As far as treatment with an apomorphine pump is concerned, there appear to be two different manufacturers (at least as far as I’ve found), namely the So Connect pump and the Crono Par 4 pump. One of them is slightly smaller (the Crono PAR). Can you choose which one you want? I’m also wondering what complications might arise if the small subcutaneous ‘needle/insertion site’ is too long? If a drop of blood comes out when you remove it, does that mean it hasn’t gone subcutaneously but directly into the bloodstream? If so, is that dangerous or worse? Kind regards, a woman who has just started pump treatment.

There are two pumps on the market that are designed for the infusion of apomorphine. There are three manufacturers of the medicine with the same concentration of 5 mg/mL, but the packaging and reservoirs for the pumps differ. In principle, it is possible to switch between different manufacturers, but this involves handling the medicine in a way that risks causing contamination and spillage, which can lead to staining of the home and clothing. The choice of pump or supplier is usually based on contracts and procurement processes; some regions have procured both pump types and the appropriate accessories, whilst others have procured only one of the systems. There is no significant difference in function between them.
If severe and intense skin reactions to a formulation of the medicine Apomorphine/Dacepton occur, it may be worth trying a different formulation, as the composition differs slightly between the three manufacturers, although the active ingredient is the same.

As regards the infusion needle, it is intended to be placed ‘subcutaneously’, i.e. in the subcutaneous tissue and usually in the connective tissue/fat layer. A needle placed too deeply ends up in muscle tissue, which has a lower absorption rate and usually causes more pain. The absorption of the medicine from the pump into the bloodstream is ‘slower’ and more gradual if the needle is in muscle tissue compared to under the skin. The effect of a given dose is then slower and may result in a poorer overall effect, which is why this should be avoided. However, nothing can happen that would cause harm or injury. Blood on the tip of the needle probably indicates that the tip has entered muscle tissue, which has more small blood vessels than the subcutaneous tissue, but this is not serious. Apomorphine is absorbed into the bloodstream via the blood vessels, so it is not dangerous if small amounts were to enter the bloodstream directly, although this is less likely to happen.

There are many different types of cannulas, needles and various aids available for this purpose, and the staff who started your pump treatment may be able to assist you with these.

/Håkan Widner