TY  - JOUR
AU  - Kia, Arash
AU  - Waterson, James
AU  - Bargary, Norma
AU  - Rolt, Stuart
AU  - Burke, Kevin
AU  - Robertson, Jeremy
AU  - Garcia, Samuel
AU  - Benavoli, Alessio
AU  - Bergström, David
PY  - 2023
DA  - 2023/9/13
TI  - Determinants of Intravenous Infusion Longevity and Infusion Failure via a Nonlinear Model Analysis of Smart Pump Event Logs: Retrospective Study
JO  - JMIR AI
SP  - e48628
VL  - 2
KW  - intravenous infusion
KW  - vascular access device
KW  - alarm fatigue
KW  - intensive care units
KW  - intensive care
KW  - neonatal
KW  - predictive model
KW  - smart pump
KW  - smart device
KW  - health device
KW  - infusion
KW  - intravenous
KW  - nonlinear model
KW  - medical device
KW  - therapy
KW  - prediction model
KW  - artificial intelligence
KW  - AI
KW  - machine learning
KW  - predict
KW  - predictive
KW  - prediction
KW  - log data
KW  - event log
AB  - 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. 
SN  - 2817-1705
UR  - https://ai.jmir.org/2023/1/e48628
UR  - https://doi.org/10.2196/48628
DO  - 10.2196/48628
ID  - info:doi/10.2196/48628
ER  -