Hepatic Arterial Infusion (HAI) Chemotherapy: Role of Infusion Pumps

What Is HAI?

Hepatic Arterial Infusion delivers chemotherapy directly into the hepatic artery, which supplies ~75% of liver blood flow (vs. 25% portal venous). Tumors derive >90% of blood supply from hepatic artery → high tumor drug concentration, low systemic exposure.

Infusion Pump Functions in HAI

Common HAI Agents & Regimens

• Floxuridine (FUDR): Classic HAI agent; continuous infusion via implanted pump; requires hepatic function monitoring.
• Oxaliplatin, Irinotecan, Gemcitabine: Investigated in modern protocols.
• Heparin: Co-infused (500–1000 U/hr) to prevent hepatic artery thrombosis.

Clinical Outcomes

• Higher response rates in colorectal liver metastases vs. systemic chemo alone.
• Conversion to resectability in initially unresectable disease.
• Reduced systemic side effects (alopecia, myelosuppression, neuropathy).
• Requires specialized surgical placement (gastroduodenal artery ligation, catheter positioning) and multidisciplinary management.

Pump Types

• Implantable (e.g., Codman 3000, Medtronic SynchroMed): Subcutaneous pocket, refilled percutaneously; months-years.
• External Ambulatory (e.g., CADD-Solis, BodyGuard): Short-term, wearable.

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Function	Benefit
Precise Flow Control	Maintains constant drug concentration; avoids peaks (toxicity) and troughs (subtherapeutic).
Programmable Schedules	Complex regimens (continuous, pulsed, cyclic) executed accurately.
Adjustable Rates	Real-time dose modification based on toxicity/response.
Safety Alarms	Occlusion, air-in-line, low battery, reservoir empty, pressure limits – prevent over/under-dosing.
Portability (Ambulatory Pumps)	Patient mobility, outpatient treatment, quality of life.
Multi-Channel Capability	Simultaneous infusion of chemo + heparin (catheter patency) + other meds.