How to set up the D-mine® apomorphine pump

For patients with advanced Parkinson's disease, motor fluctuations can be difficult to manage with oral therapy alone. Continuous subcutaneous apomorphine infusion offers more consistent symptom control. The D-mine pump is a self-filling electronic device that delivers apomorphine continuously throughout the day.

This step-by-step walkthrough from our Administering Parkinson's Therapy with Pumps and Pens series covers the complete D-mine pump preparation process from start to finish.

You’ll learn how to:

• Turn on the D-mine pump and review its key features
• Fill the D-mine reservoir with apomorphine
• Attach the infusion set
• Select and prepare a subcutaneous injection site
• Start continuous apomorphine infusion

Deepen your understanding of advanced and device-assisted treatments in our Parkinson’s Masterclass: Advanced Therapeutics course. Explore the other lessons in this series:

How to prepare and start the SO-CONNECT^TM subcutaneous apomorphine pump

Setting up the Crono® APO-go® and PAR apomorphine infusion pumps

APO-go® POD: the EASY apomorphine infusion setup

2 Levodopa infusion setups: Duodopa® pump vs Crono® LECIG

Using an apomorphine pen injector when medications wear off

How the D-mine pump delivers continuous apomorphine therapy

[00:03]

The D-mine pump continuously delivers apomorphine to minimize motor fluctuations. This pump system allows a more precise and controlled delivery of medication, providing patients with a steady supply of apomorphine throughout the day.

Key features of the D-mine pump

[00:17]

The D-mine pump is a self-filling electronic pump that has a color display and is powered by rechargeable lithium-ion battery. The dose in milligrams can be programmed for up to five different time windows, and the programming is protected by a code.

Accessing and reviewing pump delivery data

[00:36]

Delivery-specific information is stored on the pump and can be downloaded using a USB. This information is mainly used by the healthcare professionals to check the number of given boluses, the running times of the pump, or detect handling errors from patients.

D-mine pump setup

[00:53]

To prepare the D-mine pump, first disinfect the table and place all necessary materials on the work surface. This includes the D-mine pump attached to the docking station, docking station connected to the power supply, 20 mL D-mine reservoir, infusion set, which includes the needle and infusion line, 20 mL apomorphine vial, tape, hand and skin disinfectants, and waste box to discard used needles.

Inserting the D-mine reservoir

[01:31]

Disinfect your hands and open the packaging of the sterile D-mine reservoir. Insert the reservoir into the pump. You will hear a click when it is correctly positioned. The pump will ask if a new reservoir has been added. Confirm this step by pressing the checkmark button. 

Running the self-test

[02:09]

Next, the pump will run a self test to ensure that everything works properly, which takes approximately one to two seconds. If the self test fails, you will see a red light. Restart the pump by removing the battery and start the procedure again.

Preparing the apomorphine vial

[02:26]

Once the self test is complete, prepare the apomorphine. Take the vial with apomorphine and remove the cap. Make sure you don't touch the top of the vial. Place the medication vial in the center of the docking station. Disinfect the top of the vial with a wipe. Confirm this step by pressing the checkmark button. 

Attaching the apomorphine vial

[02:57]

Turn the pump upside down and attach the pump adapter to the top of the vial. Then turn the pump upright and place it in the docking station. Confirm this step by pressing the button. Tighten the adapter by turning it clockwise and start the filling process by pressing the checkmark button.

Filling the apomorphine reservoir

[03:27]

The pump will now transfer the medication from the vial into the reservoir. This takes approximately six minutes. Make sure the docking station is connected to the power supply throughout this time. You can monitor the progress on the display. When the reservoir is finished filling, you will hear a beep and the display will say 100% filled.

Attaching the infusion set

[03:55]

The pump will ask if you want to continue with the infusion line, so press yes. Remove the pump from the docking station, turn it horizontally, and twist off the adapter and empty vial together. Now take the new unused infusion set, open the packaging, remove the cap and screw the tubing tightly onto the reservoir. Click the checkmark button to confirm the step. 

Dry puncture vs. priming the infusion line

[04:42]

The pump will ask you if you want to prime the line, but this isn't necessary. Priming the line means pumping the medications through the tube until it comes out at the end to remove any air. But in this case, a dry puncture is recommended to prevent skin irritations. For catheters where the tube and the needle are separated, it makes sense to prime the line. The display will show yes or no, so select no to continue.

Preparing the injection site

[05:10]

Next prepare the injection site. Possible injection sites are the lower abdomen, inner thigh, inner upper arm, under the shoulder blades, or in the flanks. First, disinfect the injection site. Then hold the disinfected skin between thumb and index finger. Pick up the needle using the grip on the back. Insert the needle and remove the grip. Secure the needle and tube to the patient's skin with tape. Press the checkmark button again.

Starting continuous apomorphine infusion

[05:52]

To start the continuous infusion, press the start button for three seconds until you hear a beep. The patient can also give themselves an extra dose, also called bolus dose, by pressing the big orange button. The patient wears the pump in a carrying case throughout the day and in some cases also during the night. 

Stopping the D-mine pump and post-infusion care

[06:30]

To stop the pump, press the stop button. Remove and discard the infusion line. Place the pump in the docking station so it can charge, and put a stopper on the reservoir.