WoCoVA consensus on the clinical use of in-line filtration during intravenous infusions: Current evidence and recommendations for future research

Boxtel, Ton Van; Pittiruti, Mauro; Arkema, A.; Ball, Patrick; Barone, Giovanni; Bertoglio, Sergio; Biffi, Roberto; Dupont, Christian; Fonzo-Christe, Caroline; Foster, Jann P; Jones, Matthew; Keck, Cornelia M.; Ray‐Barruel, Gillian; Sasse, Michael; Scoppettuolo, Giancarlo; Hoogen, Agnes van den; Villa, Gianluca; Hadaway, Lynn; Ryder, Marcia; Schears, Gregory; Stone, Josie

doi:10.1177/1129729821989165

Cited by 6 publications

(4 citation statements)

References 52 publications

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“…Since drugs are given in ever‐changing infusions rates depending on the need of the patient it is advised to analyze mixed samples in at least three different mixing ratios. Given the variability in clinical practice where different buffered electrolyte solutions are used an extra safety precaution is to use in‐line filter, which could help to prevent infusion of precipitated particles into the bloodstream of the patient 25,26 . Last, but not least, it should be emphasized that the exact composition and pH of buffered electrolytes might be product specific, and caution should be taken if and when extrapolating the findings to other products.…”

Section: Discussionmentioning

confidence: 99%

Exploring a case of incompatibility in a complex regimen containing Plasma‐Lyte 148 in the pediatric intensive care

Nilsson

Nguyen

Nezvalová-Henriksen

et al. 2022

Pediatric Anesthesia

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Background: In the local pediatric intensive care unit, precipitation was observed in the intravenous catheter upon co-administration of four drugs together with the buffered electrolyte solution (Plasma-Lyte 148, Baxter). Co-infusion of incompatible combinations represents a safety concern. Aims:To reproduce the clinical case of precipitation. To further explore and understand the risk of precipitation, different combinations of the components as well as the corresponding electrolyte solution with 5% glucose (Plasma-Lyte 148 with 5% glucose) should be investigated. Methods: Physical compatibility of fentanyl, ketamine, midazolam, and potassium chloride was tested in combination with the buffered electrolyte solutions. The concentrations and infusion rates representative of children 10-40 kg were used to estimate mixing ratios. Analyses detecting visual particles (Tyndall beam) and sub-visual particles (light obscuration technology) were undertaken. Measured turbidity and pH in mixed samples were compared with unmixed controls.Results: Both midazolam and ketamine showed formation of visual and sub-visual particles upon mixing with Plasma-Lyte 148, respectively. Particle formation was confirmed by increased turbidity and a distinct Tyndall effect. pH in mixed samples mirrored the pH of the buffered electrolyte, suggesting that the solubility limits of midazolam, and in some ratios also ketamine, were exceeded. Midazolam also precipitated in combination with the glucose-containing product that held a lower pH, more favorable for keeping midazolam dissolved.Conclusions: Replication of the case revealed that both midazolam and ketamine contributed to the precipitation. Midazolam and ketamine were both evaluated as incompatible with the buffered electrolyte solution and midazolam also with the buffered electrolyte-glucose solution and should not be co-administered in the same i.v.catheter line. Fentanyl and potassium chloride were interpreted as compatible with both buffered electrolytes.

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Section: Discussionmentioning

confidence: 99%

Exploring a case of incompatibility in a complex regimen containing Plasma‐Lyte 148 in the pediatric intensive care

Nilsson

Nguyen

Nezvalová-Henriksen

et al. 2022

Pediatric Anesthesia

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“…When the patient developed discomfort at the insertion site or when the dressing came loose, the dressing was removed, the site was examined, then disinfected with 0.5% iodophor in preparation for a dressing change, and then resecured. When the symptoms stated above occurred, diagnosis was made as per thrombophlebitis assessment scale [4] (Fig. 2).…”

Section: Methodsmentioning

confidence: 99%

“…[2] In fact, thrombophlebitis is a common and severe complication of PIVC. [3][4][5] Thrombophlebitis refers to 2 or more of the following symptoms or signs at the catheter site or near adjacent veins: pains, tenderness, erythema, swelling, suppuration, and touchable vein swelling. [6][7][8] The mechanism of phlebitis is believed to be a result from multifactor effects on venous walls, including chemical irritation, bacterial pollution, and machinery traumas.…”

Section: Introductionmentioning

confidence: 99%

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Effect of indwelling depth of peripheral intravenous catheters on thrombophlebitis

Shi

et al. 2023

Medicine

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To clarify the effect of catheter indwelling depth on the occurrence of thrombophlebitis, a total of 339 hospitalized patients were randomly enrolled and divided by the catheter indwelling depth into 2 groups. Then the effect of indwelling depth on thrombophlebitis was analyzed, and the independent influence factors on the occurrence of thrombophlebitis were clarified. There were 49 cases of thrombophlebitis, including 8 tumor-bearing patients and 41 patients with lung infection. Thirteen of the 135 patients with indwelling depth of 1 cm, and 36 of the 204 patients with indwelling depth of 1.9 cm suffered thrombophlebitis. The relationship between incidence rate of thrombophlebitis and clinicopathological parameters was analyzed. It was found the incidence of thrombophlebitis was significantly correlated with males (X2 = 5.77), lung infection (X2 = 7.79), and indwelling depth of 1.9 cm (X2 = 4.223). Multifactor analysis of variance showed the significant independent risk factors of thrombophlebitis were male [hazard ratio (HR) 3.12 (1.39–6.98)], and lung infection (HR 0.22 [0.06–0.69]), and the indwelling depth of 1.9 cm affected the occurrence of thrombophlebitis (HR 0.79 [0.42 –3.09]) but was not an independent risk factor. In our treatment center, while appropriate fixation was ensured, the catheter indwelling depth shall be as short as possible, so as to reduce the occurrence of thrombophlebitis. For patients with lung infection, nursing at the intubation site shall be strengthened, so as to decrease thrombophlebitis.

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Comparative study between a gravity-based and peristaltic pump for intravenous infusion with respect to the generation of proteinaceous microparticles

Hada

Lee

et al. 2023

International Journal of Pharmaceutics

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WoCoVA consensus on the clinical use of in-line filtration during intravenous infusions: Current evidence and recommendations for future research

Cited by 6 publications

References 52 publications

Exploring a case of incompatibility in a complex regimen containing Plasma‐Lyte 148 in the pediatric intensive care

Exploring a case of incompatibility in a complex regimen containing Plasma‐Lyte 148 in the pediatric intensive care

Effect of indwelling depth of peripheral intravenous catheters on thrombophlebitis

Comparative study between a gravity-based and peristaltic pump for intravenous infusion with respect to the generation of proteinaceous microparticles

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