I must confess I felt a little embarrassed when ISVRA asked me to trial and make a review of the GemStar infusion pump by Abbott (Abbott Laboratories North Chicago, Illinois, USA). This was for two reasons:

1. Abbott Italia has never showed a particular interest for the veterinary market in our country; what’s more, the company behaviour towards many colleagues seemed to be very strict, so discouraging the diffusion of its products (mainly drugs, infusion equipment, monitoring equipment) in veterinary medicine, though with some exceptions. Also, unlike the USA in Italy they don’t have a range of products devoted to veterinary surgeons;
2. Having chosen to hold their marketing campaign exclusively among human hospitals, Abbott Italy propose a remarkably high-priced catalogue if compared with the mean veterinary market, providing a 60 days draft (from delivery of goods) as only form of payment . No form of extension of payment are envisaged, no special prices for payment on delivery, no delayed payments as it sometimes happens with human hospitals.

My embarrassment grew even stronger because, having had the chance to try on the field a great number of Abbott products, I must admit that the items they make are remarkably high-rank for quality and functionality. Thus, it is difficult to be less than enthusiastic when you talk of them, and one cannot help suggesting their purchase, especially to colleagues with Mida’s touch, willing to make their professional life easier, particularly in some delicate and stressing fields like anaesthesia and the post-operative care. But let’s go into details with this infusion pump.

'The Abbott GemStar pump is a single line, small light infusion device, which can be electrically supplied by an AC electric system transformer, a pack of rechargeable batteries, two AA disposable alkaline batteries or by the Abbott GemStar docking station. This infusion pump has been conceived for hospital and home use, or wherever an electronically controlled infusion is needed’. The four lines above are drawn from the first page of the Italian user’s manual, which concisely emphasizes the enormous potentials of this ingenious device in the veterinary field .

Physical dimensions: 14 x 9.7 x 5.1cm

Weight: 482 grams batteries excluded. Light as a feather !

Power supply options: transformer-plug plus wire, table net transformer or upright (as in GemStar docking station), two AA disposable alkaline batteries, a pack of rechargeable batteries with specific AC transformer. It seems really impossible not to keep it going whatever practice or clinical scenario you find yourself into!

Electronic control of infusion. You get absolute precision and safety even when ‘critical’ or ‘carefully dosed’ drugs are to be infused, which need micrograms-per-hour rating (e.g. analgesics, inotropic agents, vaso-dilators/constrictors, etc.).

The versatility of this instrument is simply amazing: with two disposable batteries you can buy at any shop you can continue the infusion started in the operating theatre during the transport of the patient, the time in the radiology room for an x-ray check, and its subsequent moving to wards, where you can reconnect the pump to mains. Your patient will continue the IV therapy with no interruption and all you have to do is carrying with you a device which is just a little bigger than three packets of cigarettes, does not need to be placed in vertical position, and weighs slightly more than a Nokia Communicator mobile phone. In the meantime, GemStar can infuse at such different rates that you may set it up for volume replacement in an 80 kg Bernese shepherd, or for CRI analgesia in a 3kg Yorkshire Terrier !

The pump is suitable for intravenous infusion (central or peripheral access), and for arterial, subcutaneous and epidural infusions as well. This instrument can satisfy any possible need for infusion in veterinary practice, total parenteral nutrition (TPN) included, and points out new ways (continual epidural infusion, subcutaneous, etc.). Seven different programs are available for infusion of drugs and fluids. Many functions are available, and each program has several options. I must be honest: I could not try all the functions and programs, I clinged to those which seemed to me more useful or interesting for veterinary surgeons, which I have reported here below.

Weight–based setting: constant infusion, automatic “KOR” (keep open rate), setup updating at any time. Infusion rates can be scheduled at mcg/kg/min, mcg/kg/h, mcg/min, mg/kg/min, mg/kg/h, mg/min, ml/h. You can select any patient’s weight between 2 and 200 kg. The setting of the pump can be changed without stopping infusion, so ensuring a continuity of therapy, a vital feature when you are using some particular drugs. When the pump finishes the infusion it had been setup for, it automatically switches to KOR (Keep Open Rate), that means it administers 1ml per hour to prevent blood clotting in the catheter.

Pain therapy setting: constant infusion, loading dose, bolus on demand .It is the program I’ve used more, and which has given me great satisfaction: it’s absolutely perfect! You can choose among continuous infusion, continuous infusion plus bolus on request, or boluses only. Also, you can set up a loading dose at any time during infusion. Both the bolus and the loading dose are infused at a fixed rate of 125 ml/hour, so it is important to choose the right drug concentration while programming the therapy (this way you can change the drug infusion rate and the total volume infused for each bolus/loading dose). As far as a bolus on demand is concerned, you can set the lock-out interval (for instance, you can make sure it will not be repeated before 20 minutes from previous administration), and also the number of times per hour you want it to be repeated, and the maximum drug dose which should be administered in an hour or in 4 hours (once the pump has reached this time limit, it will automatically stop the infusion, but will automatically resume it once the lock-out interval is over). Bolus can be started by simply pressing a button on the upper edge of the pump, but as an alternative a wire with switch are available for control at distance (patient control, in humans). The setup can be done in milligrams, micrograms or millilitres at the operator’s choice. As for all other programs in this device, you may activate the “air in the line” sensor alarm. Three options are available.

Ml/h only setting: continuous infusion, automatic keep open rate (KOR), secondary infusion (piggyback), change settings at any time. Using this program ml/hour is the only available set up. It is a quick simple setup which permits the infusion of two different fluids using a piggyback additional set. Useful for post-operative care and for fluid therapy in wards.

Intermittent infusion setting: for administration at time intervals, with adjustable keep open rate (KOR). It enables the operator to schedule multiple doses at regular intervals: useful for antibiotics, antemetics, analgesics, etc. The patient can be disconnected between one dose and another, and in the meantime you can activate the “recall alarm” function, which will remind you it’s time to repeat the dose. The KOR (keep open rate) can be set at the desired flow rate, or it can be switched off.

Continuous infusion setting: Continuous infusion, adjustable keep open rate (KOR), secondary infusion (piggyback), change settings at any time. The infusion rate can be fixed in mcg/h, mg/h, ml/h, and the drug concentration can be rated in mg/ml, mcg/ml or mls only. It allows the infusion of two fluids at the same time through a special additional set. The keep open rate (KOR) can be adjusted at the desired rate , or it can be switched off.

For those who have already had the chance of using Abbott infusion pumps, hence are already acquainted with their setup system, GemStar has no secrets: its software may be considered as the natural evolution of LifeCare 5000 software. However, the setup of this pump may have some complexity for those who are not familiar with last generation infusion pumps, therefore a close study of user’s manual may be required to take advantage of huge potentialities of this device. A common feature of all Abbott pumps is a consequential pages menu which guides any setup or change of program. Even if the menu can sometimes seem long or elaborate, it prevents any risk of incidental error in the setup procedure. At the end, as a further safety measure, GemStar will ask you to review display after display all the settings and to give a final confirmation before starting infusion.

I would also like to spend a few words about the sensor which reveals the presence of air in the infusion line, located at cassette level: the kind of user the device has originally been meant for makes this very sensitive, capable of detecting minimal volumes of air. In a few particular situations, the alarm may frequently ring; to avoid this, its sensitivity can be adjusted or it can be temporarily switched off (for the current infusion). However, you should remember that once the alarm has been switched off, it is necessary to be very precise in setting up the volume to be infused (VTBI) to avoid air infusion when the solution in the bottle is over (this is a possibility only with an open-to-air drip set).

An astonishing characteristic of GemStar software is that it keeps recorded all infusion information (times, volumes, infusion rate, boluses, no of instrument turn off/on, etc.) and reports all this in a multi-page clinical history, with the possibility of dividing it in working shifts (this has been obviously meant for nursing staff). Though not particularly appreciated in the veterinary world, the option I have just mentioned allows a very detailed revision of the adopted infusion program and a comparison with the reported clinical outcomes, making it possible to evaluate the effectiveness of the therapeutic scheme. All this information can be printed or downloaded on a PC through the data output: in this case it can be visualized with a common text editor, or may be statistically and graphically elaborated through a data managing software.

Several infusion sets are available for this pump. In my opinion the most useful are: the standard set with the drip chamber, the set without the drip chamber which allows infusion no matter what position the fluid bag has, the syringe set (using a syringe instead of a bag or a bottle), the TPN (Total Parenteral Nutrition) set, the blood transfusion set, and finally the dimmed set for photosensitive drugs. These and many others are the characteristics of Abbott GemStar, a small, versatile infusion pump which, given trials in the veterinary world, has proved to possess astounding versatility and potential.

[Lorenzo Novello, ISVRA tester]

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