Patent Publication Number: US-2023137546-A1

Title: Alarm system for intravenous pump or catheter based upon fuzzy logic

Description:
CROSS-REFERENCE TO RELATED APPLICATIONS 
     This application is a continuation of U.S. application Ser. No. 16/609,152, filed Oct. 28, 2019, which is a National Stage of International No. PCT/US2018/029901, filed on Apr. 27, 2018, which claims the benefit of Provisional Application No. 62/491,865, filed Apr. 28, 2017, the entire disclosures of which are hereby incorporated by reference herein for all purposes. 
    
    
     SUMMARY 
     This summary is provided to introduce a selection of concepts in a simplified form that are further described below in the Detailed Description. This summary is not intended to identify key features of the claimed subject matter, nor is it intended to be used as an aid in determining the scope of the claimed subject matter. 
     In some embodiments, a self-monitoring intravenous catheter system is provided. The self-monitoring intravenous catheter system comprises a catheter having a proximal portion and a distal end; a pump device coupled to the proximal portion of the catheter; and a set of sensors, including at least an oximeter and a pH sensor located at the distal end of the catheter. 
     In some embodiments, an alarm controller for a self-monitoring intravenous catheter system is provided. The alarm controller comprises at least one processor; a sensor interface configured to receive signals from at least an oximeter and a pH sensor; and a nontransitory computer-readable medium. The computer-readable medium has computer-executable instructions stored thereon which, in response to execution by the at least one processor, cause the alarm controller to monitor the signals from at least the oximeter and the pH sensor; and in response to determining that the signals indicate a failure of a catheter, cause an alert to be presented. 
     In some embodiments, a catheter is provided. The catheter comprises a tube having a proximal portion and a distal end; an oximeter located at the distal end of the tube; and a pH sensor located at the distal end of the tube. 
     In some embodiments, a method of automatically monitoring a status of an intravenous catheter is provided. A processor of an alarm controller receives a set of signals from at least one of a pH sensor and an oximeter. The processor performs a fuzzy logic analysis based on the signals to determine a catheter status value. In response to determining that the catheter status value indicates failure of the catheter, the processor causes an alert to be presented. In some embodiments, a nontransitory computer-readable medium having instructions stored thereon which, in response to execution by one or more processors of an alarm controller, cause the alarm controller to perform such a method. In some embodiments, an alarm controller is provided that comprises at least one processor, a sensor interface configured to receive signals from at least an oximeter and a pH sensor, and a nontransitory computer-readable medium having computer-executable instructions stored thereon which, in response to execution by the at least one processor, cause the alarm controller to perform such a method. 
    
    
     
       DESCRIPTION OF THE DRAWINGS 
       The foregoing aspects and many of the attendant advantages of this invention will become more readily appreciated as the same become better understood by reference to the following detailed description, when taken in conjunction with the accompanying drawings, wherein: 
         FIG.  1    is a schematic diagram that illustrates the use of an example embodiment of a self-monitoring intravenous catheter and pump system according to various aspects of the present disclosure; 
         FIG.  2    is a block diagram that illustrates component details of an example embodiment of a self-monitoring intravenous catheter system according to various aspects of the present disclosure; 
         FIG.  3    is a schematic diagram that illustrates component details of an example embodiment of a catheter for use with a self-monitoring intravenous catheter system according to various aspects of the present disclosure; 
         FIGS.  4 A- 4 B  are a flowchart that illustrates an example embodiment of a method of automatically monitoring a status of an intravenous catheter according to various aspects of the present disclosure; 
         FIGS.  5 A- 5 C  are charts that illustrate examples of the assignment of fuzzy linguistic values according to various aspects of the present disclosure; 
         FIGS.  6 A- 6 B  are a flowchart that illustrates an example embodiment of a procedure executed by an alarm controller for evaluating a set of rules using fuzzy linguistic values according to various aspects of the present disclosure; and 
         FIG.  7    is a block diagram that illustrates aspects of an exemplary computing device  700  appropriate for use as a computing device of the present disclosure. 
     
    
    
     DETAILED DESCRIPTION 
     Peripheral venous catheters in sick infants are necessary for the delivery of fluids, nutrition, and medications. Peripheral intravenous (“PIV”) catheters have been associated with extravasation, edema, sequestration of medications and caustic solutions, and skin necrosis. Peripherally inserted central venous catheters (“PICC”) have been associated with leaking, obstruction, infection, cardiac tamponade, neurological problems, and even death. Iatrogenic sequelae from PIV&#39;s and PICC&#39;s have been identified as one of the leading causes of adverse incidents and injury in hospitals, with rates as high as 78% and 62%, respectively. 
     Methods to increase the survival of intravenous infusion sites in neonatal populations have included avoidance of hyperosmolar solutions, neutralization of total parenteral nutrition, addition of heparin, implementation of inline filtration, amoxicillin prophylaxis, and aseptic techniques for insertion and catheter maintenance. Rescue interventions for occluded catheters have included flushing with saline, heparin, urokinase, and alteplase. Conscientious monitoring for signs of complications has been recommended as a way to reduce morbidity and mortality related to PIV&#39;s and PICC&#39;s in the NICU. Similar interventions may improve survival in other populations, as well. Presently, monitoring systems are dependent upon in-line measures of intraluminal pressure and resistance to trigger alarms when outside preset limits. However, in a few, limited studies, pressure or resistance measures or alarms have not been shown to be predictive of IV infiltration but may ring only after the extravasation, when the pressure in the tissue compartment has increased. Pressure is just one of various factors that affect the physics of flow of the neonatal PIV catheter and infusion pump system. These factors include fluid flow rate, pressure, resistance, viscosity, and the length of each component of the IV administration system. In older populations, pressure has been studied as a possible predictor of impending catheter infusion failure, but in the neonatal population, these principles have limited applicability since the overall flow rates, in most cases, are relatively low. 
     Infants cannot speak for themselves and cannot call for help when experiencing the initial signs of discomfort, pain, edema, or erythema, making this problem particularly acute in the neonatal population. Therefore, it would be desirable for an intravenous pump system to be outfitted with an alarm which can alert a health care provider to impending catheter failure in infants and other patients. The problem is to use variables whose characteristics are different when IV catheters are about to fail versus when they are situated properly. 
     There have been few published studies of monitoring as a way to detect problems with intravenous catheters. Phelps et al. studied intraluminal pressure in 44 infants and resistance in 52 infants under one year of age (median, 1 month) and found that intraluminal pressure changes predicted only 25% and resistance changes predicted 4% of PIV infiltrations. Fluid flow in the human intravenous system has been represented by a model which depicts physical devices as ideal resistors, pressure sources, and flow sources, and the venous system as a combination of ordinary and Starling resistors (Philip, 1989). Normal intravenous flows can be represented by the pressure-flow relationship where pressure=flow×resistance. However, it has been suggested that the current infusion devices may not behave as predicted during adverse situations because of physiological changes, which affect the pressure-flow relationship. During extravasation, tissue pressure is lower than venous pressure until the fluid fills the tissue compartment. This may explain why pressure or resistance measures or alarms have not been shown to be predictive of intravenous infiltration but may ring only after the extravasation, when the pressure in the tissue compartment has increased. 
     Although there are no published studies of measures of pH at the tip of the peripheral intravenous catheter, the normal pH of neonatal parenteral nutrition has been measured and determined to vary little, from one preparation facility. Porcelli et al. (2000) measured the pH of 135 samples of neonatal parenteral nutrition solution and developed a linear regression model, with which they predicted the pH of another 70 neonatal parenteral solutions. The measured pH was 5.364+0.110 (mean+SD, range 5.03-5.73). The absolute mean pH difference between the predicted and measured value for the 70 test samples was 0.04+0.04 (r2=0.77). 
     Based upon published theoretical causes, a neonatal PIV catheter may fail if occluded by various types of matter, either directly, as in the case of a fibrin clot, or indirectly, e.g. as a result of inflammation related to phlebitis after movement of the catheter (Ekelund, 1970; Maki, 1973; Peters, 1984; Pettit, 2003; Tobin, 1984; Wright, 1996). The pH of catheters about to fail, because of occlusion from fibrin, microbial matter, other foreign matter, or obstruction against tissue, may be different from those that are patent. To investigate this phenomenon, a study was conducted to measure the pH of PIV catheter tips removed from neonates because of failure versus elective removal. The study included a convenience sample of discarded PIV catheter tips (25G) after use from 47 neonates in a tertiary Level NICU. 
     Catheter infusion failure was defined as failure of a catheter infusion site to function while needed. Upon removal of a PIV catheter, one inch of the catheter tip was cut off and placed in a sterile test tube and labeled with catheter insertion date, removal date and reason for removal (Failure or Elective Removal) noted by the nurse who cared for the infant. The labeled catheter tips were tested in batches. One milliliter of sterile water was placed in a test tube and the pH of the solution was measured using a calibrated pH Meter (Oaklon Instruments, Vernon Hills, Ill.). The meter was calibrated, on each day of testing, with known calibrating solutions with pH of 4, 7, and 10. 
     Differences in pH between PIV catheters removed because of catheter infusion failure, versus electively, was compared using independent t-tests with significance alpha (two-sided)=0.05 and beta=0.20 (Hulley et al., 2007). There were 47 catheter tips collected in the convenience sample. Thirty-two were removed because of catheter infusion failure. Fifteen of the PIV catheters were removed, electively, because they were not needed. The pH (mean+S.D.) of PIV catheters removed because of failure was significantly lower than those removed electively (5.94±0.21, N=32 vs. 6.08±0.19, N=15; P=0.039). There was no significant difference in the time from removal to analysis between the catheters removed because of failure versus those removed electively. 
     The pH may have been lower in the catheter infusion failure group if there was material in the lumen at the tip, comprised of fibrin or other red blood cell products. It is known that serum acidification will occur in stored blood, over time, due to increased lactate, a metabolite of anaerobic metabolism of red blood cells. (Uvizl et al, 2011). The catheters removed electively, presumably, may have had fewer red blood cells, or other, material at the tips, since they were functioning without known problems at the time of removal. The catheter tips were analyzed in batches, but there was no significant difference in the time from removal to analysis between the groups. 
     The pH may have been lower in the catheter infusion failure group if there were some other material at the failed catheter tips with a pH that was lower than parenteral nutrition, which was infused via most of the PIVs, as common practice in the NICU where the samples were obtained. In Porcelli et al.&#39;s (2000) predictive regression modeling study, the neonatal parenteral solution pH of the total 205 samples was 5.36+0.11 (mean+SD, range 5.03-5.73). The pH of some of the catheter tips removed electively in this study were within range of predicted values for neonatal parenteral nutrition, which, we assume, was the solution which had infused through most of the catheters in the study. This is what we would expect if a catheter were removed electively, when it was still functioning. 
     If some process occurred that affected the lumen or tip of a catheter, resulting in catheter infusion failure, then the pH may be one of a number of characteristics that may change, whether or not this is due to fibrin, red blood cells, or other materials at the tip. It may not be necessary, ultimately, to identify the process that produced the change in pH. The finding that the pH of the catheter groups was different indicates that one may be able to differentiate between catheter tips that are occluded or obstructed from those that are operating properly in vivo. 
     In embodiments of the present disclosure, a self-monitoring intravenous catheter system is provided. The catheter may have sensors arranged at its distal end that are configured to measure various characteristics of the environment at the distal end of the catheter, such as a pH value or an oxygen saturation value. Fuzzy logic may then be used on these characteristics to indicate normal and abnormal conditions, and thereby provide alerts when a catheter is likely to fail. Such techniques can help avoid injury to patients caused by failed catheters, particularly in neonates and other patients that cannot communicate or understand the signs of catheter failure. Such techniques can also improve the administration of care, in that the automated detection of impending failure, instead of requiring a physical examination to detect failure, allows electronic alerts to be transmitted from a pump system to a remote monitoring location. By conducting the fuzzy logic analysis of pH, oxygen saturation, and pressure, the self-monitoring intravenous catheter system is given new functionality that was not currently present in intravenous catheter systems, at least in that previous systems could not accurately predict or detect catheter failure, particularly in neonates. 
       FIG.  1    is a schematic diagram that illustrates the use of an example embodiment of a self-monitoring intravenous catheter and pump system according to various aspects of the present disclosure. In some respects, the self-monitoring intravenous catheter and pump system  100  is similar to other infusion pump systems. For example, the system  100  includes a pump system  102  and a pump  104 . The pump  104  performs the physical act of pumping fluid through a catheter, while the pump system  102  provides control signals for controlling operation of the pump  104 . The catheter  108  is operably coupled to the pump  104 , such as having the catheter  108  physically threaded through a mechanism of the pump  104 . A proximal end of the catheter  108  is coupled to a fluid bag. A distal end of the catheter  108  is inserted into a blood vessel of a patient  90 . In use, the pump  104  applies pressure to fluid that enters the catheter from the fluid bag  110 , such as medication or parenteral nutrition solution, to cause the fluid to travel through the catheter  108  and into the patient  90 . The pump system  102  may have a variety of user interface devices thereon for controlling operation of the pump system  102  such as buttons or dials. The pump system  102  may also include a display  106  for presenting visual indicators of pump status, configuration values, alerts, warnings, and/or the like. Further details regarding the system  100  are described below. 
       FIG.  2    is a block diagram that illustrates component details of an example embodiment of a self-monitoring intravenous catheter system according to various aspects of the present disclosure. As shown, the system  100  includes a pump system  102  and a catheter  108 . A pump controller (not illustrated) of the pump system  102  controls operation of a pump  104 . The pump  104  includes a mechanism (not illustrated) that physically interacts with the catheter  108  to pump fluid through the catheter  108 . In some embodiments, the pump  104  includes a pressure sensor  208  configured to determine an amount of back pressure that is generated in the distal portion of the catheter  108 . This allows the pump system  102  to monitor and control the amount of fluid that is delivered. In some embodiments, the pressure sensor  208  may be located outside of the pump  104 , instead of inside of the pump  104  as illustrated. 
     As shown, the pump system  102  includes an alarm controller  210 , a memory  212 , a network interface  214 , and one or more alarm presentation devices  216 . In some embodiments, both the network interface  214  and the alarm presentation devices  216  may be present. In some embodiments, only one of the network interface  214  or the alarm presentation devices  216  may be present. 
     In some embodiments, the alarm controller  210  includes one or more computer processors configured to receive signals from one or more sensors and to process the signals to determine a state of the catheter  108 . In some embodiments, the processors of the alarm controller  210  may also be configured to cause visual or audible notifications to be presented based on the determined state of the catheter  108 . In some embodiments, the alarm controller  210  may include an ASIC, an FPGA, or other hardware device that has been configured to perform the tasks described herein. In some embodiments, the alarm controller  210  may be a general purpose processor that is configured to read instructions from a computer-readable medium to cause the alarm controller  210  to perform the tasks described herein. The computer-readable medium may be any type of computer-readable medium including but not limited to a ROM, an EEPROM, a flash memory, or a magnetic drive. 
     In some embodiments, the memory  212  is configured to store sensor values and other values determined by the alarm controller  210 , and to provide the stored values to the alarm controller  210  when requested. In some embodiments, the memory  212  may include any suitable form of computer-readable medium, including but not limited to a flash memory, a magnetic drive, or RAM. 
     In some embodiments, the alarm presentation devices  216  are configured to receive commands from the alarm controller  210  to present visual or audible notifications. In some embodiments, one or more alarm presentation devices  216  may be present. Some non-limiting examples of alarm presentation devices  216  include an LCD display, a touchscreen display, an indicator light, an LED display, and a loudspeaker. 
     In some embodiments, the network interface  214  is configured to receive commands from the alarm controller  210  for visual or audible notifications to be presented, and to transmit the commands to a remote computing device  218  via a network  92 . The remote computing device  218  may then present the notifications on a display or via a loudspeaker. The remote computing device  218  may also store the notifications for future reference. The network  92  may include any suitable types of wired or wireless network communication technologies, including but not limited to Ethernet, USB, Firewire, Bluetooth, WiFi, WiMAX, 3G, 4G, LTE, and the Internet, and the network interface  214  may be configured to communicate via one or more of these technologies. In some embodiments, the remote computing device  218  may be a desktop computing device, a laptop computing device, a tablet computing device, a smartphone, a server computing device, or a cloud computing service. In some embodiments, the pump system  102  may be located in a room with a patient, and the remote computing device  218  may be located at a remote monitoring station, such as a nurses&#39; station or a telehealth service center. 
     The catheter  108  includes a set of distal sensors  202  located at the distal end of the catheter  108 . As illustrated, the set of distal sensors  202  includes a pH sensor  206  to detect a pH value at the distal end of the catheter  108  and an oximeter  204  to detect an oxygen saturation value at the distal end of the catheter  108 . The oximeter  204  may be any suitable type of oximeter for use with a catheter, such as a CO-oximeter, and may measure any type of oxygen saturation (SO 2 ), such as arterial oxygen saturation (SaO 2 ) or venous oxygen saturation (SvO 2 ). In some embodiments, only one of the pH sensor  206  or the oximeter  204  may be present in the set of distal sensors  202 . In some embodiments, more sensors may be included in the set of distal sensors  202 . Further illustration and discussion of an example embodiment of the structure of the catheter  108  and the set of distal sensors  202  is provided below. 
     The set of sensors of the system  100 , including the set of distal sensors  202  and the pressure sensor  208 , all provide signals indicating values associated with the various sensors to the alarm controller  210 . The alarm controller  210  may store the values in the memory  212 . The alarm controller  210  may also convert the values into fuzzy linguistic values, which may also be stored in the memory  212 . The alarm controller  210  also processes the values in order to determine a state of the catheter  108 , and causes warnings and alerts to be presented by the alarm presentation devices  216  and/or the remote computing device  218  based on the determined state of the catheter  108 . A detailed description of processing performed by an example embodiment of the alarm controller  210  is provided below. 
       FIG.  3    is a schematic diagram that illustrates component details of an example embodiment of a catheter for use with a self-monitoring intravenous catheter system according to various aspects of the present disclosure. Details of the distal portion of the catheter  108  are shown in the FIGURE. Similar to many catheters, the catheter  108  includes a hub  301  and a tube  303 . Unlike other catheters, however, the catheter  108  includes one or more sensors  306  at the distal end of the tube  303 . In some embodiments, the sensors  306  are communicatively coupled to one or more conductors  302 ,  304  that travel back the length of the tube  303  and can be communicatively coupled to the alarm controller. In some embodiments, the conductors  302 ,  304  are embedded within the material of the tube  303  such that the interior area of the tube  303  is not reduced (thereby avoiding a restriction of fluid flow) and the exterior area of the tube  303  is not increased (thereby avoiding an increase in likelihood of damage to the blood vessel and/or surrounding tissue). In some embodiments, the conductors  302 ,  304  may be omitted if the sensors  306  can communicate wirelessly with the alarm controller  210 , either using a power source embedded within the sensors  306 , or by reflecting a signal from or drawing power from a wireless interrogation signal transmitted to the sensors  306 . 
     In some embodiments, more than one separate sensor device  306  may be located at the distal end of the tube  303 , such as separate oximeter and pH sensor devices. In some embodiments, an oximeter and a pH sensor may be combined into a single multi-modal sensor device positioned at the distal end of the tube  303 . As shown, in some embodiments the sensors  306  are located such that they wrap around a portion of a distal outer surface of the tube  303 , extending proximally for a suitable distance from the distal tip in order to obtain sensor values from the region immediately adjacent to the distal tip of the tube  303 . In some embodiments, the sensors  306  may also cover a flat surface of the distal tip of the tube  303 . 
     As shown, the distal tip of the catheter  108  is inserted into a blood vessel  94 . As discussed above, the presence of an obstruction  96  can cause the pH value, the oxygen saturation value, and/or the pressure value obtained by the sensors to change in ways that can be detected by the pump system  102 . Other failures, such as the distal tip of the catheter  108  passing through the blood vessel  94  into the surrounding tissue, can also be detected. 
       FIGS.  4 A- 4 B  are a flowchart that illustrates an example embodiment of a method of automatically monitoring a status of an intravenous catheter according to various aspects of the present disclosure. From a start block, the method  400  proceeds to block  402 , where a proximal portion of a catheter  108  having a set of sensors  202  located at a distal end of the catheter  108  is operably coupled to a pump system  102 . In some embodiments, the proximal portion of the catheter  108  may be fed through or placed within physical pump  104  as illustrated in  FIG.  1   . Though not illustrated in the flowchart, it is assumed that a furthest proximal end of the catheter  108  is connected to a fluid source to be administered. In some embodiments, operably coupling the catheter  108  to the pump system  102  includes communicatively coupling the set of sensors  202  to the alarm controller  210 . The communicative coupling may use any suitable technique, including but not limited to physically coupling the conductors  302 ,  304  of the tube  303  to an interface within the pump system  102 , wirelessly pairing the set of sensors  202  with the pump system  102 , or locating the conductors  302 ,  304  within the pump system such that the pump system  102  can inductively detect the signals generated in the conductors  302 ,  304  without a direct electrical connection. 
     At block  404 , the distal end of the catheter  108  is inserted into a patient. Techniques known to those of ordinary skill in the art for inserting catheters  108  into patients may be used. Further, traditional techniques known to those of ordinary skill in the art may be used to verify that the initial insertion of the catheter  108  was successful. If inserted correctly, the distal sensors  202  will be located within a target blood vessel. 
     The method  400  then proceeds through a continuation terminal (“terminal A”) to block  406 , where an alarm controller  210  of the pump system  102  receives a set of signals from at least the set of distal sensors  202 , the set of signals indicating a set of sensor values. In some embodiments, the signals may indicate analog values which are converted to digital values by the alarm controller  210 . In some embodiments, analog signals may pass through an A/D converter (not illustrated) before being received by the alarm controller  210 . In some embodiments, the set of signals may also include signals from sensors that are not located at the distal end of the catheter  108 , such as the pressure sensor  208 . 
     At block  408 , the alarm controller  210  stores the set of sensor values in a memory  212  of the pump system  102 . In some embodiments, the alarm controller  210  may store the set of sensor values as an entry in a time series stored in the memory  212 . In some embodiments, the entry may include a timestamp. In some embodiments, the entry may be appended to the time series without a timestamp, and a standard amount of time between sensor readings may be used to interpret the time series. At block  410 , the alarm controller  210  determines a rate of change of at least one sensor value of the set of sensor values, and stores the rate of change in the memory  212 . In some embodiments, the alarm controller  210  may use one or more previously stored sets of sensor values to determine the rate of change. 
     At block  412 , the alarm controller  210  assigns fuzzy linguistic values to the set of sensor values and the rate of change, and stores the fuzzy linguistic values in the memory. In some embodiments, the rate of change calculations may be optional, in which case fuzzy linguistic values may not be assigned or stored for the rate of change. 
       FIGS.  5 A- 5 C  are charts that illustrate examples of the assignment of fuzzy linguistic values according to various aspects of the present disclosure. In each of the charts, the horizontal axis represents a continuum of sensor values and is not to scale, and the vertical axis represents a level of confidence that a given linguistic value is associated with the sensor value on the horizontal axis. The level of confidence ranges from zero, indicating certainty that the associated condition is not present, to one, indicating certainty that the associated condition is present. 
       FIG.  5 A  illustrates an example of the assignment of fuzzy linguistic values to an oxygen saturation percentage (SO 2 ) sensor value. Three possible fuzzy linguistic values are illustrated: an SO 2  low linguistic value (illustrated by the solid line), an SO 2  medium linguistic value (illustrated by the regularly broken line), and an SO 2  high linguistic value (illustrated by the irregularly broken line). For the SO 2  low linguistic value, confidence starts at one, then falls off starting at a point before 60%, and ends up at zero after 60%. For the SO 2  medium linguistic value, confidence starts at zero, then starts rising at a point before 60%, and reaches one at a point between 60% and 85%. Confidence then starts falling at a subsequent point between 60% and 85%, and ends up at zero after 85%. For the SO 2  high linguistic value, confidence starts at zero, then begins to rise at a point before 85%, and ends up at one at a point after 85%. This results in SO 2  values below 60% to be associated with the SO 2  low linguistic value, SO 2  values between 60% and 85% to be associated with the SO 2  medium linguistic value, and SO 2  values above 85% to be associated with the SO 2  high linguistic value. The particular crossover values of 60% and 85% are an example only, and in some embodiments, these values may be lower or higher as appropriate. For example, the values of 60% and 85% may be useful for an embodiment in which SaO 2  (arterial oxygen saturation) is measured, while different values may be used for an embodiment in which SvO 2  (venous oxygen saturation) is measured. 
       FIG.  5 B  illustrates an example of the assignment of fuzzy linguistic values to a pH sensor value. Three possible fuzzy linguistic values are illustrated: a pH low linguistic value (illustrated by the solid line), a pH medium linguistic value (illustrated by the regularly broken line), and a pH high linguistic value (illustrated by the irregularly broken line). For the pH low linguistic value, confidence starts at one, then falls off starting at a point before 5.89, and ends up at zero after 5.89. For the pH medium linguistic value, confidence starts at zero, then starts rising at a point before 5.89, and reaches one at a point between 5.89 and 6.15. Confidence then starts falling at a subsequent point between 5.89 and 6.15, and ends up at zero after 6.15. For the pH high linguistic value, confidence starts at zero, then begins to rise at a point before 6.15, and ends up at one at a point after 6.15. This results in pH values below 5.89 to be associated with the pH low linguistic value, pH values between 5.89 and 6.15 to be associated with the pH medium linguistic value, and pH values above 6.15 to be associated with the pH high linguistic value. 
       FIG.  5 C  illustrates an example of the assignment of fuzzy linguistic values to a pressure sensor value. Three possible fuzzy linguistic values are illustrated: a pressure low linguistic value (illustrated by the solid line), a pressure medium linguistic value (illustrated by the regularly broken line), and a pressure high linguistic value (illustrated by the irregularly broken line). For the pressure low linguistic value, confidence starts at one, then falls off starting at a point before 0.12 psi, and ends up at zero after 0.12 psi. For the pressure medium linguistic value, confidence starts at zero, then starts rising at a point before 0.12 psi, and reaches one at a point between 0.12 psi and 0.8 psi. Confidence then starts falling at a subsequent point between 0.12 psi and 0.8 psi, and ends up at zero after 0.8 psi. For the pressure high linguistic value, confidence starts at zero, then begins to rise at a point before 0.8 psi, and ends up at one at a point after 0.8 psi. This results in pressure values below 0.12 psi to be associated with the pressure low linguistic value, pressure values between 0.12 psi and 0.8 psi to be associated with the pressure medium linguistic value, and pressure values above 0.8 psi to be associated with the pressure high linguistic value. 
     Though linear transitions between and within the high confidence regions and the low confidence regions are illustrated, in some embodiments, nonlinear transitions may be used, thereby moving the cross-over points which separate the linguistic values. Also, though the particular values listed above were determined experimentally to be appropriate for use in detecting arterial catheter status for neonates, they are examples only, and in some embodiments, other values may be used. At each transition point between linguistic values, a less than, less than or equal to, greater than, or greater than or equal to relationship may be used as appropriate. In some embodiments, particular values for these transition points may be modified by a user during use in order to adjust the sensitivity of the determinations to an appropriate level. 
     Returning to  FIG.  4 A , the method  400  then proceeds to a continuation terminal (“terminal B”). From terminal B ( FIG.  4 B ), the method  400  proceeds to procedure block  414 , where the alarm controller  210  evaluates a set of rules using the fuzzy linguistic values and, optionally, a set of previously stored fuzzy linguistic values. An output of the procedure is a catheter status value. In some embodiments, the catheter status value may be a catheter OK value, a catheter warning value, or a catheter failed value. In some embodiments, these values may be represented by fuzzy logic linguistic values. In some embodiments, these values may be represented by a numerical confidence value that is then compared to thresholds to determine whether a catheter OK value, a catheter warning value, or a catheter failed value is indicated. In some embodiments, the procedure called by procedure block  414  may store status information that persists between multiple loops of the method  400 . Any suitable procedure may be used to evaluate a set of rules using the fuzzy linguistic values. One example procedure is illustrated in  FIGS.  6 A- 6 B  and is described in further detail below. 
     After the procedure in procedure block  414  returns a catheter status value, the method  400  proceeds to decision block  416 , where a test is performed to determine whether the catheter status value is a catheter OK value indicating that the catheter has been confirmed to be correctly placed. If the catheter status value is a catheter OK value, then the result of the test at decision block  416  is YES, and the method  400  proceeds to decision block  420 . Otherwise, if the catheter status value is not a catheter OK value, then the result of the test at decision block  416  is NO, and the method  400  proceeds to block  418 . 
     At block  418 , the alarm controller  210  causes an alert to be presented. The alarm controller may cause the alert to be presented by transmitting a command to one or more alarm presentation devices  216  of the pump system  102 , by transmitting a command to a remote computing device  218  via the network interface  214  of the pump system  102 , or both. The alert itself could be a visual indicator to be presented by an indicator light or a display, a tone to be played by a loudspeaker, or both. In some embodiments, the type of alert presented may be determined by the catheter status value. For example, if the catheter status value is a catheter warning value, a first type of indicator may be displayed and/or a first tone may be played, while if the catheter status value is a catheter failed value, a second type of indicator may be displayed and/or a second tone may be played. The first type of indicator and the second type of indicator may differ by color (e.g., the first type of indicator may be yellow and the second type of indicator may be red), size, (e.g., the first type of indicator may be smaller than the second type of indicator), text description, brightness, or in any other suitable way. Likewise, the first tone and the second tone may differ by pitch, volume, rate of repetition, spoken message, or in any other suitable way. In some embodiments, the tone of an alert may change over time in order to draw attention to the alert if it is not cleared in a timely manner. 
     At block  420 , a determination is made regarding whether the method  400  should continue. In some embodiments, the method  400  may end after any alert is presented by block  418 , and may only loop or restart if manual intervention takes place to clear the alert. In some embodiments, the method  400  may end after a catheter failure alert is presented by block  418 , but may automatically continue if a catheter warning alert is presented or the catheter is OK. In some embodiments, the alert may be automatically cleared or silenced after a predetermined amount of time if method  400  does continue. In some embodiments, the particular behavior at decision block  420  made may be configurable by a user. If it is determined that the method  400  should continue, then the result of decision block  420  is YES, and the method  400  returns to terminal A. Otherwise, if it is determined that the method  400  should end, then the result of decision block  420  is NO, and the method  400  proceeds to an end block and terminates. 
       FIGS.  6 A- 6 B  are a flowchart that illustrates an example embodiment of a procedure executed by an alarm controller for evaluating a set of rules using fuzzy linguistic values according to various aspects of the present disclosure. The procedure  600  is an example of a procedure suitable for use at block  414  of  FIG.  4 B . One should note that though passive voice is used in the flowchart and in the following description to help clarify the description, it should be assumed that, unless specifically stated otherwise, the actions described are being performed by the alarm controller  210  (or the alarm controller  210  interacting with other components of the pump system  102 ). 
     The illustrated embodiment of the procedure  600  accepts as input fuzzy linguistic values that represent a pressure linguistic value, a pH linguistic value, and an SO 2  linguistic value. The possible values for the pressure linguistic value are a pressure high linguistic value, a pressure medium linguistic value, and a pressure low linguistic value. The possible values for the pH linguistic value are a pH high linguistic value, a pH medium linguistic value, and a pH low linguistic value. The possible values for the SO 2  linguistic value are an SO 2  high linguistic value, an SO 2  medium linguistic value, and an SO 2  low linguistic value. In some embodiments, one fuzzy linguistic value will be provided as input for each type of data. For example, an input set of fuzzy linguistic values will include only one value selected from the pressure high linguistic value, the pressure medium linguistic value, and the pressure low linguistic value; only one value selected from the pH high linguistic value, the pH medium linguistic value, and the pH low linguistic value; and only one value selected from the SO 2  high linguistic value, the SO 2  medium linguistic value, and the SO 2  low linguistic value. In some embodiments, the procedure  600  may receive the sensor values themselves as input, and may either determine the fuzzy linguistic values based thereon, or may directly compare the sensor values to threshold values in making its determinations without formally assigning fuzzy linguistic values. 
     Beginning in  FIG.  6 A , from a start block, the procedure  600  advances to block  602 , where a new set of fuzzy linguistic values is obtained. In some embodiments, the new set of fuzzy linguistic values may be the result of block  412  of the method  400  described above. In some embodiments, the new set of fuzzy linguistic values may be retrieved from the memory  212 , in which case the new set of fuzzy linguistic values may be the latest set of fuzzy linguistic values in a stored time series. 
     Next, at block  604 , a determination is made regarding whether a pressure low linguistic value or a pressure medium linguistic value is present. Determining whether a particular fuzzy linguistic value is present comprises determining whether the particular value is the value provided in the set of fuzzy linguistic values for that type of information. In other words, to determine whether a pressure low linguistic value is present, a determination is made regarding whether the pressure linguistic value in the set of fuzzy linguistic values is the pressure low linguistic value (instead of the pressure medium linguistic value or the pressure high linguistic value). If the pressure low linguistic value is present or the pressure medium linguistic value is present, then the result of subsequent decision block  606  is YES, and the procedure  600  advances to block  612 , where a high pressure duration timer is cleared, and then to block  614 . The high pressure duration time and block  614  are described separately below. If neither the pressure low linguistic value nor the pressure medium linguistic value is present (in other words, if the pressure high linguistic value is present), then the result of decision block  606  is NO, and the procedure  600  advances to block  608 . One of ordinary skill in the art will recognize that determining that neither a pressure low linguistic value is present nor a pressure medium linguistic value is present is equivalent to determining that a pressure high linguistic value is present, and that determining that either a pressure low linguistic value is present or a pressure medium linguistic value is present is equivalent to determining that a pressure high linguistic value is not present. 
     At block  608 , a determination is made regarding whether both of a pH high linguistic value and an SO 2  high linguistic value are present. If both are present, then the result of subsequent decision block  610  is YES, and the procedure  600  advances to block  614 . At block  614 , the procedure  600  has determined that the rules indicate that the status of the catheter remains acceptable because either (1) the pressure is low or medium, or (2) the pressure is high, but both of the pH and the SO 2  are high as well. Accordingly, at block  614 , a catheter OK value is returned as the result of the procedure  600 , and the procedure  600  advances to an exit block and terminates. 
     Returning to decision block  610 , if either the pH high linguistic value or the SO 2  high linguistic value is not present, then the result of decision block  610  is NO, and the procedure  600  advances to block  620 . At block  620 , a determination is made regarding whether both of a pH medium linguistic value and an SO 2  medium linguistic value are present. If both are present, then the result of subsequent decision block  622  is YES, and the procedure  600  advances to block  626 . Otherwise, the result of decision block  622  is NO, and the procedure advances to to continuation terminal (“terminal B”). 
     At block  626 , the procedure  600  has determined that the rules indicate that the catheter might have failed, or at least cannot be confirmed as either definitely being OK or definitely having failed. Accordingly, at block  626 , a pressure moving average value is reset. The procedure  600  then advances to block  628 , where a catheter warning value is returned as the result of the procedure  600 , and the procedure  600  advances to an exit block and terminates. 
     From terminal B ( FIG.  6 B ), the procedure  600  advances to block  630 , where a determination is made regarding whether both of a pH low linguistic value and an SO2 low linguistic value are present. If both are present, then the result of subsequent decision block  632  is YES, and the procedure  600  advances to block  634 . At block  634 , the procedure  600  has determined that the rules indicate that the catheter has failed. Accordingly, at block  634 , a catheter failure value is returned as the result of the procedure  600 , and the procedure  600  advances to an exit block and terminates. 
     Returning to decision block  632 , if at least one of the pH low linguistic value and the SO 2  low linguistic value are missing, then the result of decision block  632  is NO, and the procedure  600  advances to block  636 . At block  636 , a determination is made regarding whether the high pressure duration timer is greater than a threshold timer value. The high pressure duration timer persists between executions of the procedure  600 , and may be used to delay presentation of a warning when high pressure is detected in absence of a clear indication from the pH and SO 2  values that an alert should be presented. This can help the alarm controller  210  ignore transient high pressure conditions that are artifacts or otherwise do not actually indicate failure. As discussed above, the high pressure duration timer may be reset in a subsequent execution of the procedure  600  upon detection of a pressure low linguistic value or a pressure medium linguistic value. 
     If the high pressure duration timer is greater than the threshold timer value, then the result of subsequent decision block  638  is YES, and the procedure  600  advances to block  640 . At block  640 , a catheter warning value is returned as the result of the procedure  600 , and the procedure  600  advances to an exit block and terminates. In some embodiments, the catheter warning value at block  640  may be the same value as the catheter warning value at block  628 . In some embodiments, the catheter warning values in these two blocks may be different to allow distinct alarms to be presented depending on how the warning was triggered. 
     Returning to decision block  638 , if the high pressure duration timer is not greater than the threshold timer value, then the result of decision block  638  is NO, and the procedure  600  advances to block  642 . At block  642 , the high pressure duration timer is incremented. In some embodiments, incrementing the high pressure duration timer may include a count of a number of times the procedure  600  has executed, and the threshold timer value may be a predetermined number of times of execution. In some embodiments, the high pressure duration timer may include a timestamp generated when the timer is started, and may be represented by an elapsed time between the timestamp and a current time. In such an embodiment, a timer value may not actually be incremented at block  642 , but instead the timestamp value may be set the first time the procedure  600  arrives at block  642 . The determination at block  636  may then be based on a comparison of a timestamp of the first time arriving at block  642  and a current time. 
     The procedure  600  then advances to block  644 , where a catheter OK value is returned as a result of the procedure  600 , and then advances to an exit block where it terminates. Even though a catheter OK value is returned at block  644 , subsequent executions of the procedure  600  by the method  400  will continue to check if the pressure has been high for too long, and if so, will advance to block  640  instead of blocks  642 - 644 . 
     The method  400  and procedure  600  are primarily described above as operating contemporaneously with the collection of the sensor data. In some embodiments, the method  400  and procedure  600  could instead operate over previously stored sensor data, either to study archived data, to provide a time delay to the alerts, or to perform the analysis remotely from the collection of the data, if desirable. 
       FIG.  7    is a block diagram that illustrates aspects of an exemplary computing device  700  appropriate for use as a computing device of the present disclosure. While multiple different types of computing devices were discussed above, the exemplary computing device  700  describes various elements that are common to many different types of computing devices. While  FIG.  7    is described with reference to a computing device that is implemented as a device on a network, the description below is applicable to servers, personal computers, mobile phones, smart phones, tablet computers, embedded computing devices, and other devices that may be used to implement portions of embodiments of the present disclosure. Moreover, those of ordinary skill in the art and others will recognize that the computing device  700  may be any one of any number of currently available or yet to be developed devices. 
     In its most basic configuration, the computing device  700  includes at least one processor  702  and a system memory  704  connected by a communication bus  706 . Depending on the exact configuration and type of device, the system memory  704  may be volatile or nonvolatile memory, such as read only memory (“ROM”), random access memory (“RAM”), EEPROM, flash memory, or similar memory technology. Those of ordinary skill in the art and others will recognize that system memory  704  typically stores data and/or program modules that are immediately accessible to and/or currently being operated on by the processor  702 . In this regard, the processor  702  may serve as a computational center of the computing device  700  by supporting the execution of instructions. 
     As further illustrated in  FIG.  7   , the computing device  700  may include a network interface  710  comprising one or more components for communicating with other devices over a network. Embodiments of the present disclosure may access basic services that utilize the network interface  710  to perform communications using common network protocols. The network interface  710  may also include a wireless network interface configured to communicate via one or more wireless communication protocols, such as WiFi, 2G, 3G, LTE, WiMAX, Bluetooth, Bluetooth low energy, and/or the like. As will be appreciated by one of ordinary skill in the art, the network interface  710  illustrated in  FIG.  7    may represent one or more wireless interfaces or physical communication interfaces described and illustrated above with respect to particular components of the system  100 . 
     In the exemplary embodiment depicted in  FIG.  7   , the computing device  700  also includes a storage medium  708 . However, services may be accessed using a computing device that does not include means for persisting data to a local storage medium. Therefore, the storage medium  708  depicted in  FIG.  7    is represented with a dashed line to indicate that the storage medium  708  is optional. In any event, the storage medium  708  may be volatile or nonvolatile, removable or nonremovable, implemented using any technology capable of storing information such as, but not limited to, a hard drive, solid state drive, CD ROM, DVD, or other disk storage, magnetic cassettes, magnetic tape, magnetic disk storage, and/or the like. 
     The particulars shown herein are by way of example and for purposes of illustrative discussion of example embodiments of the present disclosure only and are presented in the cause of providing what is believed to be the most useful and readily understood description of the principles and conceptual aspects of various embodiments of the disclosure. In this regard, no attempt is made to show structural details in more detail than is necessary for the fundamental understanding of the disclosure, the description taken with the drawings and/or examples making apparent to those skilled in the art how the several forms of the disclosure may be embodied in practice. 
     As used herein and unless otherwise indicated, the terms “a” and “an” are taken to mean “one”, “at least one” or “one or more”. Unless otherwise required by context, singular terms used herein shall include pluralities and plural terms shall include the singular. 
     Unless the context clearly requires otherwise, throughout the description and the claims, the words ‘comprise’, ‘comprising’, and the like are to be construed in an inclusive sense as opposed to an exclusive or exhaustive sense; that is to say, in the sense of “including, but not limited to”. Words using the singular or plural number also include the plural and singular number, respectively. Additionally, the words “herein,” “above,” and “below” and words of similar import, when used in this application, shall refer to this application as a whole and not to any particular portions of the application. 
     The description of embodiments of the disclosure is not intended to be exhaustive or to limit the disclosure to the precise form disclosed. While the specific embodiments of, and examples for, the disclosure are described herein for illustrative purposes, various equivalent modifications are possible within the scope of the disclosure, as those skilled in the relevant art will recognize. 
     All of the references cited herein are incorporated by reference. Aspects of the disclosure can be modified, if necessary, to employ the systems, functions, and concepts of the above references and application to provide yet further embodiments of the disclosure. These and other changes can be made to the disclosure in light of the detailed description. 
     Specific elements of any foregoing embodiments can be combined or substituted for elements in other embodiments. Moreover, the inclusion of specific elements in at least some of these embodiments may be optional, wherein further embodiments may include one or more embodiments that specifically exclude one or more of these specific elements. Furthermore, while advantages associated with certain embodiments of the disclosure have been described in the context of these embodiments, other embodiments may also exhibit such advantages, and not all embodiments need necessarily exhibit such advantages to fall within the scope of the disclosure.