Madson ZC, Vangala S, Sund GT, Lin JA. Does carrier fluid reduce low flow drug infusion error from syringe size? World J Clin Pediatr 2020; 9(2): 17-28 [PMID: 33014719 DOI: 10.5409/wjcp.v9.i2.17]
Corresponding Author of This Article
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
Research Domain of This Article
Pediatrics
Article-Type of This Article
Basic Study
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (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/
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 byNIH 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 Processing time: 140 Days and 5.8 Hours
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.
