Health risks posed by use of Di-2-ethylhexyl phthalate (DEHP) in PVC medical devices: A critical review

Abstract

Background Polyvinyl chloride plastics (PVC), made flexible through the addition of di‐2‐ethylhexyl phthalate (DEHP), are used in the production of a wide array of medical devices. From the late 1960s, leaching of DEHP from PVC medical devices and ultimate tissue deposition have been documented. Methods A critical review of DEHP exposure, metabolism, and toxicity data from human and animals studies was undertaken. A brief analysis of alternatives to DEHP‐plasticized PVC for use in medical device manufacture was completed. Results DEHP leaches in varying concentrations into solutions stored in PVC medical devices. Certain populations, including dialysis patients and hemophiliacs may have long‐term exposures to clinically important doses of DEHP, while others, such as neonates and the developing fetus, may have exposures at critical points in development. In vivo and in vitro research links DEHP or its metabolites to a range of adverse effects in the liver, reproductive tract, kidneys, lungs, and heart. Developing animals are particularly susceptible to effects on the reproductive system. Some adverse effects in animal studies occur at levels of exposure experienced by patients in certain clinical settings. DEHP appears to pose a relatively low risk of hepatic cancer in humans. However, given lingering uncertainties about the relevance of the mechanism of action of carcinogenic effects in rodents for humans and interindividual variability, the possibility of DEHP‐related carcinogenic responses in humans cannot be ruled out. Conclusions The observed toxicity of DEHP and availability of alternatives to many DEHP‐containing PVC medical devices presents a compelling argument for moving assertively, but carefully, to the substitution of other materials for PVC in medical devices. The substitution of other materials for PVC would have an added worker and community health benefit of reducing population exposures to DEHP, reducing the creation of dioxin from PVC production and disposal, and reducing risks from vinyl chloride monomer exposure. Am. J. Ind. Med. 39:100–111, 2001. © 2001 Wiley‐Liss, Inc.

Aqueous leaching of di-2-ethylhexyl phthalate and “green” plasticizers from poly(vinyl chloride)

“…Furthermore, it has been shown that the ingestion of DEHP produces toxic effects in the organ systems of adult and developing animals; particularly, high levels of testicular toxicity and endocrine disruption (Tickner et al, 2001). These concerns have led to the banning of DEHP in children's toys across the European Union.…”

Di-(2-ethylhexyl)-phthalate (DEHP) activates the constitutive androstane receptor (CAR): A novel signalling pathway sensitive to phthalates

“…Di-(2-ethylhexyl)-phthalate (DEHP) is a widely used congener for which dietary exposure (food processing, packaging) likely represents the main source of contamination for the general population [5]. The highest levels of exposure have been reported in specific populations such as patients and neonates exposed to PVC medical devices [8] or PVC factory workers [9].…”

Di(2-ethylhexyl)phthalate (DEHP)

“…6,7 The phthalates are hepatically metabolized via glucuronidation and are primarily eliminated through urinary excretion. Due to developmental issues these mechanisms of elimination are not developed in healthy infants until the age of 3 months.…”