Trouble Shooting with Intrathecal Baclofen: Earn Your Detective Badge-Session Recording

Video Transcription

Video Summary

The session on managing baclofen pumps was led by Kristen Caldera, who emphasized the importance of troubleshooting intrathecal baclofen pumps and shared insights from field experts. The session included detailed discussions and case studies on diagnosing and addressing pump-related issues. <br /><br />Dr. Caldera presented an algorithm for troubleshooting intrathecal baclofen pumps, focusing on catheter access port studies and x-rays as diagnostic tools. Case studies highlighted scenarios such as catheter patency issues causing reductions in doses and the importance of comparing recent x-rays with previous ones for detecting catheter movement.<br /><br />Dr. Kimberly Heckert discussed the challenge of diagnosing loss of efficacy and intermittent withdrawal. In one case, a patient had a catheter embedded in scar tissue, which was only resolved through full system replacement. Dr. Heckert emphasized that normal test results do not always rule out catheter problems.<br /><br />Dr. Michael Salino provided an overview of beta-2 transferrin testing and CT myelograms, introducing methods to safely execute these procedures for detecting catheter issues. He shared research on the high concordance of beta-2 transferrin results with surgical findings.<br /><br />Dr. Rez Farid shared a case highlighting the use of nuclear medicine scans in troubleshooting pump issues, emphasizing the financial aspects and reimbursement challenges of such procedures. He noted that troubleshooting times vary and shared insights about the intricacy of diagnosing issues with pump systems.<br /><br />Andrea Toomer, operating in a private practice, presented a case of suspected withdrawal linked to constipation rather than pump failure. She emphasized the importance of ruling out other causes of increased spasticity and planning bowel management before pump replacement surgeries.<br /><br />The session concluded with discussions on ICU monitoring for overdose or withdrawal, the importance of preoperative antibiotics, and the role of routine catheter studies for pump patients. The panel emphasized the need for thorough evaluation and management strategies to prevent complications from baclofen pump issues.

Keywords

baclofen pumps

intrathecal troubleshooting

catheter issues

diagnostic tools

case studies

x-rays

beta-2 transferrin

CT myelograms

nuclear medicine scans

withdrawal diagnosis

spasticity management

ICU monitoring