UHM 2016, Vol. 43, No.

1 THREE INFUSION PUMPS FOR MONOPLACE CHAMBERS

Performance of three large-volume infusion pumps

with the monoplace hyperbaric chamber
James Bell, CHT, EMT, CFPS 1,2, Lindell K. Weaver, M.D., FACP, FCCP, FCCM, FUHM 1,2,3,
Kayla Deru 1,2
1 Hyperbaric

Medicine, LDS Hospital, Salt Lake City, Utah, U.S.

Medicine, Intermountain Medical Center, Murray, Utah, U.S.
3 University of Utah School of Medicine, Salt Lake City, Utah, U.S.
2 Hyperbaric

CORRESPONDING AUTHOR: James Bell james.bell@imail.org

______________________________________________________________________________________________________________________________________________________

ABSTRACT

We evaluated the Zyno Medical Z-800F, CME Body

Guard 323 Color Vision, and Baxter Flo-Gard 6201
infusion pumps for monoplace chamber conditions.
We adjusted pump occlusion pressure allowing
infusion to 3 atmospheres absolute (atm abs).
Baxter and Zyno pumps were connected to the
chamber pass-through with rigid small-bore tubing.
The CME infusion set was connected directly to
the pass-through. We infused saline to a collection
manifold inside a monoplace chamber at 1-100 mL/
hour under pressures ranging from 0.85-3.0 atm abs.
We averaged results from three to five separate tests
for each condition. At baseline, pumps performed
within 10% of expected (our measurement capability). However, clinical engineering verified perfor-

mance within manufacturer specifications (5% at

atmospheric pressure). During a carbon monoxide
hyperbaric protocol (3 atm abs/2 atm abs), measured
flow with the Baxter, CME and Zyno pumps was
5% of setting at 10 mL/hour (95%, 103%, 95%,
respectively); at 1 mL/hour, average flow were 91%,
83%, 83%, respectively. During timed testing (volume
recorded before decompression), pump accuracy
was 10% at 10 and 100 mL/hour. Tubing compliance compromised performance at lower flow
rates, magnified by increased pressure. These pumps
have potential for monoplace chamber use, although
not supported by the manufacturers or FDA-cleared.
At low flow rates, tubing compliance affects
delivered volumes.

______________________________________________________________________________________________________________________________________________________

INTRODUCTION
As of this writing, hyperbaric facilities in the United
States do not have U.S. Food and Drug Administration
(FDA)-cleared large-volume infusion pumps for use
with monoplace or multiplace chambers. However,
patients receiving hyperbaric oxygen (HBO2) therapy
may require intravenous (IV) infusions during their
hyperbaric chamber sessions to support clinical care [1],
which might include crystalloid or antibiotics, or in the
case of critically ill patients, norepinephrine, vasopressin,
dobutamine, insulin, to name a few. To meet these
patient needs, the hyperbaric medicine facility ideally
should select, test, and approve a pump appropriate to

the facility setting and the treated patient population [2].

Several IV pumps have been tested for use in multiplace hyperbaric chambers, with variable results [3-11].
While fire safety is a primary concern because the IV
pump is inside the multiplace chamber, many of the
standard pump features such as the occlusion settings
and alarms work as designed. In contrast, a pump operating outside a monoplace chamber must overcome a
significant pressure differential to deliver fluids inside
the chamber, and many infusion pumps have a default
upper occlusion pressure setting in the range of
6-10 psig, which is insufficient for monoplace infusion
pump operation.

_______________________________________________________________________________________________________________________

KEYWORDS: hyperbaric oxygenation, intravenous infusion, hyperbaric oxygen therapy, drug infusion system

Copyright 2016 Undersea & Hyperbaric Medical Society, Inc.

UHM 2016, Vol. 43, No. 1 THREE INFUSION PUMPS FOR MONOPLACE CHAMBERS
Facilities in the United States with monoplace
hyperbaric chambers have used the IVAC 530 (IVAC
Corporation, San Diego, California), the Hospira (formerly Abbott) Lifecare Hyperbaric Pump (Hospira,
Chicago, Illinois), and the Baxter Flo-Gard 6201
(Baxter Healthcare Corporation, Deerfield, IL) [1214]. Of these pumps, only the Lifecare Hyperbaric was
cleared by the FDA for hyperbaric chamber use, and
only the Flo-Gard 6201 is currently available (secondhand and unsupported by the manufacturer). For
monoplace chamber use, the Baxter Flo-Gard 6201
downstream occlusion setting must be increased for
hyperbaric operation [12].
In 2008, FDA cleared the Hospira Plum A+ Hyperbaric infusion pump for monoplace and multiplace use.
Hospira retired this device in 2014 and stopped selling
the associated infusion sets a few months later [15].
Following the pumps retirement, we searched for an
FDA-cleared infusion pump that could be used with
monoplace chambers.
We contacted ECRI Institute (Plymouth Meeting,
Pennsylvania, formerly, Emergency Care Research
Institute) for large-volume infusion pumps options with
configurable downstream occlusion settings. ECRI
Institute suggested the Z-800F (Zyno Medical LLC,
Natick, Massachusetts) and provided contact information for the pump manufacturer. We also learned that
a hyperbaric facility in Europe used the CME 323
Bodyguard Color Vision infusion pumps (Caesarea
Medical Electronics, Caesarea, Israel) with monoplace
chambers, although this pump is not yet FDA-cleared
for marketing in the United States. We evaluated
the performance of these two infusion pumps with
monoplace chambers, along with the Flo-Gard 6201
under a variety of infusion conditions.
METHODS
After the candidate pumps were identified, we contacted the pump manufacturers to request the loan of
equipment for testing. Both manufacturers agreed to
loan a pump and provide infusion sets for this testing.
Caesarea Medical Equipment also provided the proprietary software for management of the occlusion
setting. The Baxter Flo-Gard 6201 was used from our
own stock. The tested pumps, specifications and FDA
clearance status are presented in Table 1. ECRI In-

10

stitute provided its internal evaluation procedure for

large-volume infusion pump [16]; however, because
of our measurement equipment setup, we did not
have the precision capability to fully follow their acceptance criteria of 5% accuracy at low flow rates.
Our hospitals clinical engineering department performed standard acceptance inspection for new equipment and approved the loaned pumps for testing by
the hyperbaric department. We reviewed the operator
and service manuals and met with Zyno Medical representatives for training on the Z-800F. Training was not
available for the CME Body Guard 323 Color Vision.
We completed practice runs on both pumps at various
settings and conditions to reduce operator error during
testing.
Equipment setup
Our Baxter Flo-Gard 6201 occlusion had been previously set to greater than 30 pounds per square inch gauge
(psig) [12]. Using the technician code supplied in the
product manual [17], we reset the CME Body Guard
323 Color Vision downstream occlusion to the maximum setting, 2000 mmHg (38.7 psig). To accommodate a 3-atmosphere absolute target chamber pressure at
our altitude (0.85 atm abs requires pressurizing the
chamber to 32 psig/44.1 psia), we disabled the upper
occlusion setting (30 psig) on the Z-800F using the
technicians code provided by the manufacturer [18].
For pressures less than 3 atm abs, we used the configurable occlusion settings available on the pump.
The pumps remained plugged into 110-volt electrical
power during all experiments.
We infused normal saline (1-liter bags) using each
manufacturers recommended proprietary infusion set
(Baxter Interlink System Continu-Flo Solution Set Ref.
2C6537s, Baxter Healthcare Corporation, Deerfield,
Illinois) (CME non-sterile sample infusion sets, Caesarea
Medical Electronics, Caesarea, Israel) (Zyno Medical
Administration Set B2-70071-P, Zyno Medical LLC,
Natick, Massachusetts) (Figure 1). As is our standard
clinical practice, we used small-bore neonatal pressure monitoring line tubing (#197822, Argon Medical
Devices, Athens, TX) to connect the Baxter and Zyno
pumps to a 3-way stopcock at the chamber door, with
the shortest possible length of the pump manufacturers
tubing exiting the pump discharge to reduce tubing dis-

Bell J, Weaver LK, Deru K

__________________________________________________________________________________________________________________________________________________________

Table 1: Comparison of Infusion Pumps

Pump

FDA 510(K)

Specifications

Baxter Healthcare
Corporation
Deerfield, Illinois

K915522

Pump type
linear peristaltic

Not cleared for

hyperbaric use

Pump tested
Flo-Gard 6201
Not currently
manufactured or
supported but infusion
sets are available

Flow rate
0.1-99.9 mL/hr in 0.1 mL increments
1-9999 mL/hr in 1 mL increments
Free-flow protection
set-based
Configurable occlusion setting
approximately 6-17 psig
occlusion setting can be mechanically
reset to >30 psig
Battery type
12 Volt, 2.0 Ah sealed lead-acid

__________________________________________________________________________________________________________________________________________________________

Caesarea Medical
Electronics
Caesarea, Israel

No FDA 510(K)
at this time

Pump type
piston pump

Pump tested
Body Guard 323
Color Vision CE

Flow rate
0.1-99.9 mL/hr in 0.1 mL increments
1-9999 mL/hr in 1 mL increments

BodyGuard 323 Color

Vision is not currently
available in the USA

Free-flow protection
set-based
Configurable occlusion setting
100 to 2000 mmHg
Battery type
rechargeable Li-polymer 7.4v or
two 9v alkaline battery pack

__________________________________________________________________________________________________________________________________________________________

Zyno Medical, LLC

Natick, Massachusetts
Pump tested
Z-800F

K130690
Not cleared for
hyperbaric use

Pump type
linear peristaltic
Flow rate
1-1200 mL/hr in 1 mL increments
Free-flow protection
set-based
Configurable occlusion setting
4 to 30 psig
Battery type
rechargeable nickel-metal-hydride

__________________________________________________________________________________________________________________________________________________________

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11

UHM 2016, Vol. 43, No. 1 THREE INFUSION PUMPS FOR MONOPLACE CHAMBERS
tention from back pressure [11, 12]. The CME infusion
set did not allow for this option, and that tubing ran the
full length from the pump to the 3-way stopcock at the
chamber hatch. Infusion sets and tubing were changed
every 72 hours in accordance with hospital policy.
The IV tubing from each pump was connected to a hyperbaric IV extension kit (pass-through) (041600503A,
Argon Medical Devices, Athens, Texas), passed through
the hatch of a 32-inch monoplace hyperbaric chamber
(3200, Sechrist Industries, Anaheim, California) in the
standard fashion (Figure 1). The extension kit tubing
was then luer-locked into a collection manifold consisting of three three-way stopcocks (AG7934, ICU
Medical, San Clemente, California) attached to 3-, 5-,
10- and 50-mL syringes with the plungers removed
(BD, Franklin Lakes, New Jersey). Air in the lines was
removed and saline brought to the zero level using a
flush syringe (306546, BD, Franklin Lakes, New
Jersey) on each three-way stopcock.
We tested pump performance at a range of flow rates
(1-, 2-, 5-, 10- and 100-mL/hour) at ambient pressure
and 2, 2.4, and 3 atm abs (Table 2). The chamber was
pressurized at 5 psi/minute, and pressure was measured using a digital absolute pressure gauge (DPG1000B100PSIA5, Cecomp Electronics, Libertyville,
Illinois) [16]. Some runs included 15-30 minutes of data
collection at ambient pressure to verify pump performance under normal conditions (Table 2). For the 30-60
minute tests at 2.0-3 atm abs, we turned the pump off
before chamber decompression to assess tubing distension, but for the longer carbon monoxide hyperbaric
oxygen treatment profile runs (140 minutes) [19], the
pump was left running through decompression (Table 2).
We recorded the saline volume delivered to the syringe manifold inside the chamber. Actual volumes
delivered were averaged for each flow rate and time
point and compared to the volume expected to be
delivered based on the programmed flow rate.
RESULTS
We collected data for 70 trials at ambient pressure
(30 minutes each). The mean delivered volumes at
30 minutes were very near expected for all flow rates
(Table 3). While 24 of 70 trials were not within 5%,
our experiment was not set up to measure volumes

12

with the necessary precision to validate the pumps

against this standard.
At 1 mL/hour, no saline was infused during the
initial 10-minute period that included pressurization
for 2.4 atm abs and 3 atm abs trials, and because the
experiment was open to the chamber atmosphere,
some saline flowed back toward the pump in a retrograde fashion (Figure 2). During six of the nine trials
at 2 atm abs (Figure 2), no saline was delivered during
the initial 10-minute interval that included pressurization. Saline was delivered during compression
in two of three Zyno trials and one of three Baxter
trials at 2 atm abs At decompression, all pumps
delivered a bolus infusion, even though the pump was
stopped (mean bolus volume 0.3 mL, range 0.1-0.6 mL).
At 2 mL/hour (Figure 2), no pump delivered saline during the 10-minute period that included pressurization for the 3-atm abs trials. The Zyno pump
delivered saline during this interval at 2.4 atm abs
during all three trials, but the Baxter and CME pumps
did not. At 2 atm abs, the Zyno pump delivered saline
during all three trials, and the Baxter and CME pumps
each delivered saline for one of three trials. The mean
decompression bolus was 0.3 mL, range 0.1-0.6 mL.
The 5-mL/hour and 10-mL/hour (Figure 3) flow rates
were fast enough to overcome the pressure gradient
during chamber pressurization. All pumps delivered
saline during this interval on all trials (Figure 3). The
decompression bolus for 5 mL/hour was influenced by
chamber pressure: mean bolus for 3 atm abs 0.6 mL
(range 0.3-1.0 mL); for 2.4 atm abs 0.3 mL (range 0.20.4 mL); and for 2 atm abs 0.1 mL (range 0.1-0.3 mL).
At 10 mL/hour, the mean decompression bolus was
0.4 mL for 3 atm abs (range 0.1-0.6 mL), 0.2 for 2.4 atm
abs (range 0 to 0.4 mL), and 0.2 for 2 atm abs
(range 0.1-0.3 mL).
Saline was also delivered in the compression period
on 100 mL/hour trials (Figure 4). The decompression bolus could not be measured accurately during
these trials because the measurement precision was
limited to 1 mL increments. However, 5 of the 18 trials appeared to have a bolus of approximately 1 mL.
For the carbon monoxide protocol [19] trials (a single
trial for each pump at the two flow rates), saline delivery
was significantly delayed in all pumps when the flow rate

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Figure 1: Equipment setup

Chamber
hatch

normal
saline

Baxter Interlink
System Continu-o
Solution Set
2C6537s

Baxter
Flo-Gard 6201

Argon Neonatal Line

197822

Occlusion setting
>30 psig

normal
saline

CME Body
Guard 323
Color VisionTM

CME
Infusion Set
SAMPLE

CME Infusion Set

SAMPLE

Occlusion setting
2000 mmHg
normal
saline
Zyno 800-F
Zyno Medical
Administration Set
B2-70071-P

Occlusion setting
Congurable
up to 2.4 atm
Disabled at 3 atm

Argon Neonatal Line

197822

was set to 1 mL/hour (Figure 5). No measurable saline

was delivered by the Baxter for 20 minutes, the Zyno for
30 minutes, and the CME for 70 minutes. However, at 10
mL/hour, all pumps were delivering saline by the time the
chambers reached 3 ATA at 10 minutes, but at less than
the goal rate during the compression interval (Figure 5).
DISCUSSION
While the Baxter Flo-Gard 6201, CME Body Guard 323
Color Vision, and Zyno Z-800F are not cleared by the
FDA for use with monoplace or multiplace hyperbaric
chambers, these infusion pumps can be configured to
deliver infusions inside a monoplace chamber. Though
the Baxter Flo-Gard 6201 is not currently manufactured
or supported, it can be purchased aftermarket, with
the modifications necessary for monoplace hyperbaric

Argon Hyperbaric
IV Extension Kits
041600503A

3-way stopcock
with open,
zeroed syringe

chamber use. The CME Body Guard 323 Color Vision

is not currently marketed in the United States, but its
configuration software allows the occlusion setting to
be adjusted up to 2000 mmHg (38.7 psig). The Zyno
Z-800F is sold in the United States and has a configurable occlusion setting of 4-30 psig, which can
be disabled if higher operating pressure is needed.
ECRI Institute has evaluated the Zyno Z-800F at
atmospheric pressure and found its flow accuracy
to be within 5% accuracy [20].
Our testing demonstrates that these pumps are generally satisfactory for infusions at flow rates of 5 mL/
hour or greater and chamber pressures up to 3 atm abs.
In previous testing of other infusion pumps for monoplace chamber use, tubing compliance resulted in little
or no saline delivery during compression and boluses
continued on Page 637

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Table 2: Summary of test conditions

programmed chamber
flow rate
pressure
1 mL/hr
3 atm (44.1 psia)
2 mL/hr
2.4 atm (35.4 psia)
5 mL/hr
10 mL/hr

test
profile
Start pump
Atmospheric pressure for 30 minutes
Compression to target pressure at 5 psi/min
3 atm reached at minute 36
2.4 atm reached at minute 35
Maintain target pressure to minute 60
Stop pump
Decompress chamber

data recorded at
0 minutes (atmospheric pressure)
10 minutes (atmospheric pressure)
20 minutes (atmospheric pressure)
30 minutes (atmospheric pressure)
40 minutes (target pressure)
50 minutes (target pressure)
60 minutes (target pressure)
After chamber decompression

_______________________________________________________________________________________________________________________________

2 atm (29.4 psia)
Start pump

Compression to target pressure at 5 psi/min

2 atm reached at minute 4

Maintain target pressure to minute 60

Stop pump

Decompress chamber

0 minutes (atmospheric pressure)

10 minutes (target pressure)
20 minutes (target pressure)
30 minutes (target pressure)
40 minutes (target pressure)
50 minutes (target pressure)
60 minutes (target pressure)
After chamber decompression

100 mL/hr
2.4 atm (35.4 psia)

2 atm (29.4 psia)

0 minutes (atmospheric pressure)

15 minutes (atmospheric pressure)
25 minutes (target pressure)
30 minutes (target pressure)
After chamber decompression

__________________________________________________________________________________________________________________________________________________

Start pump
Atmospheric pressure for 15 minutes
Compression to target pressure at 5 psi/min
2.4 atm reached at minute 20
2 atm reached at minute 18
Maintain target pressure to minute 30
Stop pump
Decompress chamber

__________________________________________________________________________________________________________________________________________________

1 mL/hr
Carbon monoxide profile
Start pump

Compress to 3 atm at 5 psi/min

3 atm reached at minute 6

Maintain 3 atm to minute 70

Decompress to 2 atm at 4 psi/min

Maintain at 2 atm to minute 135

Decompress chamber at 2 psi/min

Stop pump

0 minutes (atmospheric pressure)

10 minutes (3 atm)
20 minutes (3 atm)
30 minutes (3 atm)
40 minutes (3 atm)
50 minutes (3 atm)
60 minutes (3 atm)
70 minutes (3 atm)
75 minutes (2 atm)
135 minutes (2 atm)
145 minutes (atmospheric pressure)

10 mL/hr
Carbon monoxide profile

0 minutes (atmospheric pressure)

10 minutes (3 atm)
70 minutes (3 atm)
75 minutes (2 atm)
135 minutes (2 atm)
145 minutes (atmospheric pressure)

__________________________________________________________________________________________________________________________________________________

__________________________________________________________________________________________________________________________________________________

Table 3: Saline delivery at ambient pressure flow rate (mL/hr)

flow rate
pump
trials

mean volume
infused, mL
(% of expected)

Baxter
CME
Zyno

5
4
5

0.5 (100)
0.5 (100)
0.5 (100)

Baxter
CME
Zyno

6
6
6

1.0 (100)
1.1 (110)
1.0 (100)

flow rate
pump
trials

mean volume
infused, mL
(% of expected)

_______________________________________________________________________

Baxter 11 2.5 (100)

CME 7
2.6 (104)
Zyno 8
2.6 (104)

_______________________________________________________________________

10

Baxter 4
CME 4
Zyno 4

_______________________________________________________________________

5.0 (100)
5.3 (107)
5.2 (103)

_______________________________________________________________________

(30-minute infusion interval). Mean volumes are rounded to 1 significant digit, as we were unable to measure more precisely than per 0.1 mL.

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Figure 2: Mean saline delivery at 1 and 2 mL/hour for each of 3 infusion pumps.
1 mL/hour 3 atm abs

2 mL/hour 3 atm abs

1 mL/hour 2.4 atm abs

2 mL/hour 2.4 atm abs

1 mL/hour 2 atm abs

2 mL/hour 2 atm abs

During the 3-atm abs and 2.4-atm abs trials, the pumps ran at atmospheric pressure for 30 minutes, then the chamber
was compressed to the target pressure at 5 psi/minute. At Minute 60, the pumps were turned off, and the chamber was
decompressed. For the 2-atm abs trials, the pumps were turned on at chamber compression (5 psi/minute) and ran for
60 minutes. They were then turned off, and the chamber was decompressed.

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Figure 3: Mean saline delivery at 5 and 10 mL/hour for each of 3 infusion pumps.
5 mL/hour 3 atm abs

10 mL/hour 3 atm abs

5 mL/hour 2.4 atm abs

10 mL/hour 2.4 atm abs

5 ml/hour 2 atm abs

10 ml/hour 2 atm abs

During the 3-atm abs and 2.4-atm abs trials, the pumps ran at atmospheric pressure for 30 minutes, then the chamber
was compressed to the target pressure at 5 psi/minute. At Minute 60, the pumps were turned off, and the chamber was
decompressed. For the 2-atm abs trials, the pumps were turned on at chamber compression (5 psi/minute) and ran for
60 minutes. They were then turned off, and the chamber was decompressed.

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__________________________________________________________________________

Figure 4: Mean saline delivery at 100 mL/hour

for each of 3 infusion pumps

Figure 5: Mean saline delivery at 1 and 10 mL/hour

for each of 3 infusion pumps, under a carbon
monoxide treatment protocol

100 mL/hour 2.4 atm abs

1 mL/hour CO profile

100 mL/hour 2 atm abs

10 mL/hour CO profile

The pumps ran at atmospheric pressure for 15 minutes, then

the chamber was compressed to the target pressure at 5 psi/
minute. At Minute 30, the pumps were turned off, and the
chamber was decompressed.

The chamber was compressed to 3 atm abs at 5 psi/minute,

and the pumps were started when compression began.
At Minute 70, the chamber was decompressed from 3 atm abs
to 2 atm abs at 4 psi/minute. At Minute 135 the chamber was
decompressed from 2 atm abs to ambient pressure at 2 psi /
minute. At ambient pressure, the pumps were turned off, and
the volume delivered measured.

during decompression [11, 12], even when rigid smallbore tubing was used. Saline delivery during this
present study was also negatively affected by tubing
compliance. As the chamber pressure increased, the
IV tubing expanded and the delivery of saline was
reduced. During decompression, as the chamber pressure decreased, the extra saline in the expanded tubing
was delivered as a bolus to the saline collection apparatus even though the pump was turned off. This

effect was observed even with the rigid, smallbore tubing in this study for two of the pumps
and would be magnified with standard IV tubing.
Drugs that are infused at low flow rates (<5 mL/hour),
such as vasoactive drugs or insulin, are likely to have
reduced delivery during chamber compression. Therefore, patients would not receive the expected volume
of drug during chamber compression and could receive
a bolus of drug during decompression. Clinicians

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UHM 2016, Vol. 43, No. 1 THREE INFUSION PUMPS FOR MONOPLACE CHAMBERS
administering these types of drugs at low infusion
rates during hyperbaric oxygen treatment should appropriately monitor patients for unexpected or adverse
effects of delayed drug delivery or decompression
bolus. One solution to overcome this problem is to
increase a low infusion rate during compression and
decrease the rate with decompression, titrating the
IV infusion rate to a clinical effect.
Taking the availability issues and this functional
limitation into consideration, any of these pumps may
be used for the monoplace chamber. Other factors
influencing pump acquisition include battery life,
maintenance and support. All three pumps operate on
standard 110-volt electrical power and a self-contained
rechargeable battery. For this experiment, the pumps
were plugged into wall power, and we did not
evaluate battery life.
LIMITATIONS
This study is limited by the number of infusion trials
we were able to perform. We evaluated only a single
pump from each manufacturer, and a study evaluating
multiple pumps of the same model may have found
inter-pump variability. Our measurement precision was
also limited, as we took the measurements visually,
through the chamber acrylic, and could not make measurements more precise than by 0.1-mL increments
for low flow rate experiments. We also acknowledge
the possibility of human error in these measurements.
However, the magnitude of effect observed during
compression and decompression was well within our
capability to measure, even at low flow rates.

18

CONCLUSIONS
These three infusion pumps may be considered for
use by monoplace hyperbaric medicine departments
that treat patients who need intravenous infusions. For
hyperbaric practitioners in the United States the Z-800F
has a valid 510K number and is currently manufactured.
Although no longer manufactured or supported, the
Baxter Flo-Gard 6201 may be an alternative pump for
these practitioners. For services outside the United States,
the Body Guard 323 Color Vision can be considered.
Tubing compliance may affect drug delivery in
monoplace chambers, especially at low flow rates when
delivered volumes are minimal. We advise careful monitoring of patients receiving critical infusions, particularly during chamber compression and decompression.
Acknowledgments
The authors have received no financial support for this
research. Zyno Medical LLC, 177 Pine St., Natick, MA
01760, USA, and CME, Caesarea Medical Electronics,
16 Shacham St., POB 3009, Caesarea 3088900, Israel,
provided intravenous pumps by loan and donated infusions
sets for this investigation. ECRI Institute, 5200 Butler Pike,
Plymouth Meeting, PA 19462-1298, USA, provided
contact information and technical support.



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