The Impact of Insulin Adsorption onto the Infusion Sets in the Adult Intensive Care Unit

Jakobsson, Therese; Shulman, Robert; Gill, Hardyal; Taylor, Kevin

doi:10.1177/193229680900300126

Cited by 29 publications

(42 citation statements)

References 5 publications

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“…They measured insulin by radioimmunoassay, and concluded that insulin was adsorbed on PVC and that this was increased by low concentrations and flow rates. These interactions can have severe consequences since drug concentrations are not totally delivered to patients [ 3 ]. The insulin formula used in clinical services consists mainly of insulin (human or modified) and of preservatives (phenol and/or metacresol).…”

Section: Introductionmentioning

confidence: 99%

In vitro assessment of the influence of intravenous extension set materials on insulin aspart drug delivery

Masse¹,

Maton

Genay³

et al. 2018

PLoS ONE

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Insulin is a frequently prescribed drug in hospitals and is usually administered by syringe pumps with an extension line which can be made of various materials. Two insulin solutions were studied: an insulin analogue, Novorapid® which contains insulin aspart and two phenolic preservatives (e.g. phenol and metacresol) and Umuline rapide® with human insulin and metacresol as preservative. Some studies have indicated interactions between insulin, polyvinyl chloride (PVC) and polyethylene (PE). The aim of this work was to study such interactions between Novorapid® or Umuline rapide® and infusion extension line materials (PVC, PE and coextruded (PE/PVC)). Insulin solution at 1 IU/mL was infused at 2 mL/h over 24 hours with 16 different extension lines (8 in PVC, 3 in PE and 5 in PE/PVC). Ultra-Fast Liquid Chromatography with diode array detection (UFLC-DAD) was performed to quantify insulin (human and aspart) and preservatives (metacresol and phenol). Limited human insulin sorption was observed thirty minutes after the onset of infusion: 24.3 ± 12.9%, 3.1 ± 1.6% and 18.6 ± 10.0% for PVC, PE and PE/PVC respectively. With insulin aspart, sorption of about 5% was observed at the onset of infusion for all materials. However, there were interactions between phenol and especially metacresol with PVC, but no interactions with PE and PE/PVC. This study shows that insulin interacts with PVC, PE and PE/PVC at the onset of infusion. It also demonstrates that insulin preservatives interact with PVC, which may result in problems of insulin conservation and conformation. Some more studies are required to understand the clinical impact of the latter during infusion.

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Section: Introductionmentioning

confidence: 99%

In vitro assessment of the influence of intravenous extension set materials on insulin aspart drug delivery

Masse¹,

Maton

Genay³

et al. 2018

PLoS ONE

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“…[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%

“…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%

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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“…To date, there are limited models and most are limited in the scale, number, and level of validation. There is thus significant research opportunity for new developments, including in the inclusion or clinical use of device dynamics, where, for example, insulin adsorption to infusion lines [206,207] and infusion pump dynamics [208,209] are not accounted for as yet, but may play a major role. Equally, the use of continuous glucose monitors (CGMs) for far higher bandwidth control has been only little studied in this context (e.g.…”

Section: Summary and Future Possibilitiesmentioning

confidence: 99%

Glycemic control in the intensive care unit: A control systems perspective

Chase

Benyó

Desaive

2019

Annual Reviews in Control

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Computers and automation have revolutionised quality and productivity in many industries, but not in medicine. Healthcare costs are thus growing beyond the ability of society to pay for them, multiplied by the impact of increasingly aging populations, and specifically in the demand placed on intensive care unit (ICU) services. Glycemic control is a core ICU therapy with the potential to reduce both mortality and cost, which makes it an area where greater personalisation and automation could play a leading role in improving productivity and care. This review presents the background to the problem and the main issues arising in this area of care from a control systems technology perspective. It then presents a vision of a more automated future with specific goals in the areas of dynamic systems modeling, system identification and control. These areas are then given a state of the art review, mixing both medicine and control systems perspectives. It is concluded by specific recommendations for the field, where control systems expertise can be leveraged to best advantage.

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The Impact of Insulin Adsorption onto the Infusion Sets in the Adult Intensive Care Unit

Cited by 29 publications

References 5 publications

In vitro assessment of the influence of intravenous extension set materials on insulin aspart drug delivery

In vitro assessment of the influence of intravenous extension set materials on insulin aspart drug delivery

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

Glycemic control in the intensive care unit: A control systems perspective

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