Effect of tubing length on adsorption of diazepam to polyvinyl chloride administration sets

Yliruusi, Jouko; Uotila, Jaakko A.; Kristoffersson, Eeva

doi:10.1093/ajhp/43.11.2789

Cited by 4 publications

(7 citation statements)

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“…This increase could be in favor of a saturation of the tubing surface, decreasing the tendency to adsorption, or could also cause a faster renewal of the solution which gives less time for the molecules to adsorb onto the tubing wall. Similar results to ours have also been reported for diazepam 8 and insulin 29 infusion (less drug loss for faster infusion rates), thus limiting the potential clinical impact for the patient.…”

Section: Discussionsupporting

confidence: 89%

“…reported 7 , sorption related loss of drug is underappreciated. This issue was reported with PVC bags and tubings from the 80’s 4 with different drugs such as diazepam 8,9 , amiodarone 10 , isosorbide dinitrate 11 , insulin 12,13 . More recently, many studies also highlighted losses of drug during administration with PVC but also with non-PVC based catheters or IV tubings 2,14–17 .…”

Section: Introductionmentioning

confidence: 97%

See 1 more Smart Citation

Impact of alternative materials to plasticized PVC infusion tubings on drug sorption and plasticizer release

Tokhadzé

Chennell

Bernard

et al. 2019

Sci Rep

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Medical tubings in plasticized polyvinylchloride (PVC) are widely used for the infusion of medications but are known in some cases to cause content-container interactions (drug sorption and plasticizer release). The aim of this study was to assess interactions between drugs and five alternative materials to a reference plasticized PVC intravenous (IV) infusion tubing: three were PVC coextruded with polyethylene (PE), polyurethane (PU) or a thermoplastic elastomer (Styrene-EthyleneButadiene-Styrene (SEBS)) and two were SEBS or thermoplastic olefin (TPO) monolayer tubings. Diazepam and insulin were chosen as respective reference of absorption and adsorption while paracetamol acted as a negative control. The concentration of each drug was quantified with liquid chromatography to evaluate a potential loss after a static contact condition and simulated infusion at 1 mL/h and 10 mL/h dynamic condition by an electric syringe pump. A characterization of each material’s surface was performed by Fourier transform infrared spectroscopy in attenuated total reflection mode (ATR-FTIR) and by measurement of surface zeta potential. Plasticizer release was quantified by gas chromatography coupled with mass spectrometry (GC-MS). For all tubings except PVC/PU, no loss of paracetamol was observed in any condition. Diazepam sorption appeared to be less important with PVC/PE, PVC/SEBS, SEBS and TPO tubings than with PVC, but was more important when using PVC/PU tubings. PVC tubings induced the least loss of insulin amongst all the studied materials. Surface analysis by ATR-FTIR highlighted the presence of a plasticizer (that could be attributed to Tris (2-Ethylhexyl) Trimellitate (TOTM)) in the coextruded SEBS layer of PVC/SEBS, which could have influenced drug sorption, probably as a consequence of a migration from the PVC layer. Coextruded PVC/SEBS and PVC/PE presented the lowest zeta potential of all studied materials with respective values of −39 mV and −36 mV and were related to the highest sorption of insulin while PVC/PU with the highest zeta potential (about −9 mV) presented the highest absorption of diazepam. Coextruded layered materials appeared to have a lower plasticizer release than PVC alone. As a conclusion, PVC/PE and thermoplastic elastomers alone or coextruded with PVC could be interesting alternatives to PVC tubings with regards to sorption phenomena and plasticizer release.

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Section: Discussionsupporting

confidence: 89%

Section: Introductionmentioning

confidence: 97%

Impact of alternative materials to plasticized PVC infusion tubings on drug sorption and plasticizer release

Tokhadzé

Chennell

Bernard

et al. 2019

Sci Rep

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“…This can be explained by the sorption of diazepam to the PVC tubing that is distal to the filter housing (14,15). As this PVC tubing length is rather short, the sorption of diazepam is minimal (16). None of the end-line filters investigated sorbed fentanyl when this drug was administered by continuous infusion.…”

Section: R E S U L T S a N D Discussionmentioning

confidence: 96%

“…It is a well-known phenomenon that diazepam is sorbed by polyvinyl chloride bags and administration sets (12)(13)(14)(15)(16). In order to investigate the binding of diazepam to end-line filters, polybutadiene and polyethylene were used as infusion material as they do not sorb diazepam (13)(14)(15).…”

Section: R E S U L T S a N D Discussionmentioning

confidence: 99%

Binding of Drugs to End-Line Filters: A Study of Four Commonly Administered Drugs in Intensive Care Units

et al. 1988

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The binding of diazepam, digoxin, dopamine and fentanyl to different 0.2 microns end-line filters was investigated under simulated infusion conditions. All the drugs were diluted in either 5% dextrose or 0.9% NaCl infusion fluid. For digoxin and diazepam a marked reduction in the amount of drug delivered to the patient in the first 20-60 min of infusion is observed. For dopamine, the drug loss was less pronounced and no fentanyl was absorbed to the filters during the infusion experiment.

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“…Patients requiring high-dose diazepam regimens should be monitored for lactic acidosis, for which patients with renal or hepatic impairment are at increased risk [23,24]. Due to its high lipophilicity, diazepam does not incorporate into solution well and is adsorbed by standard plastic infusion bags resulting in less drugs being administered to the patient [25,26]. Dilution in IV fluids, especially if performed at the bedside due to emergent need of infusion over 30 minutes, may cause the drug precipitate out of solution [27].…”

Section: Discussionmentioning

confidence: 99%

Intentional Hydroxychloroquine Overdose Treated with High-Dose Diazepam: an Increasing Concern in the COVID-19 Pandemic

et al. 2020

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Introduction Recent attention on the possible use of hydroxychloroquine and chloroquine to treat COVID-19 disease has potentially triggered a number of overdoses from hydroxychloroquine. Toxicity from hydroxychloroquine manifests with cardiac conduction abnormalities, seizure activity, and muscle weakness. Recognizing this toxidrome and unique management of this toxicity is important in the COVID-19 pandemic. Case Report A 27-year-old man with a history of rheumatoid arthritis presented to the emergency department 7 hours after an intentional overdose of hydroxychloroquine. Initial presentation demonstrated proximal muscle weakness. The patient was found to have a QRS complex of 134 ms and QTc of 710 ms. He was treated with early orotracheal intubation and intravenous diazepam boluses. Due to difficulties formulating continuous diazepam infusions, we opted to utilize an intermitted intravenous bolus strategy that achieved similar effects that a continuous infusion would. The patient recovered without residual side effects. Discussion Hydroxychloroquine toxicity is rare but projected to increase in frequency given its selection as a potential modality to treat COVID-19 disease. It is important for clinicians to recognize the unique effects of hydroxychloroquine poisoning and initiate appropriate emergency maneuvers to improve the outcomes in these patients.

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Effect of tubing length on adsorption of diazepam to polyvinyl chloride administration sets

Cited by 4 publications

References 0 publications

Impact of alternative materials to plasticized PVC infusion tubings on drug sorption and plasticizer release

Impact of alternative materials to plasticized PVC infusion tubings on drug sorption and plasticizer release

Binding of Drugs to End-Line Filters: A Study of Four Commonly Administered Drugs in Intensive Care Units

Intentional Hydroxychloroquine Overdose Treated with High-Dose Diazepam: an Increasing Concern in the COVID-19 Pandemic

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