Amiodarone and Phlebitis – Can Filters Help?
Amiodarone Filtration: Explore the Problem and Learn the Solution
December 11th, 2020
Amiodarone is a well-known drug against heart arrhythmia, which is linked to high rates of phlebitis1, a painful inflammation of the veins. Are filters helpful? Could they reduce the concentration of the drug reaching the patient or impair the flush kinetics?
What’s the problem?
Amiodarone has been the first line treatment for certain forms of heart arrhythmia since it was first used in 1961. However, intravenous (IV) administration of the drug frequently leads to phlebitis, which is defined as an inflammation of the vein wall characterized by pain, edema, erythema, streak formation and/or a palpable cord.2
What can help?
A recent systematic review of articles published before 2016 showed that phlebitis incidence was lower with bolus administration of amiodarone than with longer infusions (P=0.002). Additionally, the use of in-line filters and nursing guidelines for amiodarone administration significantly reduced phlebitis rates (P<0.001) with one study also showing a reduction in phlebitis severity.3
What about drug concentration and flush kinetics?
So, filters have been shown to help, but how is the drug affected by the presence of the filter?
- Do filters bind amiodarone, in effect changing the concentration of the infusion?
- Do filters impair the flush kinetics and therefore the ability to flush residual amounts of amiodarone from the infusion system when more than one drug is administered in sequence (particularly if they are incompatible)?
Based on our data with Pall AEF1 and ELD96 families of filters at low concentrations of amiodarone the answer to both questions is a clear “no”4.
- Norton L, Ottoboni LK, Varady A, et al. (2013). Phlebitis in amiodarone administration: incidence, contributing factors, and clinical implications. Am J Crit Care. 22(6):498-505.
- Washington, G., & Barrett, R. (2012). Peripheral phlebitis. A point prevalence study. Journal of Infusion Nursing. 35 (4), 252-258.
- Oragano, C. A., Patton, D., & Moore, Z. (2019). Phlebitis in Intravenous Amiodarone Administration: Incidence and Contributing Factors. Critical care nurse. 39(1), e1–e12.
- Capewell A. (2018) Filterability of Amiodarone Through Pall ELD Family and AEF1E Filters. Pall SLS Medical Europe Technical Report.
Dr. Volker Luibl, MBA
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