data Sheet as filed with the present application are hereby incorporated by reference under 37 CFR 1.57.
This disclosure relates to detection systems and methods for detecting an end of bag (EOB) event or air in an infusion system.
Infusion pumps often do not have an end-of-infusion detection system. Instead, an air-in-line alarm is provided in the event that the medication container becomes prematurely empty and air is present in the infusion line. However, many customers utilize the air-in-line alarm as a mechanism to detect when the medication container is empty rather than titrate an unknown quantity of drug containing fluid after the set volume to be infused (VTBI) is complete. Caregivers often struggle with delivering 100% of the prescribed medication to a patient because the diluent typically varies in volume up to approximately 10%.
Existing strategies for detecting air often involve the use of ultrasonic sensors that are physically located on opposite sides of a tubing segment. When fluid is present in the tube, propagation of the acoustic signal is efficient and produces a large electrical signal via the receiver circuit. On the other hand, the presence of air in the tube causes an acoustical open circuit which substantially attenuates the detected signal. In current practice, detection of air in the tubing segment is often performed on the basis of a simple (static) air-fluid boundary or threshold that is applied to the air sensor voltage signal. When the air sensor signal moves beyond the pre-defined air/fluid threshold, an alarm condition occurs and the IV infusion is paused.
However, when the medication container is emptied (i.e., EOB reached) during an infusion program, a transition occurs from delivery of fluid to air. A film of liquid trails the liquid front as it moves in the tube. This film can break up leading to a stationary fluid droplet formation between the ultrasound transducers that is large enough to create an acoustic short circuit, yet small enough to allow air to pass. This acoustic short circuit can produce an absolute sensor signal similar to that of a fluid, which will cause false indication of fluid in the line and fail to detect the EOB and air in the line.
Currently, there exist methods/algorithms that utilize plunger force sensor readings to detect the presence of air in a plunger chamber. Several pumps made by Hospira, Inc. involve the use of a cassette with a chamber that is compressed by an actuated plunger to pump fluid at a controlled rate from the drug container to the patient. The measured force during a pumping cycle is directly related to the type of fluid in the chamber. For instance, fluids are relatively incompressible and generate a higher and different force profile than air.
However, using the existing force algorithms for detecting EOB often leads to a large number of false positives since the medication type (e.g., frothy fluids), proximal/distal pressure change and other factors can cause variability in force sensor observations.
A system and method is needed to overcome one or more issues of one or more of the current infusion systems and methods in order to detect an EOB event or to determine whether air is in the infusion system.
In one embodiment, an infusion system for being operatively connected to a fluid delivery line and to an infusion container containing an infusion fluid is disclosed. The infusion system includes a pump, at least one sensor, at least one processor, and a memory. The at least one sensor is connected to the pump or the fluid delivery line. The at least one sensor is configured to indicate whether air is in the fluid delivery line. The at least one processor is in electronic communication with the pump and the at least one sensor. The memory is in electronic communication with the at least one processor. The memory includes programming code for execution by the at least one processor. The programming code is configured to determine an air determination related to the air in the fluid delivery line. This determination is based on measurements taken by the at least one sensor. This determination is also based on: (1) medication information regarding the infusion fluid or infusion information regarding the infusion of the infusion fluid; or (2) multichannel filtering of the measurements from the at least one sensor or non-linear mapping of the measurements from the at least one sensor; and statistical process control charts applied to the multi-channel filtered measurements or applied to the non-linear mapped measurements.
In another embodiment, a method for infusing an infusion fluid is disclosed. In one step, infusion fluid is pumped through a fluid delivery line of an infusion system. In another step, measurements are taken with at least one sensor connected to the infusion system. In an additional step, an air determination is determined with at least one processor. The air determination is related to air in the fluid delivery line. The air determination is based on the measurements taken by the at least one sensor. The air determination is further based on: (1) medication information regarding the infusion fluid or infusion information regarding the infusion of the infusion fluid; or (2) multi-channel filtering of the measurements from the at least one sensor or nonlinear mapping of the measurements from the at least one sensor; and statistical process control charts applied to the multi-channel filtered measurements or applied to the non-linear mapped measurements.
The scope of the present disclosure is defined solely by the appended claims and is not affected by the statements within this summary.
The disclosure can be better understood with reference to the following drawings and description. The components in the figures are not necessarily to scale, emphasis instead being placed upon illustrating the principles of the disclosure.
The instant disclosure discloses in part a system and method for detecting the end-of-infusion (i.e., depletion of fluid in the medication infusion reservoir such as an IV bag or infusion container) for IV medication infusion pumps (e.g., Symbiq™, Gemstar™, or Plum™). Current air-in-line detection systems often are not robust and reliable enough to be used routinely as end-of-infusion detectors. Applicant has discovered that the combination of multiple sensors as well as a priori knowledge about the infusion and medication significantly improves the robustness of detecting an empty medication container via the presence of air in the line.
The disclosure integrates multiple sensors, drug information and VTBI (volume of the drug in the container to be infused) into the decision making process in order to improve the robustness, and the true negative and false positive performance of end-of-bag (EOB) detection systems (e.g., qualifies a decision only within VTBI ±10%). Disclosed are methods of qualifying the signals from plunger force sensor and combining the VTBI to improve the reliability of end-of-bag detection systems. The disclosed system(s) are designed to function as a redundant safety layer in case of air-sensor based AIL (air-in-line) detection systems fail to detect the EOB. In an alternate embodiment, the disclosure can be used to detect and quantify the presence of air in the pumping chamber using multi-channel filtering, wavelet transforms, neural networks and SPC (Statistical Process Control) charts.
The following is a summary of some distinguishing elements of the disclosure. In one embodiment of the disclosure, an event detection and qualifier algorithm is disclosed that determines EOB during delivery on the basis of sensor observations (such as plunger force sensor observations, air sensor readings, pressure sensor readings) and on other information (such as infusion information or medication information). In another embodiment of the disclosure, an event detection algorithm is disclosed that determines confidence levels for presence of air in the infusion system. In an additional embodiment of the disclosure, an event detection algorithm is disclosed that determines the presence of air in the infusion system on the basis of multi-channel filtering of the force sensor observations and SPC (Statistical Process Control) charts. In still another embodiment of the disclosure, an event detection algorithm is disclosed that determines the presence of air in the infusion system on the basis of wavelet transform of the force sensor observations and SPC (Statistical Process Control) charts. In yet another embodiment of the disclosure, an event detection algorithm is disclosed that determines the presence of air in the infusion system on the basis of non-linear mapping (e.g., neural networks) of sensor observations. In still another embodiment of the disclosure, quantitative information is provided regarding the volume of air in a pumping chamber at any particular time.
One problem addressed in the disclosure is to develop a robust end-of infusion detection system that will indicate to clinicians when the infusion container is empty. Another problem addressed in this disclosure is to rely on additional information such as infusion information or medication information to function as a redundant safety layer in case sensor based air detection systems fail to detect the EOB. Systems and methods are discloses for qualifying the signals from one or more sensors and combining the additional information (such as infusion information or medication information) to improve the reliability of end-of bag detection systems.
Another problem addressed in this disclosure is to develop a novel algorithm (e.g., multi-channel, non-linear mapping such as wavelet transform and neural networks, SPC charts) for detecting air in the infusion system using sensor observations. In current practice, force algorithms are typically based on singe-channel and linear filters.
The disclosure satisfies a customer user need for an accurate and reliable system for detecting the end of an infusion. This is frequently observed at cancer treatment facilities in which nurses spend valuable time titrating 1-100 mL after the programmed VTBI is complete. The reason for the additional titration is that infusion bags are typically overfilled by up to 10%.
One embodiment of the disclosure improves the EOB detection capability of existing infusion pump systems that rely on sensors to make a real-time assessment. In doing so, the disclosed method does not require additional hardware modifications but instead leverages the acquired multi-sensor signals. Additionally, the disclosure does not necessarily replace existing software modules for air detection but adds an additional safety layer.
Another embodiment of the disclosure provides a method for improving the robustness of EOB detection systems by reducing the likelihood of a false positive air detection and by reducing the likelihood of a missed alarm. This reduces the chances of an interruption of therapy due to a false alarm and also reduces the chances that the system will miss a true alarm. Still another embodiment of the disclosure provides a means to improve the sensitivity and specificity of air-in-line detection.
The infusion container 102 comprises a container for delivering an infusion fluid such as IV fluid or a drug to a patient 118. The fluid delivery line 104 comprises one or more tubes, connected between the infusion container 102, the pump device 106, at least one sensor 114, and the delivery/extraction device 116, for transporting infusion fluid from the infusion container 102, through the pump device 106, through the at least one sensor 114, through the delivery/extraction device 116 to the patient 118. The fluid delivery line 104 may also be used to transport blood, extracted from the patient 118 using the delivery/extraction device 116, through the at least one sensor 114 as a result of a pumping action of the pump device 106. The pump device 106 comprises a pump for pumping infusion fluid from the infusion container 102 or for pumping blood from the patient 118. The pump device 106 may comprise a plunger based pump, a peristaltic pump, or another type of pump.
The processing device 108 is in electronic communication with the pump device 106 and the at least one sensor 114. The processing device 108 comprises at least one processor for processing information received from the at least one sensor 114 and for executing one or more algorithms to determine an air determination related to the air in the fluid delivery line based on measurements taken by the at least one sensor 114 and on: (1) medication information regarding the infusion fluid or infusion information regarding the infusion of the infusion fluid; or (2) multi-channel filtering of the measurements from the at least one sensor 114 or non-linear mapping of the measurements from the at least one sensor 114; and statistical process control charts applied to the multi-channel filtered measurements or applied to the non-linear mapped measurements.
The air determination made by the processing device 108 using the programming code may be based on: mean values; variances; derivatives; principal component scores; frequencies; wavelet coefficients; shapes; distance metrics; threshold crossings; coherence between signals; correlation between signals; phase shifts; peak values; minimum values; pattern recognition; Bayesian networks; support vector machines; linear discriminant analysis; decision trees; K-nearest neighbor; template matching; thresholds/limits; normalization; digitization; factor decomposition; simple aggregation; or one or more other factors or information.
The medication information regarding the infusion fluid delivered from the infusion container 102 may comprise a formulation of the infusion fluid, a rate of the infusion fluid, a duration of the infusion fluid, a viscosity of the infusion fluid, a therapy of the infusion fluid, or a property of the infusion fluid. The infusion information regarding the infusion fluid delivered from the infusion container 102 may comprise a volume of the infusion fluid in the infusion container, a volume to be infused (VTBI), or another parameter regarding the infusion of the infusion fluid. The processing device 108 includes or is in electronic communication with a computer readable memory, containing programming code containing the one or more algorithms for execution by the processor, and a clock.
The air determination made by the processing device 108 using the programming code may comprise determining an end-of-container event when the infusion container 102 has been emptied of the infusion fluid, determining a confidence level (which may comprise a probability that the infusion system 100 contains the air) that the line 104 of the infusion system 100 contains the air, or determining whether the air is in the infusion system 100. The processing device 108 may determine the end-of-container event or the confidence level based on the medication information regarding the infusion fluid, based on the infusion information regarding the infusion of the infusion fluid, or based on a combination thereof. The processing device 108 may determine whether the air is in the infusion system 100 or to predict or forecast future measurements of the at least one sensor 114 based on the multi-channel filtering of the measurements from the at least one sensor 114. The processing device 108 may determine whether the air is in the infusion system 100 based on the non-linear mapping of the measurements from the at least one sensor 114. In other embodiments, the processing device 108 may make the air determination using another type of information based on any system, method, or other information disclosed herein, or based on another system, method, or information not disclosed herein.
The alarm device 110 comprises an alarm, triggered by the processing device 108, for notifying the clinician (also referred to as ‘user’ herein) of: (1) when there is an end-of-container event when the infusion container 102 has been emptied of the infusion fluid; or (2) when the infusion system 100 contains air. The alarm device 110 may be configured to stop the pump device 106 prior to a significant amount of air being delivered through the fluid delivery line 104 and the delivery/extraction device 116 to the patient 118.
The input/output device 112 comprises a device which allows a clinician to input or receive information. The input/output device 112 allows a clinician to input information such as: medication information regarding the infusion fluid being delivered from the infusion container 102; infusion information regarding the infusion of the infusion fluid being delivered from the infusion container 102; the selection of settings for the processing device 108 to apply in using the programming code containing the algorithm(s); or other information that is pertinent to the infusion. The input/output device 112 may allow a clinician to select and/or confirm a user-inputted medication infusion program to be applied by the processing device 108. The input/output device 112 may further output information to the clinician. In other embodiments, any of the information inputted into the input/output device 112 may be pre-installed into the programming code or the processing device 108. In another embodiment, the information may be remotely programmed into the processing device 108 from a remote computer or the input/output device 112 may be a remote and/or portable computer.
The one or more sensors 114 may comprise any number, combination, or configuration of one or more pressure sensors, one or more force sensors, one or more air sensors, one or more rate sensors, one or more temperature sensors, or one or more other type of sensors located and connected to anywhere within the infusion system including the fluid delivery line 104, the pump device 106, or elsewhere for determining whether air is disposed in the infusion system 100. As illustrated the sensor 114 can be located upstream (proximal), downstream (distal) or at the pump device 106.
If a pressure sensor is used, it may comprise one or more proximal or distal pressure sensors for detecting the amount of pressure in the fluid delivery line 104 proximal, distal or at the plunger or pumping member of the pump device 106. It can also comprise one or more chamber pressure sensors for detecting the amount of pressure in the chamber of the pumping device 106. The amount of pressure detected by the one or more pressure sensors is indicative of whether air, fluid, or some combination thereof is present in the fluid delivery line 104. For instance, U.S. Pat. No. 8,403,908 to Jacobson et al., which is commonly owned and hereby incorporated by reference, discloses the use of pressure sensors to determine whether air, fluid, or some combination thereof is present in the fluid delivery line 104.
If a force sensor is used, it may comprise one or more force sensors (such as a plunger force sensor or other type of sensor) for detecting the amount of force on the plunger of the pump device 106. The amount of force detected by the one or more force sensors is indicative of whether air, fluid, or some combination thereof is present in the fluid delivery line 104. For instance, U.S. Ser. No. 13/851,207 filed 27 Mar. 2013, which is commonly owned and hereby incorporated by reference, discloses the use of force sensors to determine whether air, fluid, or some combination thereof is present in the fluid delivery line 104.
If an air sensor is used, it may comprise one or more air sensors (such as a proximal air sensor, a distal air sensor, or another air sensor) for detecting whether air, fluid, or a combination thereof is present in the fluid delivery line 104. The strength of the signal that propagates from the one or more air sensors through the fluid delivery line 104 is indicative of whether air, fluid, or some combination thereof is present in the fluid delivery line 104. For instance, U.S. Pat. No. 7,981,082 to Wang et al., which is commonly owned and hereby incorporated by reference, discloses the use of air sensors to determine whether air, fluid, or some combination thereof is present in the fluid delivery line 104.
If a rate sensor is used, it may comprise one or more rate sensors for detecting a rate of the infusion fluid traveling through the fluid delivery line 104 to assist in making the air determination. If a temperature sensor is used, it may comprise one or more temperature sensors for detecting a temperature of the infusion fluid traveling through the fluid delivery line 104 to assist in making the air determination. In other embodiments, any number, type, combination, or configuration of sensors 114 may be used to determine whether air, fluid, or some combination thereof is present in the fluid delivery line 104. For instance, in one embodiment, a plurality of different types of sensors 114 may be used.
The delivery/extraction device 116 comprises a patient vascular access point device for delivering infusion fluid from the infusion container 102 to the patient 118, or for delivering blood to or extracting blood from the patient 118. The delivery/extraction device 116 may comprise a needle, a catheter, a cannula, or another type of delivery/extraction device. In other embodiments, the infusion system 100 of
The air determination may comprise determining an end of container event when the infusion container has been emptied of the infusion fluid, determining a confidence level (which may comprise a probability that the infusion system contains the air) that the infusion system contains the air, or determining whether the air is in the infusion system. The medication information regarding the infusion fluid delivered from the infusion container may comprise a formulation of the infusion fluid, a rate of the infusion fluid, a duration of the infusion fluid, a viscosity of the infusion fluid, a therapy of the infusion fluid, or a property of the infusion fluid. The infusion information regarding the infusion fluid delivered from the infusion container may comprise a volume of the infusion fluid in the infusion container, a volume to be infused (VTBI), or another parameter regarding the infusion of the infusion fluid.
In step 128, an alarm device generates or turns on an alarm if step 126 determines that air is in the infusion system. Step 128 may further comprise the alarm shutting down the infusion system. In other embodiments, the method 120 may be altered to vary the order or substance of any of the steps, to delete one or more steps, or to add one or more steps.
Infusion fluid is delivered from the infusion container 132 through the fluid delivery line 134 through the delivery/extraction device 146 to a patient. The plurality of sensors 136 take measurements during the infusion. The plurality of sensors 136 may comprise any combination, number, or configuration of one or more plunger force sensor, one or more proximal air sensor, one or more distal air sensor, one or more proximal pressure sensor, one or more chamber pressure sensor, one or more distal pressure sensor, or one or more varying other types of sensor. The infusion information 138 may comprise a volume of the infusion fluid in the infusion container 132 or another parameter regarding the infusion of the infusion fluid. The medication information 140 may comprise a formulation of the infusion fluid, a rate of the infusion fluid, a duration of the infusion fluid, a viscosity of the infusion fluid, a therapy of the infusion fluid, or a property of the infusion fluid. The infusion information 138 and the medication information 140 may be scanned in, entered by the clinician, auto-programmed, or inputted through varying means.
The end of infusion detector 142 may comprise one or more algorithms to be applied by programming code of a processing device to determine that the infusion container 132 is empty (i.e. the end of the infusion) or to determine whether or not air, fluid, or some combination thereof is present in the infusion system 130. In order to make this determination, the end of infusion detector 142 may rely on the infusion information 138, the medication information 140, and on varying features of the signals of the plurality of sensors 136 such as: mean values; variances; derivatives; principal component scores; frequencies; wavelet coefficients; shapes; distance metrics; threshold crossings; coherence between signals; correlation between signals; phase shifts; peak values; minimum values; or one or more other types of features. The end of infusion detector 142 may utilize varying methods to combine and classify the signals of the plurality of sensors 136 such as: pattern recognition; Bayesian networks; support vector machines; linear discriminant analysis; decision trees; Knearest neighbor; template matching; thresholds/limits; normalization; digitization; factor decomposition; simple aggregation; or one or more other factors or information.
By using the varying type of information such as the information from the plurality of sensors 136, the infusion information 138, and the medication information 140, the end of infusion detector 142 determination as to whether or not the infusion container 132 is empty (i.e. the end of the bag, the end of the infusion, etc.) or whether or not air, fluid, or some combination thereof is contained in the infusion system 130 is more accurate and reliable and will lead to less nuisance alarms (when the alarm went off but shouldn't have) or missed alarms (when the alarm should have gone off but didn't). For instance, without the infusion information 138 or the medication information 140, the end of infusion detector 142 may merely rely on the information from the sensors 136 and incorrectly determine that the infusion container 132 is empty because an air slug during delivery has been detected by the sensors 136. However, this may be a temporary situation and the infusion container 132 may not in fact be empty. By relying on this varying information (such as the infusion information revealing that the infusion container is within 10% or less of being empty when the air slug is detected), the accuracy and reliability of the determination is substantially increased.
The end of infusion indicator 144 indicates, based on the determination of the end of infusion detector 142, whether or not the infusion container 132 is empty (i.e. the end of the infusion) or whether or not air, fluid, or some combination thereof is contained in the infusion system 130. The end of infusion indicator 144 may turn on an alarm indicating that the infusion container 132 is empty or that air is in the infusion system 130. The end of infusion indicator 144 may also turn off the infusion system 130 if the infusion container 132 is empty or if air is contained in the infusion system 130. In other embodiments, the infusion system 130 of
The one or more sensors 152 take measurements during the infusion. The one or more sensors 152 may comprise any combination, number, or configuration of one or more plunger force sensor, one or more proximal air sensor, one or more distal air sensor, one or more proximal pressure sensor, one or more chamber pressure sensor, one or more distal pressure sensor, or one or more varying other types of sensor. The infusion information 154 may comprise a volume of the infusion fluid in the infusion container, volume to be infused (VTBI), or another parameter regarding the infusion of the infusion fluid. The infusion information 154 may be scanned in, entered by the clinician, auto-programmed, or inputted through varying means.
The end of infusion detector 156 may comprise one or more algorithms to be applied by programming code of a processing device to determine that the infusion container is empty (i.e. the end of the infusion) or to determine whether or not air, fluid, or some combination thereof is contained in the infusion system 150. In order to make this determination, the end of infusion detector 156 may rely on the measurements taken by the one or more sensors 152 and on the infusion information 154.
By using the varying type of information such as the information from the one or more sensors 152 and the infusion information 154, the end of infusion detector 156 makes a determination as to whether or not the infusion container is empty (i.e. the end of the bag, the end of the infusion, etc.) or whether or not air, fluid, or some combination thereof is contained in the infusion system 150. This determination is more accurate and reliable and will lead to less nuisance alarms (when the alarm went off but shouldn't have) or missed alarms (when the alarm should have gone off but didn't) due to the use of the varying information.
The end of infusion indicator 158 indicates, based on the determination of the end of infusion detector 156, whether or not the infusion container is empty (i.e. the end of the infusion) or whether or not air, fluid, or some combination thereof is contained in the infusion system 150. The end of infusion indicator 158 may turn on an alarm indicating that the infusion container is empty or that air is in the infusion system 150. The end of infusion indicator 158 may also turn off the infusion system 150 if the infusion container is empty or if air is contained in the infusion system 150. In other embodiments, the infusion system 150 of
In step 162, the method starts. The method proceeds from step 162 to step 164. In step 164, the variables are set including setting sampling step k=0, setting the initial force profile X(0) associated with fluid, setting a Baseline force profile for fluid, setting a first threshold Thr1 for air detection (for instance by setting Thr1=−0.3 pounds in one embodiment), setting a second threshold Thr2 for air detection (for instance by setting Thr2=−0.6 pounds in one embodiment), setting a forgetting factor A (for instance by setting A=0.1), setting a stroke volume Stroke Vol delivered by one stroke (for instance by setting Stroke Vol=0.075 ml), and by setting a volume to be infused VTBI (for instance a user-specified volume such as 500 ml). It is noted that the Baseline force profile for fluid represents a Baseline plurality of force readings representing the Baseline force profile at each stroke k of the pump. For instance, in one embodiment the Baseline force profile may comprise six representative force readings representing fluid at six points of a stroke k of the pump. In other embodiments, the Baseline force profile may comprise any number of representative force readings representing fluid at various points of the stroke k of the pump. The first threshold Thr1, the second threshold Thr2, and the Baseline can be set to universal values or set for the particular type of medication to be infused.
The method proceeds from step 164 through location step 166 to step 168. In step 168, the baseline is updated using the equation Baseline=(1−A)* Baseline+A*X(k). By updating the Baseline at each cycle with an exponentially weighted forgetting factor, variability in the force profiles due to medication type, tubing type, pump motor control, ambient temperature, etc. may be accounted for. The method proceeds from step 168 to step 170. In step 170, the sampling step k is incremented using the equation k=k+1. The method proceeds from step 170 to step 172. In step 172, a force profile X(k) for the current sampling step k is acquired. It is noted that the force profile X(k) represents a plurality of force readings which are taken during each stroke k of the pump. For instance, in one embodiment six force readings may be taken at various points of each stroke k of the pump. In other embodiments, any number of force readings may be taken throughout each stroke k of the pump. The method proceeds from step 172 through location step 174 to step 176.
While the method proceeds from step 170 to step 172, the method also simultaneously proceeds from step 170 to step 178. In step 178, the total volume infused as of the present sampling step k is calculated using the equation InfVol=k*Stroke Vol. The method proceeds from step 178 through location step 174 to step 176.
In step 176, the force difference D(k) at the current sampling step k is determined using the equation D(k)=X(k)−Baseline. Since the force profile X(k) and the Baseline each comprise a plurality of force readings this force difference will be a vector. The method proceeds from step 176 to step 180. In step 180, a determination is made as to whether the minimum value of the force difference min(D(k)) (i.e. the minimum value in the force difference vector) at the current sampling step k is less than the second threshold Thr2 using the equation min(D(k))<Thr2. If a determination is made in step 180 that the minimum value of the force difference min(D(k)) is not less than Thr2 (i.e. if min(D(k))>Thr2) then the method proceeds from step 180 to step 182. In step 182, a determination is made as to whether the minimum value of the force difference min(D(k)) (i.e. the minimum value in the force difference vector) at the current sampling step k is greater than or equal to the second threshold Thr2 and less than or equal to the first threshold Thr1 using the equation Thr2<min(D(k))<Thr1. If a determination is made in step 182 that the minimum value of the force difference min(D(k)) at the current sampling step k is not greater than or equal to the second threshold Thr2 and less than or equal to the first threshold Thr1 (i.e. if either min(D(k))<Thr2 or if min(D(k))>Thr1) then the method proceeds from step 182 to step 184. In step 184, the confidence level Conf that there is air in the infusion system is set in the range of 0% to 40%. The method proceeds from step 184 through location step 186 through location step 166 to step 168 and repeats the process steps.
If a determination is made in step 182 that the minimum value of the force difference min(D(k)) at the current sampling step k is greater than or equal to the second threshold Thr2 and less than or equal to the first threshold Thr1 (i.e. if min(D(k))≥Thr2 and if min(D(k))≥Thr1) then the method proceeds from step 182 to step 188. In step 188, a determination is made as to whether the minimum force difference min(D(k−1)) at the preceding sampling step k−1(i.e. the minimum value in the force difference vector at sampling step k−1) is less than or equal to the first threshold Thr1 using the equation min(D(k−1))≤Thr1. If the determination is made in step 188 that the minimum force difference min(D(k−1)) at the preceding sampling step k−1 is not less than or equal to the first threshold Thr1 (i.e. min(D(k−1))>Thr1) then the method proceeds from step 188 to step 184. In step 184, the confidence level Conf that there is air in the infusion system is set in the range of 0% to 40%. The method proceeds from step 184 through location step 186 through location step 166 to step 168 and repeats the process steps.
If a determination is made in step 188 that the minimum force difference min(D(k−1)) at the preceding sampling step k−1 is less than or equal to the first threshold Thr1 (i.e. min(D(k−1))<Thr1) then the method proceeds from step 188 to step 190. In step 190, the confidence level Conf that there is air in the infusion system is set in the range of 60% to 80%. The method proceeds from step 190 through location step 192 through location step 166 to step 168 and repeats the process steps.
If a determination is made in step 180 that min(D(k)) is less than Thr2 (i.e. if min(D(k))≤Thr2) then the method proceeds from step 180 to step 194. In step 194, a determination is made as to whether the minimum force difference min(D(k−1)) at the preceding sampling step k−1 (i.e. the minimum value in the force difference vector at sampling step k−1) is less than or equal to the first threshold Thr1 using the equation min(D(k−1))≤Thr1. If a determination is made in step 194 that the minimum force difference min(D(k−1)) at the preceding sampling step k−1 is not less than or equal to the first threshold Thr1 (i.e. if min(D(k−1))>Thr1) then the method proceeds from step 194 to step 196. In step 196, the confidence level Conf that there is air in the infusion system is set in the range of 40% to 60%. The method proceeds from step 196 through location step 198 through location step 166 to step 168 and repeats the process steps.
If a determination is made in step 194 that the minimum force difference min(D(k−1)) at the preceding sampling step k−1 is less than or equal to the first threshold Thr1 (i.e. if min(D(k−1))≤Thr1) then the method proceeds from step 194 to step 200. In step 200, the confidence level Conf that there is air in the infusion system is set in the range of 80% to 100%. The method proceeds from step 200 to step 202. In step 202, a determination is made as to whether the total volume infused to present InfVol is within 10% of the total volume of the infusion fluid to be infused VTBI using the equation InfVol =VTBI±10%. If the determination is made in step 202 that the total volume infused to present InfVol is not within 10% of the total volume of the infusion fluid to be infused VTBI (i.e. InfVol:it VTBI±10%) then the method proceeds from step 202 through location step 204 through location step 166 to step 168 and repeats the process steps. It is noted that even though there is a high confidence level in a range of 80% to 100% that air is contained in the infusion system, that since the volume of infusion fluid infused to present is not within 10% of the total volume to be infused that the air in the system must be due to one or more slugs of air and is not due to an end of container (end of bag) event.
If the determination is made in step 202 that the total volume infused to present InfVol is within 10% of the total volume of the infusion fluid to be infused VTBI (i.e. InfVol=VTBI±10%) then the method proceeds from step 202 to step 206. In step 206, an end of container event (i.e. end of bag event) is detected in which the infusion container has been emptied of the infusion fluid. It is important to note that since the minimum of the force difference min(D(k)) for the current sampling step k is less than the second threshold Thr2, the minimum of the force difference min(D(k−1)) for the preceding sampling step k−1 is less than or equal to the first threshold Thr1, and the total volume infused to present InfVol is within 10% of the total volume of the infusion fluid to be infused InfVol that the determination that the end of the container has been reached is highly accurate and reliable. The method proceeds from step 206 to step 208. In step 208, the alarm is turned on indicating that the infusion container has been emptied of the infusion fluid. When the alarm is generated or turned on in step 208, the infusion system may be turned off automatically or manually by the user to stop the infusion of the infusion fluid.
In other embodiments, the method 160 may be altered to vary the order or substance of any of the steps, to delete one or more of the steps, or to add one or more steps. For instance, instead of using force sensor measurements, one or more other types of sensors may be used (i.e. pressure, air, rate, temperature, etc.) and instead of using the infusion information comprising the volume to be infused (VTBI) one or more other types of information may be used (i.e. other types of infusion information as disclosed herein, medication information as disclosed herein, etc.). In still other embodiments, any number, type, and configuration of sensor information, infusion information, medication information, or other types of information may be used.
As shown, confidence region 162 represents having a confidence level in a range of 80% to 100% that air is in the infusion system. In confidence region 162 one of the following is true: (i) in two consecutive sampling steps (cycles) k−1 and k the minimum force difference D(k−1) and D(k) was less than the second threshold Thr2 (e.g. the last two drops in the force reading were very large in magnitude); or (ii) in the current sampling step k the minimum force difference D(k) is less than the second threshold Thr2 and the minimum force difference D(k−1) for the preceding sampling step k−1 was between the second threshold Thr2 and the first threshold Thr1 (e.g. the current drop in force reading is very large and the previous drop was large in magnitude). It is noted that fluid is less compressible than air so when transitioning from fluid to air a drop in the force profile X(k) and correspondingly a drop in the force difference D(k) is expected.
Confidence region 164 represents having a confidence level in a range of 60% to 80% that air is in the infusion system. In confidence region 164 one of the following is true: (i) in two consecutive sampling steps (cycles) k−1 and k the minimum force difference D(k−1) and D(k) is between the second threshold Thr2 and the first threshold Thr1 (e.g. the last two drops in force readings were large); or (ii) the current minimum force difference D(k) is between the second threshold Thr2 and the first threshold Thr1 and the previous minimum force difference D(k−1) was lower than the second threshold Thr2 (e.g. the current drop in force reading is large and the previous drop in force reading was very large).
Confidence region 166 represents having a confidence level in a range of 40% to 60% that air is in the infusion system. In confidence region 166 the current minimum force difference D(k) is lower than the second threshold Thr2 and the previous minimum force difference D(k−1) was higher than the first threshold Thr1 (e.g. the current drop in force reading is very large and the previous drop in force reading was small or non-existent).
Confidence region 168 represents having a confidence level in a range of 0% to 40% that air is in the infusion system. In confidence region 168 one of the following is true: (i) the current minimum force difference D(k) is higher than the first threshold Thr1 (e.g. the current drop in force reading is very small or non-existent); or (ii) the current minimum force difference D(k) is between the second threshold Thr2 and the first threshold Thr1 and the previous minimum force difference D(k−1) was higher than the first threshold Thr1 (e.g. the current drop in force reading is large and the previous drop in force reading was small or non-existent). In other embodiments, the algorithms used by the method 160 of
The sensor 172 comprises a plunger force sensor which takes measurements during the infusion. In other embodiments, the sensor 172 may comprise any combination, number, or configuration of one or more plunger force sensors, one or more proximal air sensors, one or more distal air sensors, one or more proximal pressure sensors, one or more chamber pressure sensors, one or more distal pressure sensors, or one or more varying other type of sensors.
The plurality of filters 174 comprises a Kalman filter for estimating mean force based on the measurements of the sensor 172, a second Kalman filter for estimating variance force based on the measurements of the sensor 172, and a third Kalman filter for estimating derivative force based on the measurements of the sensor 172. In other embodiments, any number, type, and configuration of filters may be used to filter the measurements of the sensor 172 to determine varying information regarding the measurements of the sensor 172.
The one or more SPC charts 176 may comprise any number and type of SPC chart which are constructed based on the forecasted n-steps ahead filtered measurements of the sensor 172. For instance, a cumulative sum control chart (CUSUM), an exponentially weighted moving average control chart (EWMA), or other types of charts may be constructed based on the forecasted n-steps ahead filtered measurements of the sensor 172.
The information 178 comprises infusion information comprising the volume of the infusion fluid in the infusion container. In other embodiments, the information may comprise varying types of infusion information, may comprise medication information, or may comprise one or more other types of information. The medication information may comprise a formulation of the infusion fluid, a rate of the infusion fluid, a duration of the infusion fluid, a viscosity of the infusion fluid, a therapy of the infusion fluid, or a property of the infusion fluid. In other embodiments, one or more other type of information may be used.
The qualifier 180 may comprise one or more algorithms to be applied by programming code of a processing device to determine that the infusion container is empty (i.e. the end of the infusion) or to determine whether or not air, fluid, or some combination thereof is contained in the infusion system 170. In order to make this determination, the qualifier 180 may rely on the constructed SPC charts 176 and on the information 178. This determination is more accurate and reliable and will lead to less nuisance alarms (when the alarm went off but shouldn't have) or missed alarms (when the alarm should have gone off but didn't) due to the use of the varying types of information used. In other embodiments, the qualifier 180 may rely on varying information to make the determination.
The alarm device 182 may generate or turn on an alarm to indicate that the infusion container is empty if the qualifier 180 determines that the infusion container is empty or if it determines that air is contained in the infusion system. In this event, the alarm device 182 may further automatically or manually turn off the infusion system to stop the infusion. In other embodiments, the infusion system 170 of
The sensor 192 comprises a plunger force sensor which takes measurements during the infusion. In other embodiments, the sensor 192 may comprise any combination, number, or configuration of one or more plunger force sensors, one or more proximal air sensors, one or more distal air sensors, one or more proximal pressure sensors, one or more chamber pressure sensors, one or more distal pressure sensors, or one or more varying other type of sensors.
The plurality of filters 194 comprises a Kalman filter for estimating mean force based on the measurements of the sensor 192, a second Kalman filter for estimating variance force based on the measurements of the sensor 192, and a third Kalman filter for estimating derivative force based on the measurements of the sensor 192. In other embodiments, any number, type, and configuration of filters may be used to filter the measurements of the sensor 192 to determine varying information regarding the measurements of the sensor 192.
The one or more SPC charts 196 may comprise any number and type of SPC chart which are constructed based on the residuals of the filtered measurements of the sensor 192. The residual is defined as the difference between the actual signal characteristic as measured (for instance the actual plunger force measurement) and the estimated/expected/anticipated signal characteristic via the filtering (for instance the estimated/expected/anticipated plunger force measurement as a result of the filtering). A cumulative sum control chart (CUSUM), an exponentially weighted moving average control chart (EWMA), or other types of charts may be constructed based on the residuals of the filtered measurements of the sensor 192.
The information 198 comprises infusion information comprising the volume of the infusion fluid in the infusion container. In other embodiments, the information may comprise varying types of infusion information, may comprise medication information, or may comprise one or more other types of information. The medication information may comprise a formulation of the infusion fluid, a rate of the infusion fluid, a duration of the infusion fluid, a viscosity of the infusion fluid, a therapy of the infusion fluid, or a property of the infusion fluid. In other embodiments, one or more other type of information may be used.
The qualifier 200 may comprise one or more algorithms to be applied by programming code of a processing device to determine that the infusion container is empty (i.e. the end of the infusion) or to determine whether or not air, fluid, or some combination thereof is contained in the infusion system 190. In order to make this determination, the qualifier 200 may rely on the constructed SPC charts 196 and on the information 198. This determination is more accurate and reliable and will lead to less nuisance alarms (when the alarm went off but shouldn't have) or missed alarms (when the alarm should have gone off but didn't) due to the use of the varying types of information used. In other embodiments, the qualifier 200 may rely on varying information to make the determination.
The alarm device 202 may generate or turn on an alarm to indicate that the infusion container is empty if the qualifier 200 determines that the infusion container is empty or if it determines that air is contained in the infusion system. In this event, the alarm device 202 may further automatically or manually turn off the infusion system to stop the infusion. In other embodiments, the infusion system 190 of
The plurality of sensors 212 comprise an air sensor, a pressure sensor, a force sensor, and any number and type of other sensors that are desired to take measurements during the infusion. In other embodiments, any number, type, and configuration of sensors may be used to take measurements during the infusion.
The plurality of filters 214 comprises a Kalman filter for estimating mean force based on the measurements of the sensors 212, a second Kalman filter for estimating variance force based on the measurements of the sensors 212, and a third Kalman filter for estimating derivative force based on the measurements of the sensors 212. In other embodiments, any number, type, and configuration of filters may be used to filter the measurements of the sensors 212 to determine varying information regarding the measurements of the sensors 212.
The one or more SPC charts 216 may comprise any number and type of SPC chart which are constructed based on the residuals of the filtered measurements of the plurality of sensors 212. The residual is defined as the difference between the actual signal characteristic as measured (for instance the actual plunger force measurement) and the estimated/expected/anticipated signal characteristic via the filtering (for instance the estimated/expected/anticipated plunger force measurement as a result of the filtering). A cumulative sum control chart (CUSUM), an exponentially weighted moving average control chart (EWMA), or other types of charts may be constructed based on the residuals of the filtered measurements of the plurality of sensors 212.
The information 218 comprises infusion information comprising the volume of the infusion fluid in the infusion container or the volume to be infused (VBTI). In other embodiments, the information may comprise varying types of infusion information, may comprise medication information, or may comprise one or more other types of information. The medication information may comprise a formulation of the infusion fluid, a rate of the infusion fluid, a duration of the infusion fluid, a viscosity of the infusion fluid, a therapy of the infusion fluid, or a property of the infusion fluid. In other embodiments, one or more other type of information may be used.
The qualifier 220 may comprise one or more algorithms to be applied by programming code of a processing device to determine that the infusion container is empty (i.e. the end of the infusion) or to determine whether or not air, fluid, or some combination thereof is contained in the infusion system 210. In order to make this determination, the qualifier 220 may rely on the constructed SPC charts 216 and on the information 218. This determination is more accurate and reliable and will lead to less nuisance alarms (when the alarm went off but shouldn't have) or missed alarms (when the alarm should have gone off but didn't) due to the use of the varying types of information used. In other embodiments, the qualifier 220 may rely on varying information to make the determination.
The alarm device 222 may turn on an alarm to indicate that the infusion container is empty if the qualifier 220 determines that the infusion container is empty or if it determines that air is contained in the infusion system. In this event, the alarm device 222 may further automatically or manually turn off the infusion system to stop the infusion. In other embodiments, the infusion system 210 of
Line 232 represents the lower control limit. Line 234 represents the upper control limit. Curve 236 represents the lower CUSUM that is the cumulative sum in the negative direction. Curve 238 represents the upper CUSUM that is the cumulative sum in the positive direction. Out of control area 240 represents an area where curve 236 drops below the lower control limit 232 and substantially deviates from curve 238 which clearly indicates that the infusion container has run out of infusion fluid (i.e. the end of the bag). This determination is buttressed because not only were the SPC charts constructed based on the sensor measurements but also infusion information was utilized ensuring that out of control area 240 is within 10% of the total volume of the infusion fluid in the infusion container. This provides increased accuracy to the determination, and reduces the risk of a nuisance alarm or a missed alarm.
The sensor 252 comprises a plunger force sensor which takes measurements during the infusion. In other embodiments, the sensor 252 may comprise any combination, number, or configuration of one or more plunger force sensors, one or more proximal air sensors, one or more distal air sensors, one or more proximal pressure sensors, one or more chamber pressure sensors, one or more distal pressure sensors, or one or more varying other type of sensors.
The wavelet transform block 254 comprises a wavelet decomposition block 254a, a coefficient threshold block 254b, and a signal reconstruction block 254c. The wavelet decomposition block 254a decomposes the wavelet based on the plunger force sensor signal to obtain the wavelet coefficients. The coefficient threshold block 254b applies one or more thresholds to the obtained wavelet coefficients to remove the noise. The signal reconstruction block 254c applies an inverse wavelet transform to the threshold coefficients to obtain a de-noised signal. In other embodiments, any number, type, and configuration of wavelet transform blocks may be applied to the measurements of the sensor 252 to determine varying information regarding the measurements of the sensor 252.
The one or more SPC charts 256 may comprise any number and type of SPC chart which are constructed based on the de-noised signal obtained using the wavelet transform block 254. A cumulative sum control chart (CUSUM), an exponentially weighted moving average control chart (EWMA), or other types of charts may be constructed based on the de-noised signal obtained using the wavelet transform block 254.
The information 258 comprises infusion information comprising the volume of the infusion fluid in the infusion container. In other embodiments, the information may comprise varying types of infusion information, may comprise medication information, or may comprise one or more other types of information. The medication information may comprise a formulation of the infusion fluid, a rate of the infusion fluid, a duration of the infusion fluid, a viscosity of the infusion fluid, a therapy of the infusion fluid, or a property of the infusion fluid. In other embodiments, one or more other type of information may be used.
The qualifier 260 may comprise one or more algorithms to be applied by programming code of a processing device to determine that the infusion container is empty (i.e. the end of the infusion) or to determine whether or not air, fluid, or some combination thereof is contained in the infusion system 250. In order to make this determination, the qualifier 260 may rely on the constructed SPC charts 256 and on the information 258. This determination is buttressed because not only were the wavelet transform block used to construct SPC charts based on the plunger force sensor signal measurements but also infusion information was utilized ensuring that the out of control area was within a preset percentage of the total volume of the infusion fluid in the infusion container (e.g. 10% of the total volume of the infusion fluid in the infusion container). This determination is more accurate and reliable and will lead to less nuisance alarms (when the alarm went off but shouldn't have) or missed alarms (when the alarm should have gone off but didn't) due to the use of the varying types of information used. In other embodiments, the qualifier 260 may rely on varying information to make the determination.
The alarm device 262 may generate or turn on an alarm to indicate that the infusion container is empty if the qualifier 260 determines that the infusion container is empty or if it determines that air is contained in the infusion system. In this event, the alarm device 262 may further automatically or manually turn off the infusion system to stop the infusion. In other embodiments, the infusion system 250 of
Graph 272 plots the reconstructed signal from the wavelet transform using the infusion system of
All of the embodiments of the disclosure can be used to determine the presence of air in the pumping chamber and provide AIL (air-in-line) alarms. This can easily be achieved by excluding the information such as volume to the end of bag (VTBI) or other infusion information or medication information from the qualifier block(s). In current practice, the force algorithms developed to detect the presence of air in the chamber are typically based on singe-channel and linear filters/methods. However, the instant disclosure discloses systems and methods that utilize multi-channel filtering, non-linear mapping such as wavelet transform and neural networks, and SPC charts.
Alternate methodologies can be used to combine the diverse information provided by the varying sensors (such as force sensors, air sensors, and pressure sensors) and the additional information supplied such as the infusion information, the medication information, or other types of information. One such methodology comprises the application of a rule-based system that encompasses expert knowledge concerning the combination of events leading to the probability of an end-of-infusion event.
In another embodiment, a machine learning methodology may be used in which one or more pattern recognition systems are used to detect an end of infusion event on the basis of features extracted from the data elements. For this purpose, both parametric (linear discriminant analysis, support vector machines, artificial neural networks, logistic regression, Bayesian networks, dynamic Bayesian networks, etc.) and nonparametric (k-nearest-neighbor, decision trees, etc.) methods provide potential alternatives. This approach provides the option to uncover and learn complex patterns which occur through time to detect the likelihood of an end of infusion event.
The Abstract is provided to allow the reader to quickly ascertain the nature of the technical disclosure. It is submitted with the understanding that it will not be used to interpret or limit the scope or meaning of the claims. In addition, in the foregoing Detailed Description, it can be seen that various features are grouped together in various embodiments for the purpose of streamlining the disclosure. This method of disclosure is not to be interpreted as reflecting an intention that the claimed embodiments require more features than are expressly recited in each claim. Rather, as the following claims reflect, inventive subject matter lies in less than all features of a single disclosed embodiment. Thus the following claims are hereby incorporated into the Detailed Description, with each claim standing on its own as a separately claimed subject matter.
While particular aspects of the present subject matter described herein have been shown and described, it will be apparent to those skilled in the art that, based upon the teachings herein, changes and modifications may be made without departing from the subject matter described herein and its broader aspects and, therefore, the appended claims are to encompass within their scope all such changes and modifications as are within the true scope of the subject matter described herein. Furthermore, it is to be understood that the disclosure is defined by the appended claims. Accordingly, the disclosure is not to be restricted except in light of the appended claims and their equivalents.
| Number | Date | Country | |
|---|---|---|---|
| 61828522 | May 2013 | US |
| Number | Date | Country | |
|---|---|---|---|
| Parent | 16233740 | Dec 2018 | US |
| Child | 17929634 | US | |
| Parent | 14289848 | May 2014 | US |
| Child | 16233740 | US |
