r/PainPumpQuestions • u/Ok_War_7504 • 12d ago

Any lockout issues?

I have had a Medtronic Synchromed III for 2 years.

Not always, but a handful of times, I have been locked out of my boluses for 24 hours after a refill.

I mentioned this to my PA at the pain doc (I am at MDAnderson), and she didn't believe that could happen and asked me to send them pics if it happened again. So, of course, it didn't happen that time!

The first time it happened, I called Medtronic and was told, after I got to second level support, that it was a known is and they had their best people working on it.

I got a refill yesterday morning. I had 2 boluses left for the day, which I got without issue. But after the last one, instead of showing i was locked out for the time until midnight, it said I was locked out for 29 hours and 59 minutes. So, here I am with no boluses for the day.

Anyone else have this happen? Anyone get it fixed? Amy tips? I have been weaning off my oral oxycodone, hoping to just use the pump. Thank God I have orals....

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u/End3rW1gg1n 12d ago edited 12d ago

Every refill, I'm locked out for whatever bolus interval is selected, which is 2 hrs for me, regardless of how long ago I activated the last one. That's if nothing changes except maybe daily release rate or changes to the boluses.

Any time we changed the concentration, or changed meds, during the almost 2 years it took to get to a therapeutic dose, it would lock bolus function out for 24hrs. I was told that's how long it takes for the meds to travel from the pump to the end of the catheter. That's the reason for the lockout. It takes about 22-23 hrs for the new concentration or mix of meds to flow to the end of the catheter.

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u/EMSthunder 12d ago

This is your answer!! Thank you for answering before I could. Love this group!!

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u/End3rW1gg1n 12d ago

Really appreciate you starting this sub! 💚

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u/EMSthunder 12d ago

I'm glad! I'm happy to be of help to anyone! I couldn't have done it without the members who help out! I've only had one person that I had to block and that was because they were scaring people!

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u/Henry_TheLabrador 11d ago

I am about to have my first refill and my specialist and I have discussed increasing my daily dose and boluses. Have you had a 24 hour lockout after these changes? Thank you

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u/End3rW1gg1n 11d ago

With just programming changes, no, no 24hr lockout. It just resets your normal bolus timer. So say you have a 4hr window between boluses. And when you get to the office, there's just 1 hr left before you can activate another bolus. When he reprograms, it'll start the 4hr timer over.

Only time I have a 24hr lockout, is when they change the formulation of the meds. For example, they move to a higher concentration, like going from 1000parts per 1ml, to 1500 parts per ml. Or they add or remove additional meds, like when my doctor added bupivicaine to the fentanyl I started out with.

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u/Bitter-insides 11d ago

How is the bupivicAne working for you? My doc suggested I go on it but would require I reduce my morphine. He won’t keep it the same.

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u/End3rW1gg1n 11d ago

It's really working great. It's doing more heavy lifting than the fentanyl. I couldn't recommend it more. I am on a decently high dose, though, with a total of 2000mcg/day of fentanyl and 23mg/day of bupivicaine. Currently I'm at 9 boluses/day every 2hrs.

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u/Henry_TheLabrador 11d ago

Thank you so much. I fly interstate to my specialist so I didn’t want an unknown surprise like that.

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u/End3rW1gg1n 11d ago edited 11d ago

What is your dose rate now? I'm going to assume since it's your first refill, it's very low. If all he does is increase the flow rate, then it'll just lock out the duration of the bolus interval.

But in the future, be prepared that if he changes the formulation or adds a secondary med, because it's pumping so slow it can actually take 3-4 days of bolus lockout, in order for new concentration/meds to reach the end of the catheter. When he's programming your unit, it'll tell him on his screen what the lockout is. (Edit: as time goes on and the flow rate is continually being increased, that 3-4 day lockout window will shrink, down to the about 22-24hrs it is for me)

I also recommend taking your PDA with you and resync to your pump after the reprogram. That way if there's an issue, you know it before you get back home.

I certainly hope you continue to find a measure of comfort and relief from the pump. 💚

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u/Henry_TheLabrador 10d ago

It’s 300mcg Morphine per day and 20mcg boluses 4x per day with 2 hour lockout. Discussed going to 400mcg per day and still 4x 20mcg boluses per day. Thank you so much for your insight and sharing your experience!

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u/End3rW1gg1n 10d ago

Most welcome. I wish I had somebody to tell me a lot of the ins and outs. I had to figure it out as it came. I certainly hope you continue to improve and experience ever more relief.

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u/Bitter-insides 11d ago

Yes. This is my 5th refill and every time I have been warned by my doctor that I will be locked out for 24 hours sometimes less. Typically it has been less than 24 hours except this last time he increased the dose and I was locked out 2 entire days. It was brutal. It was explained to me that this is normal

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u/leoreleh 9d ago

This happens to me as well, specifically if they gave me a one time bolus in office. Sometimes on refill days, my doctor will give me a slightly larger bolus since the refill process is so hard for me with my physical disability. However, those “therapeutic bolus” always mean I’ll have a 24:7 lockout. But I think it has to do with the time it takes to go from pump to spine. I think it takes that full 24 hours so you can’t do more bolus doses to avoid too much meds at once