Dynamic Image Analysis To Evaluate Subvisible Particles During Continuous Drug Infusion In a Neonatal Intensive Care Unit

Abstract

Studies have shown that infused particles lead to numerous complications such as inflammation or organ dysfunctions in critically ill children. Nevertheless, there is very little data available to evaluate the amount of particulate matter potentially administered to patients, and none with regard to infants. We have investigated the quantity received by these patients during multidrug IV therapies. Two different protocols commonly used in our neonatal intensive care unit (NICU) to manage excessively preterm infants were reproduced in the laboratory and directly connected to a dynamic particle analyser. The particulate matter of infused therapies was measured over 24 h, so that both overall particulate contamination and particle sizes could be determined. No visible particles were observed during drug infusions. Particulate analyses showed a significant number of particles that can reach 85,000 per day, with peaks during discontinuous drug infusions. Moreover, we showed that very large particles of about 60 µm were infused to infants. This study showed that despite very low infusion flow rates, infants may receive a large number of particles during drug infusion, especially in NICUs. Particulate contamination of IV fluids is not without consequences for fragile infants. Preventive solutions could be effective, such as the use of in-line filters.

Effectiveness of in-Line Filters to Completely Remove Particulate Contamination During a Pediatric Multidrug Infusion Protocol

“…The study also indicated however that patients can receive up to 900,000 particles per day during hospitalisation despite these infusion systems, which caused us to turn our attention to in-line filtration. Neonatal and pediatric populations receiving a great number of particles, especially large ones, are particularly affected as shown in a previous study 3 . These may cause serious damage to the body, especially large particles of about 10 µm in diameter 4 .…”

Analysis of particulate exposure during continuous drug infusion in critically ill adult patients: a preliminary proof-of-concept in vitro study

“…In our case, the particulate load was evaluated over a 6-h infusion period which can be extrapolated to a 24-h period and our results show lower particulate contamination than observed in previous studies [ 13 , 14 ]. Perez et al investigated the number of particles received by preterm infants over 24 h during multidrug IV therapies [ 13 ]. Two different protocols commonly used in an NICU were reproduced in vitro and analysed with the same equipment as that described in our study.…”

“…Our study is the first to quantify the particulate matter potentially administered to critically ill adult patients during a standard infusion protocol for the treatment of septic shock or acute respiratory distress syndrome. Previous studies have explored particulate contamination during leukaemia treatment in children [ 14 ] and NICU multidrug IV therapies [ 13 ].…”

“…The egress of the IV line was connected to a Qicpic® dynamic image analysis device (Sympatec GmbH Inc., Clausthal-Zellerfeld, Germany) linked to a Lixell module (Sympatec GmbH). The Qicpic® particle analyser with Windows 5.0 software also determines particle sizes of between 1 μm and 30 mm and provides dynamic imaging analysis [ 13 ].…”

“…However, little data is available to quantify particle exposure during simultaneous IV-drug infusion. A dynamic particle count test was used recently to evaluate in vitro the amount of particulate matter potentially administered to patients in a neonatal ICU [ 13 ] and a paediatric haematology unit [ 14 ]. This method appeared promising and enabled us to assess particulate exposure during continuous drug infusion in critically ill adult patients.…”