Published online Sep 19, 2020. doi: 10.5409/wjcp.v9.i2.17
Peer-review started: April 30, 2020
First decision: May 24, 2020
Revised: June 7, 2020
Accepted: August 31, 2020
Article in press: August 31, 2020
Published online: September 19, 2020
Critically ill neonates and pediatric patients frequently require drug delivery via low flow infusions below 0.5 mL/h. The use of carrier fluid has become common in clinical practice to facilitate delivery of these low flow drug infusions.
Flow continuity problems of low flow infusions are known to be related to syringe size. However, competing safety considerations encourage pharmacy standardization to the largest common syringe size. As such, in clinical practice, carrier fluids are commonly used to reduce variability of drug delivery from larger syringe sizes.
To evaluate whether carrier fluid improves continuity in low flow drug delivery.
We simulated pediatric low flow infusions using dyed fluids in a drug infusion model. In-line spectrometry was used to measure drug concentrations. Administered fluid was determined volumetrically.
Low flow continuity errors were associated with larger syringe sizes and exacerbated by interactions with carrier fluid. Drug over- and underdosing, backward flow at the tubing connector, and frequent air bubbles from carrier fluid were observed.
Our study provides no evidence to suggest that carrier fluid might reduce variability associated with low flows from larger syringes.
Our study provides empiric data to suggest that continuity errors of low flow infusions are associated with larger syringes and not improved by carrier fluid. Syringe size should be matched to the rate of infusion. In our health system, we now match syringe size to critical low flow pediatric infusions by using the smallest syringe capable of providing 12 h of infusion.