Smart infusion pumps are a state of the art technology for delivering medication accurately. Yet, the idea behind this modern advance originated in the medieval times. Transfusions were a treatment that were first attempted in the middle ages between animals and humans without the scientific understanding that we have today.
Ancient medical beliefs prior to the renaissance period focused around humours, rather than physiological knowledge. Medical beliefs were based on the four humours: Phlegm, blood, yellow bile, and black bile. If the humours stayed in balance then a person remained healthy, but if there was too much of one humour then illness occurred. They believed it was important to keep the patient’s body in balance by removing excess fluid such as bleeding into a bowl or using leeches.
With the beginning of dissection, anatomical knowledge and physiological understanding advanced. Even with further anatomical exploration, knowledge of human anatomy was limited by the scientific understanding of physiology.
It is believed that the first infusion by accessing a vein occurred in the renaissance period of 1492.
In the mid 1600s in Europe, there were advances in knowledge of human anatomy and circulation during the Scientific Revolution in which systematic experimentation was developing in the context of other major discoveries in science such as Newton’s law of universal graviation, Galileo in the field of astronomy and Bacon’s scientific method.
Figure 1 Sir Christopher Wren
Figure 2 Image from Chirurgiae Infusoriae in John Martin Rare Book Room Collection. This is the third reprint of the book originally published in 1664.
In 1665, Richard Lower (1631-1691) of Cornwall and subsequently Oxford was the first to perform the successful transfusion of blood from one animal to another, saving the life of the animal that had suffered severe blood loss. Richard Lower used quills to transfer blood from the carotid artery of one dog to the jugular vein of another. He repeated the procedure on one Arthur Conga in the presence of the Royal Society. Because adequate venous access was a problem, he used a primitive syringe comprising a bladder and a hollow metal tube to infuse the agent into a vein.
Figure 3 Engraving showing transfusion in the neck and leg of a dog, from animal to man, and from man to man, by J. S. Elsholtz, 1667. Wellcome Library, London, CC BY.
In France, 1667 an experiment of renewing the blood of a fifteen-year-old boy with blood from a sheep to improve his health was performed by Jean-Baptiste Denys, to help the boy recover from health problems. The transfusion made the boy even sicker, but he managed to survive the experience.
Figure 4Attempt at blood transfusion from lamb to man, depicted in an illustration dating from 1705. Wellcome Library, London, CC BY.
Dr Laurent (Lorenz) Heister, (1683-1758) a German anatomist, botanist and surgeon described the technique of infusion and produced his own apparatus—a tube and bladder—for injecting liquors into the veins. He added a bright suggestion of his own, namely, that the morbid blood should be removed , and the patient transfused with a replacement of warm milk and broth. Despite this, Dr Heister is considered the founder of scientific surgery in Germany, and was best known for his surgery textbook published in 1719.
Modern medicine came a long way in a short time. It wasn't until the early-to-mid-1800s that injections and transfusions started to be readily used to improve patient health. Early in the 19th century, early prototypes of infusion pumps were invented to help control the rate of flow during intravenous procedures.
Developments in the understanding of infusions and their benefits were developing the first part of the twentieth century. During the 1930s, Dr. Thomas Latta found that salt water (saline), injected into the bloodstream, could help fight cholera.
A couple of years later, Dr. James Blundell used transfusions during postpartum hemorrhages and observed that the speed of infusion had a direct impact on its success. Blundell later developed a device to monitor an infusion's speed of flow. Additionally, Dr. James Blundell proved that transfusing animal blood into humans was unsafe. Only human blood can be transferred into humans.
Figure 5 Blundell’s apparatus in use. From J. Blundell (1828). ‘Observations on the transfusion of blood’, The Lancet, 2, 321. Wellcome Library, London, CC BY.
It wasn't until the 1940s that a nurse was allowed to administer IV therapy. Until that time, only doctors were permitted to do so. These days, nurses are the ones who typically handle IV therapy for patients.
Figure 6 Nurse training on preparing a syringe at the Babies Hospital, New York, 1942. Photo by Fritz Henle for the Office of War Information.
The method of medications and fluids storage for infusions was developed. Prior to the 1930s, infusions were contained in open containers. In the 1930s they were kept in a vacuum-sealed glass bottle instead. Up until the 1970s, infusions were contained in glass bottles. With the invention of a new screw cap, began the demise of the glass bottle. Sepsis in hospitals with 50 deaths were linked to the lab producing the new screw bottle which had bacterial contamination and resulted in criminal changes to the hospital. This in combination with the invention of flexible IV bags resulted in a transition period from glass to plastic containers in the 70s. By the 1980s IV infusions were mostly delivered in plastic IV bags, with less safety concerns from the broken glass and easier administration of piggyback infusions.
In the 1960s, IV infusion pumps became a ubiquitous sight in hospitals all across the country. This was also during the time when Dr. John Myers started injecting patients with what he called a “cocktail” of vitamins and minerals. His exact formula was lost upon his death in the 1980s, but experts came up with a modified version that's pretty close. The cocktail includes vitamins B and C, magnesium sulphate, calcium gluconate, and selenium to manage conditions ranging from allergies and asthma, to heart disease and fibromyalgia. This showed that IV therapy can help patients receive valuable nutrients in addition to blood transfusions. All of these advances in transfusion and resuscitative therapies were coupled to advances in drug infusion technologies, including the hollow-bore metallic needle by the mid-19th century and adoption of antiseptic techniques in the late 19th century. In 1930, the first plastic IV catheter was demonstrated. In 1960, central line cannulation was first described. Since then, there have been a multitude of advances in catheters, IV tubing systems, connectors, reservoirs, and fluid propulsion devices (9).
Towards the end of the 19th century, the Luer Company developed the Luer connection, which is still used today. This allows the head of the hypodermic needle to be easily attached and detached with improved safety. This connector is part of the Sapphire infusion sets. In the 1980s the first computerized ambulatory pump was invented. Before the development and adoption of electromechanical pumps, most drug infusions were propelled by gravity. Drug infusions today may still be given by gravity, especially in environments with fewer resources available (9).
No longer a controversial treatment, infusion is used on a daily basis. It's used to both improve and save lives in numerous ways. But even though it's widely accepted, it's always being improved upon. Smart pumps such as the Sapphire Infusion Pump which has been on the market since 2013 provide accurate treatment delivery. The Sapphire Infusion pump offers a drug library and multiple therapy options to help improve patient treatment whilst not compromising on quality. Although those early experiments may not have seemed like milestones, they were truly the building blocks of treatments on which we rely today.
Sapphire infusion technology is constantly improving and further technological advances such as the Insights platform and remote treatment capability are advances that are coming out soon.
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