Flow variability and its physical causes in infusion technology: a systematic review of in vitro measurement and modeling studies

Abstract

Infusion therapy is medically and technically challenging and frequently associated with medical errors. When administering pharmaceuticals by means of infusion, dosing errors can occur due to flow rate variability. These dosing errors may lead to adverse effects. We aimed to systematically review the available biomedical literature for in vitro measurement and modeling studies that investigated the physical causes of flow rate variability. Special focus was given to syringe pump setups, which are typically used if very accurate drug delivery is required. We aimed to extract from literature the component with the highest mechanical compliance in syringe pump setups. We included 53 studies, six of which were theoretical models, two articles were earlier reviews of infusion literature, and 45 were in vitro measurement studies. Mechanical compliance, flow resistance, and dead volume of infusion systems were stated as the most important and frequently identified physical causes of flow rate variability. The syringe was indicated as the most important source of mechanical compliance in syringe pump setups (9.0×10-9 to 2.1×10-8 l/Pa). Mechanical compliance caused longer flow rate start-up times (from several minutes up to approximately 70 min) and delayed occlusion alarm times (up to 117 min).

Analytical method for calculation of deviations from intended dosages during multi-infusion

“…However, in recent years, ample evidence has been found [1–4], including a number of clinical cases and in vivo studies [5–9], indicating that physical effects related to the infusion hardware are equally important to understand [10, 11]. Especially in critical care, on the ICU and the OR, where multiple medications are typically delivered through one single lumen of a thin catheter, these physical effects may cause ambiguous and counter-intuitive discrepancies between the intended dose and the dose that has been actually delivered.…”

Validation d’un banc d’étalonnage primaire en microdébitmétrie liquide et application aux dispositifs médicaux de perfusion

“…Les professionnels du milieu médical admettent que les risques liés à l'utilisation d'un dispositif de perfusion sont sous-estimés [1], particulièrement aux très faibles débits (de l'ordre de 1 mL•h −1 ). Ces risques peuvent conduire à une mauvaise efficacité des traitements.…”

“…L'usage grandissant des perfusions multi-pompes nécessite un meilleur contrôle des concentrations en médicament, et donc du débit d'injection. L'influence des caractéristiques du dispositif de délivrance de médicament (délai de démarrage, compliance 1 , stabilité du débit) et l'effet des conditions d'utilisation sur la concentration sont mal connus. En général, le paramètre le plus important, lors de l'administration d'un médicament par perfusion, est le volume (ou la masse) délivré au patient.…”

Hypertensive Crisis During Norepinephrine Syringe Exchange

“…A dverse events related to intravenous administration of vasoactive medication are relatively common as the result of preparation and prescription errors 1 ; however, many errors with vasoactive medications have been related to infusion technology, 2 for example, pump malfunctions. 3 In addition, characteristics of the infusion system may yield dosing deviations after interventions, such as a syringe exchange, 4 flow rate changes, 5,6 and vertical displacement of the pump.…”