Adsorption of insulin onto infusion sets used in adult intensive care unit and neonatal care settings

Zahid, Najam; Taylor, Kevin; Gill, Hardyal; Maguire, Fiona; Shulman, Rob

doi:10.1016/j.diabres.2008.02.013

Cited by 38 publications

(65 citation statements)

References 7 publications

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“…Insulin adsorption can also be decreased by infusing insulin solutions with a higher concentration or at higher rates. 5,7,9,12,13 These methods may not be possible in patients requiring small titrations, such as infants and small children, or those who cannot tolerate high fluid volumes. Flushing the intravenous tubing with insulin or dwelling the insulin solution within the tubing for a period of time prior to the start of therapy also decreases adsorption losses by saturating binding sites within the tubing.…”

Section: Introductionmentioning

confidence: 99%

“…[1][2][3][4][5][6][7] Insulin adsorption lowers the concentration of insulin delivered to the patient within the first 6-22 h of an infusion, which can be clinically significant. 5,[7][8][9] Different strategies have been proposed to minimize insulin adsorption. Priming tubing with albumin or whole blood prior to initiating an insulin infusion decreases adsorption 5,10,11 ; however, this method unnecessarily exposes patients to blood products.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

The Effect of Tubing Dwell Time on Insulin Adsorption During Intravenous Insulin Infusions

Thompson

Vital-Carona

Faustino

2012

Diabetes Technology & Therapeutics

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Background: Insulin adsorbs to plastic tubing, which decreases the concentration of an insulin solution delivered from an intravenous infusion set. Dwelling insulin within tubing before starting the infusion decreases adsorption but delays treatment initiation and wastes time in infusion preparation. The lack of data on dwell time effects results in wide variability in practice. We aim to determine the effect of dwell time on insulin concentration from intravenous infusion tubing. Materials and Methods: In this in vitro study, we used insulin solutions with concentrations of 0.1 unit/mL, 1 unit/mL, and 10 units/mL. Each solution dwelled in intravenous infusion sets for 0, 15, 30, or 60 min. After the dwell, we measured insulin concentrations from the solution bags and tubing. We repeated each insulin concentration-dwell time combination five times. Comparisons were performed using analyses of variance. Results: For each of the three insulin concentrations, the mean insulin concentrations from the tubing were not significantly different between dwell times. Duration of dwell time did not affect insulin adsorption in polypropylene intravenous infusion sets. Conclusions: We recommend that following a 20-mL flush, insulin infusions can be started without any dwell time. Removal of dwell times may improve clinical practice by minimizing preparation time and will allow faster initiation of insulin infusion therapy.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

The Effect of Tubing Dwell Time on Insulin Adsorption During Intravenous Insulin Infusions

Thompson

Vital-Carona

Faustino

2012

Diabetes Technology & Therapeutics

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“…At 0.1 mL/h the initially measured concentration was 54.19% after 180 min. At either flow rate, the concentration of insulin had not reached 100% of the syringe concentration after 24 h [8]. Moreover, the sorption of drugs to infusion materials may have clinical consequences by physically affecting the materials themselves, which may lead to changes in mechanical properties and biocompatibility [49,50].…”

Section: Container-content Interactionmentioning

confidence: 99%

“…Moreover, the sorption of drugs to infusion materials may have clinical consequences by physically affecting the materials themselves, which may lead to changes in mechanical properties and biocompatibility [49,50]. Drugs affected by this problem include, non-exhaustively, nitroglycerin [51], isosorbide dinitrate [52], diazepam [53], chlorpromazine [54], vitamin A [55] and insulin [8,56].…”

Section: Container-content Interactionmentioning

confidence: 99%

Criteria for choosing an intravenous infusion line intended for multidrug infusion in anaesthesia and intensive care units

Maiguy-Foinard

Genay²,

Lannoy

et al. 2017

Anaesthesia Critical Care & Pain Medicine

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“…[4][5][6] Significant adsorption was also observed during administration of undiluted protein drug products. 7,8 Current pharmaceutical regulations require that i.v.-delivered medications be consistently within 10% of the nominal concentration. [9][10][11] Thus, protein loss due to adsorption onto containers, filters, and tubing used for administration must be investigated and addressed in parallel with the formulation development efforts, particularly for low-dose products.…”

Section: Introductionmentioning

confidence: 99%

Development of a stable low-dose aglycosylated antibody formulation to minimize protein loss during intravenous administration

Morar-Mitrica

Puri

Sassi

et al. 2015

mAbs

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The physical and chemical integrity of a biopharmaceutical must be maintained not only during long-term storage but also during administration. Specifically for the intravenous (i.v.) delivery of a protein drug, loss of stability can occur when the protein formulation is compounded with i.v. bag diluents, thus modifying the original composition of the drug product. Here we present the challenges associated with the delivery of a low-dose, highly potent monoclonal antibody (mAb) via the i.v. route. Through parallel in-use stability studies and conventional formulation development, a drug product was developed in which adsorptive losses and critical oxidative degradation pathways were effectively controlled. This development approach enabled the i.v. administration of clinical doses in the range of 0.1 to 0.5 mg total protein, while ensuring liquid drug product storage stability under refrigerated conditions.

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Adsorption of insulin onto infusion sets used in adult intensive care unit and neonatal care settings

Cited by 38 publications

References 7 publications

The Effect of Tubing Dwell Time on Insulin Adsorption During Intravenous Insulin Infusions

The Effect of Tubing Dwell Time on Insulin Adsorption During Intravenous Insulin Infusions

Criteria for choosing an intravenous infusion line intended for multidrug infusion in anaesthesia and intensive care units

Development of a stable low-dose aglycosylated antibody formulation to minimize protein loss during intravenous administration

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