Table 6.

Diagnostic Approach to IDDS Failure

Initial evaluation, including patient history will often identify the source of the problem

Verification of pump contents, volume and pump setting is the critical initial step

Plain x-ray (PA and Lateral to visualize the entire catheter)

Serial x-ray or fluoroscopy to confirm that the pump roller is moving at the expected rate

Magnetic resonance imaging (MRI) study

Catheter access port aspiration

Nuclear medicine scan

Fluid collection assay

Note: Reproduced with permission from Smith TJ, Staats PS, Deer T, et al. Randomized clinical trial of an implantable drug delivery system compared with comprehensive medical management for refractory cancer pain: impact on pain, drug-related toxicity, and survival. J Clin Oncol. 2002;20(19):4040–4049.¹⁰² https://ascopubs.org/journal/jco.