Extraction of Diethylhexylphthalate by Home Total Parenteral Nutrition From Polyvinyl Chloride Infusion Lines Commonly Used in the Home

Abstract

Diethylhexylphthalate and its metabolite monoethylhexylphthalate have been demonstrated to be carcinogenic, embryotoxic, hepatotoxic, pneumotoxic, and cardiotoxic and are known to disrupt endocrine pathways and liver detoxifying capacity in animals. They are suspected of having multiple effects in humans as well. The doses presented above should therefore be avoided in children receiving home TPN by the use of tubing systems that are completely free of DEHP. Such systems are available.

Influence of Lipid Type on Bis (2‐ethylhexyl)phthalate (DEHP) Leaching From Infusion Line Sets in Parenteral Nutrition

“…DEHP concentrations in nutrition admixtures after 24-hour contact between infusion lines and the lipid emulsions range from 1.4 to 540 µg/mL. [7][8][9][10][11] The factors reportedly driving this variability include tube length, DEHP content in the manufactured delivery system, infusion rate, and ambient temperature. However, these factors do not fully explain the variability observed.…”

DinCH and ESBO actual migration from PVC infusion tubings used in an oncopediatric unit

“…DINCH migration according to medicine is summarized in Table . Therapeutic classes or molecules were selected due to their chemical structure or their known properties as a risk factor for plasticizer leaching . Five samples were exposed to etoposide and other chemotherapy drugs, such as carboplatin, melphalan, cytarabine, and carmustine.…”

“…DINCH has a higher leaching ratio than TOTM from PVC matrices when exposed to a stimulant . The real leaching rates from infusion tubings are not known, as this depends on many factors, including temperature, flow, chemicals present, plasticizers, and the design of the tubing …”

Mechanisms Mediating Environmental Chemical-Induced Endocrine Disruption in the Adrenal Gland

“…Additional routes of exposure occur through dermal contact, house dust (46), and medical interventions. For example, high phthalate levels in medical equipment, such as blood (47, 48) and parenteral nutrition (49) bags and other tubing equipment, account for some of the highest exposures recorded (50). Phthalates are also used as drug excipients (51), and their use correlates with high urinary levels of its metabolites (52, 53).…”