There is a maintenance program associated with treating spasticity or other forms of hypertonia with intrathecal baclofen. The pump's reservoir will hold enough medication for one to three months’ use. An alarm within the pump will sound (audible beeping) when the volume of medication drops below a certain defined amount. Parents can discuss what this amount should be with their physician, as it is a simple matter to customize the point at which you wish the alarm to go off, thus giving an appropriate amount of time to schedule a refill. Parents can also be told at the time of reservoir refill how long it will last and when they should have it refilled.
The refilling of the reservoir is a straightforward matter. A refill kit is available with medication in one of two concentrations. The physician will know which is best for the patient. The kit also contains materials needed to inject the medication into the pump's reservoir as well as to clean the skin overlying it.
As an initial step for refilling the pump, the computer's antenna is used to read information from the pump about how much drug remains, its concentration and the rate at which the drug is being delivered. This is reviewed for any changes that might be felt to be appropriate.
In the center of the pump is a raised portion that outlines the self-sealing rubber septum. The individual refilling the pump will first palpate this or use a template that comes with the refill kit to determine where the septum is. After cleaning the skin, a needle is inserted thought the skin and septum into the pump's reservoir. The reservoir is then emptied, and the volume of drug removed is compared with what the pump has told the computer should be present. This is done to check the accuracy of the pump and its drug delivery system. The reservoir is then refilled with new drug, and changes are made to the delivery rate of the pump as felt to be appropriate using the computer and its antenna after the needle has been removed.
It is not unusual for there to be a period of adjustment that results in the body's needing increasing amounts of the drug over the first several months of its use before a steady state is reached. If this occurs, frequent visits to the physician's office may be required to reprogram the pump.