Determinants of Intravenous Infusion Longevity and Infusion Failure via a Nonlinear Model Analysis of Smart Pump Event Logs: Retrospective Study

Abstract

Background: Infusion failure may have severe consequences for patients receiving critical, short-half-life infusions. Continued interruptions to infusions can lead to subtherapeutic therapy.

Objective: This study aims to identify and rank determinants of the longevity of continuous infusions administered through syringe drivers, using nonlinear predictive models. Additionally, this study aims to evaluate key factors influencing infusion longevity and develop and test a model for predicting the likelihood of achieving successful infusion longevity.

Methods: Data were extracted from the event logs of smart pumps containing information on care profiles, medication types and concentrations, occlusion alarm settings, and the final infusion cessation cause. These data were then used to fit 5 nonlinear models and evaluate the best explanatory model.

Results: Random forest was the best-fit predictor, with an F₁-score of 80.42, compared to 5 other models (mean F₁-score 75.06; range 67.48-79.63). When applied to infusion data in an individual syringe driver data set, the predictor model found that the final medication concentration and medication type were of less significance to infusion longevity compared to the rate and care unit. For low-rate infusions, rates ranging from 2 to 2.8 mL/hr performed best for achieving a balance between infusion longevity and fluid load per infusion, with an occlusion versus no-occlusion ratio of 0.553. Rates between 0.8 and 1.2 mL/hr exhibited the poorest performance with a ratio of 1.604. Higher rates, up to 4 mL/hr, performed better in terms of occlusion versus no-occlusion ratios.

Conclusions: This study provides clinicians with insights into the specific types of infusion that warrant more intense observation or proactive management of intravenous access; additionally, it can offer valuable information regarding the average duration of uninterrupted infusions that can be expected in these care areas. Optimizing rate settings to improve infusion longevity for continuous infusions, achieved through compounding to create customized concentrations for individual patients, may be possible in light of the study's outcomes. The study also highlights the potential of machine learning nonlinear models in predicting outcomes and life spans of specific therapies delivered via medical devices.

Keywords: AI; alarm fatigue; artificial intelligence; event log; health device; infusion; intensive care; intensive care units; intravenous; intravenous infusion; log data; machine learning; medical device; neonatal; nonlinear model; predict; prediction; prediction model; predictive; predictive model; smart device; smart pump; therapy; vascular access device.

Figure 1

Variable importance in infusion occlusion prediction for “Hospitals infusion data set: Spain” for CareFusion/BD Alaris Plus syringe pumps.

Figure 2

Total number of infusions with and without occlusion for binary variables, which are essentially bound to the treatment process or location and beyond the direct control or manipulation of clinicians. (A) HUCA 4.5 6.7 VP+CC (profile). (B) Insulin 1 IU/mLl (medication). (C) Omeprazole (medication). (D) Fentanil (medication). (E). UCI Hosp Gral (profile). (F) Anesthesia Rea (profile). (G) Fentanil 1.2 Mg (medication). (H) UCI trauma (profile). (I) Remifentanil (medication).

Figure 3

Occlusion versus no occlusion in nonbinary variables of (A) occlusion threshold (mm Hg), (B) infusion rate (mL/hr), and (C) concentration (units/mL). these variables are within the control of clinicians or clinical teams. Concentration units pertain to several units in the International System of Units per ml (eg, mg, mcg, ng, and IU). Blue indicates no occlusion (no infusion failure) and orange indicates occlusion (infusion failure).

Figure 4

Low-flow infusion rates versus the number of infusions with occlusion (unexpected infusion interruption) and no occlusion (planned infusion cessation). Blue indicates no occlusion and orange indicates occlusion.