The first steps in intravenous infusion date back to the 17th century and are a product of curiosity and the desire to experiment. Interestingly, these steps were not taken by doctors of that era (who were extremely fond of blood-letting as a solution to all evils) but rather by several of the founders of the Royal Society in London who began to experiment with using this technique on animals. More specifically, it was the renowned architect Christopher Wren that injected wine and beer into the veins of a dog in 1656 to examine the results. He used a pig’s bladder as a receptacle and a goose plume as a needle: experiments continued by his Royal Society colleagues Robert Boyle and Robert Hooke.
However, it was German doctors such as Johann Daniel Major – who described the method in humans in his Chirurgia infusoria in 1664 – and his contemporary Johann Sigismund Elsholtz that demonstrated its effectiveness in humans, leading the technique to spread widely among doctors of that era.
However, the fact that the causes of many infectious diseases were unknown and that the current notion of asepsis was lacking meant that the technique was rudimentary, and it led to infections that had a significant death rate among patients. It was not until the middle of the 19th century that the doctor Alexander Wood became the pioneer to use a hypodermic needle for the administration of intravenous drugs, with the French doctor Charles Gabriel Pravaz (1791-1855) designing a syringe – a precursor of current models – and therefore making the technique more widespread.
By the 1930s and 1940s, intravenous lines had begun to be used in anaesthetic induction with the introduction of thiopental.
During the Second World War, intravenous infusion was part of an important development when it was common to infuse a mixture of glucose and amino acids in those injured in war: a technique which presented certain difficulties due to the small calibre of peripherical veins used in those instances. This led to the first central line being channelled in 1945. In 1952, the venous-puncture technique in large-calibre veins was developed, which enabled the infusion of vesicant drugs, avoiding damage of endotelial cells that cover the inner layer of the vein.
Technology meets intravenous infusion
Intravenous infusion, up until the arrival of the first electromechanical pumps at the end of the 1960s, had previously been based on gravity. This involved using the classic “droppers”, in which the control of the infusion flow was highly imprecise. Despite this, these models continue to be used in cases when it is not practical to use an infusion pump or it is considered unnecessary, something that is still relatively common nowadays.
These days, almost all patients admitted to hospital receive a catheter in a peripheral vein (normally in the arm or the back of the hand) as part of the admittance routine. This enables the patient to keep an adequate hydration level through the continuous infusion of serum, in addition to providing a rapid and safe line for the intravenous administration of medication when this is necessary.
Infusion pumps, which arcomed was among the first to manufacture in 1974, spurred a revolution in the control of medication dosages and in the accuracy of their administration, which from then on became increasingly efficient and reliable.
Today infusion pumps have evolved into high-technology devices which are completely programmable and which, in the case of arcomed Chroma pumps, can be adapted to the requirements of any area of the hospital. These pumps have large libraries of drugs programmed according with the needs of every service, and incorporate pharmacokinetic infusion models in TCI (Target Controlled Infusion) mode and are also capable of wireless communication with one another, as well as connectivity with the hospital’s PDMS system for remote monitoring and control. The pumps enable patients to solicit analgesic boluses (PCA) and they incorporate the latest developments in visibility, ease of operation and systems preventing medication errors.
This is already the present. Can you imagine what the future will look like?