Ultrasound-Guided Localization of Difficult-to-Access Refill Port of the Intrathecal Pump Reservoir

ABSTRACT

Introduction. Ultrasound guidance is being increasingly utilized in many chronic pain interventions. This is a report of the use of ultrasound imaging for accessing an intrathecal pump. Case Report. A 56-year-old patient with a programmable implanted intrathecal drug delivery system for chronic non-malignant pain needed a pump refill of sufentanil. Attempts to access the refill port using the manufacturer supplied template were difficult because of the presence of a seroma. Using ultrasound guidance, the seroma, reservoir, and the refill port were visualized and the pump was successfully accessed. This imaging-guided refill technique is fully described in this article. As the patient continued to have a collection of fluid during his following visit, the collection was aspirated under ultrasound guidance. The specimen revealed a proteinaceous collection with minimal quantities of sufentanil. Conclusion. This is a successful demonstration of ultrasound guidance to facilitate access to a difficult-to-access refill port of a pump reservoir secondary to the formation of a seroma.