Basic Study
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Pediatr. Sep 19, 2020; 9(2): 17-28
Published online Sep 19, 2020. doi: 10.5409/wjcp.v9.i2.17
Does carrier fluid reduce low flow drug infusion error from syringe size?
Zachary C Madson, Sitaram Vangala, Grace T Sund, James A Lin
Zachary C Madson, Pediatric Hospitalist Medicine, Lutheran Children's Hospital, Fort Wayne, IN 46804, United States
Sitaram Vangala, Medicine Statistics Core, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095, United States
Grace T Sund, Department of Nursing, UCLA Mattel Children's Hospital, Los Angeles, CA 90095, United States
James A Lin, Department of Pediatrics, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095, United States
Author contributions: Madson ZC and Lin JA conceived and designed and personally conducted all the experiments, made observations, analyzed results, and wrote the initial draft and revisions of the manuscript; Sund GT helped to conceive and design and interpret the experiments; Vangala S provided statistical analysis, analyzed results, and helped draft and revise portions of the manuscript. All authors reviewed and approved of the manuscript.
Supported by NIH National Center for Advancing Translational Sciences (NCATS) UCLA CTSI, No. UL1TR001881.
Institutional review board statement: This work was performed at UCLA Medical Center, Santa Monica and the UCLA Department of Medicine Statistics Core.
Conflict-of-interest statement: The authors report no financial relationships relevant to this article.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: James A Lin, BSc, MD, Assistant Professor, Attending Doctor, Department of Pediatrics, David Geffen School of Medicine at UCLA, 10833 Le Conte Ave, A2-383 MDCC, Los Angeles, CA 90095, United States. jameslin@mednet.ucla.edu
Received: April 30, 2020
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
ARTICLE HIGHLIGHTS
Research background

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.

Research motivation

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.

Research objectives

To evaluate whether carrier fluid improves continuity in low flow drug delivery.

Research methods

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.

Research results

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.

Research conclusions

Our study provides no evidence to suggest that carrier fluid might reduce variability associated with low flows from larger syringes.

Research perspectives

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.