Watch Particles in an Infusion Line Entering a Patient’s Bloodstream

Most likely, the answer is no, you haven’t seen particles infused into a patient in real-time. And that is part of the problem: Because if more health-care professionals could see what they inadvertently infuse into a patient, they would probably be more willing to do something about it.

Watch the video and see the motion of particles at the egress of a catheter.¹

Perez, M., Décaudin, B., Abou Chahla, W. et al. Effectiveness of in-Line Filters to Completely Remove Particulate Contamination During a Pediatric Multidrug Infusion Protocol. Sci Rep 8,7714 (2018).

https://doi.org/10.1038/s41598-018-25602-6

Video can be obtained from Electronic supplementary material under

https://www.nature.com/articles/s41598-018-25602-6#additional-information

Link to Public License: https://creativecommons.org/licenses/by/4.0/legalcode

Link to the Creative Commons license: http://creativecommons.org/licenses/by/4.0/

The video was produced in the context of a study conducted by Maxime Perez, a hospital pharmacist at the University of Lille, France, and his colleagues at the university’s neonatology and intensive care departments. The authors measured particles in simulated multi-drug infusions over a 24-hour period, using various combinations of catheters, single- and multi-lumen infusion and extension sets, stopcocks and central venous lines, with or without Pall intravenous in-line filters (AEF1NTE). What is shown in the video is that particles  had precipitated at the distal end of IV infusion lines, and which were invisible to the naked eye. In addition, the authors demonstrated that adding extension sets or stopcocks significantly increases overall particulate matter, and that a Pall IV intravenous in-line filter (AEF1NTE) connected to the ventral venous catheter significantly decreased the overall particulate contamination compared to infusions without filters.

In light of the potentially serious damage particles can cause – blockages of blood vessels due to large particles^2-4, systemic hypercoagulability due to the activation of the coagulation system⁵, impairment of the microcirculation^6,7, immune-modulation effects and / or systemic inflammatory reactions^5,8-11 – the authors stress two clear conclusions of this study:

1. Intravenous in-line filters effectively prevent particle administration to patients.
2. Intravenous in-line filters should be positioned as closed as possible to the patient.

Regarding the placement of IV intravenous filter the Infusion Nursing Society (INS) and the American Parenteral Nutrition Society (ASPEN) recommend:

• “Locate the in-line filter on the administration set as close to the VAD hub as possible. Add-on components (eg, extension sets, stopcocks) below or after the filter will result in additional particulate matter infusing to the patient.”¹²
• “Filters should be placed as close to the patient as possible on the administration system.”¹³

References:

1.      Perez M. et al. (2018). Effectiveness of in-Line Filters to Completely Remove Particulate Contamination During a Pediatric Multidrug Infusion Protocol (Electronic Supplementary Material). Sci Rep; 8 (7714): 1-8

2.      Ilium L. et al. (1982) et al. Blood clearance and organ deposition of intravenously administered colloidal particles. The effects of particle size, nature and shape. Int J Pharm.; 12(2): 135-46

3.      Bradley J.S., Wassel R.T., Lee L., Nambiar S. (2009). Intravenous ceftriaxone and calcium in the neonate: assessing the risk for cardiopulmonary adverse events. Pediatrics; 123(4): e609-13

4.      Puntis J.W.L. et al. (1992). Hazards of parenteral treatment: do particles count? Archives of Disease in Childhood; 67: 1475-1477

5.      Boehne M. et al. (2013). In-line filtration minimizes organ dysfunction: New aspects from a prospective, randomized, controlled trial. BMC Pediatrics, 13 (21): 1-8

6.      Kirkpatrick CJ. et al (2013). Non-Equivalence of Antibiotic Generic Drugs and Risk for Intensive Care Patients. Pharmaceut Reg Affairs; 2 (1): 1-7

7.      Schaefer SC. et al (2008). 0.2 µm in-line filters prevent capillary obstruction by particulate contaminants of generic antibiotic preparations in postischemic muscle. Chemother J; 17: 172-8

8.      Jack T. et al. (2012). In-line filtration reduces severe complications and length of stay on pediatric intensive care unit: a prospective, randomized, controlled trial. Intensive Care Med, 38, 1008-1016

9.      Jack T. et al. (2010). Analysis of particulate contaminations of infusion solutions in a pediatric intensive care unit. Intensive Care Med; 36:707-711

10.  Schmitt E. et al. (2019). In-line filtration of intravenous infusion may reduce organ dysfunction of adult critical patients. Critical Care; 23 (373): 1-11

11.  Chisholm C.F., Behnke W., Pokhilchuk Y., Frazer-Abel A.A., Randolph T.W. (2020). Subvisible Particles in IVIg Formulations Activate Complement in Human Serum. J Pharm Sci.; 109(1): 558-565

12.  Gorski L.A., Hadaway L., Hagle M.E. et al. (2021). Infusion Therapy Standards of Practice, 8th Edition. J Infus Nurs; 01(44):S1-S224

13.  Ayers P., Adams S., Boullata J. et al (2014) A.S.P.E.N. Parenteral Nutrition Safety Consensus Recommendations. Journal of Parenteral and Enteral Nutrition; 38 (3): 296-333