Re-using residual drug during intravenous infusion treatment

To minimize drug loss residual drug from an intravenous infusion are sometimes used on multiple patients. The non-return valves in the infusion system should in theory prevent the rest of the system from being contaminated. There are currently no Swedish guidelines for if this is appropriate or not.

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SBU Enquiry Service

Consists of structured literature searches to highlight studies that can address questions received by the SBU Enquiry Service from Swedish healthcare or social service providers. We assess the risk of bias in systematic reviews and when needed also quality and transferability of results in health economic studies. Relevant references are compiled by an SBU staff member, in consultation with an external expert when needed.

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Published: Report no: ut202109 Registration no: SBU 2021/122

Question

What scientific studies are there on the use of residual drug from an intravenous infusion for more than one patient?

Identified literature

Table 1 Included studies.
The primary studies have not been assessed for risk of bias by SBU enquiry service.
Author
Year
Ref		 Study design Setting Outcome
Azevedo et al
2020
[1]		 Experimental, in vitro Radiology, contrast fluid Bacterial migration
Goebel et al
2019
[2]		 Experimental, in vivo Radiology, contrast fluid Bacterial migration
Nandy et al
2017
[3]		 Experimental, in vitro Component testing Bacterial migration
Cona et al
2012
[4]		 Experimental, animal Radiology, contrast fluid Radiotracer migration
Ellger et al
2011
[5]		 Experimental, in vitro Intensive care unit Bacterial migration
Sikora et al
2010
[6]		 Mathematical modelling Radiology, contrast fluid Blood-born transmission
Radke et al
2010
[7]		 Experimental, in vitro Anasthesia, propofol Bacterial migration
Buerke et al
2008
[8]		 Experimental, in vitro Radiology, contrast fluid Bacterial migration
Eichler
2004
[9]		 Experimental, in vitro Anasthesia, propofol Bacterial migration
Garcia et al
1996
[10]		 Experminental, in vivo Radiology, contrast fluid Bacterial migration
Turner et al
1991
[11]		 Experimental, in vitro Pain, opioid analgesia Retrograde flow
Trépanier et al
1990
[12]		 Experimental, human Anasthesia Blood detection

References

  1. Azevedo MPF, Monteiro RM, Castelani C, Bim FL, Bim LL, Macedo AP, et al. Biosafety of Non-Return Valves for Infusion Systems in Radiology. Sci Rep 2020;10:9574.
  2. Goebel J, Steinmann J, Heintschel von Heinegg E, Hestermann T, Nassenstein K. Bacterial contamination of automated MRI contrast injectors in clinical routine. GMS Hyg Infect Control 2019;14:Doc05-Doc05.
  3. Nandy P, Young M, Haugen SP, Katzenmeyer-Pleuss K, Gordon EA, Retta SM, et al. Evaluation of one-way valves used in medical devices for prevention of cross-contamination. Am J Infect Control 2017;45:793-798.
  4. Cona MM, Bauwens M, Zheng Y, Coudyzer W, Li J, Feng Y, et al. Study on the microbial safety of an infusion set for contrast-enhanced imaging. Invest Radiol 2012;47:247-51.
  5. Ellger B, Kiski D, Diem E, van den Heuvel I, Freise H, Van Aken H, et al. Non-return valves do not prevent backflow and bacterial contamination of intravenous infusions. J Hosp Infect 2011;78:31-35.
  6. Sikora C, Chandran AU, Joffe AM, Johnson D, Johnson M. Population risk of syringe reuse: estimating the probability of transmitting bloodborne disease. Infect Control Hosp Epidemiol 2010;31:748-54.
  7. Radke OC, Werth K, Borg-Von-Zepelin M, Saur P, Apfel CC. Two serial check valves can prevent cross-contamination through intravenous tubing during total intravenous anesthesia. Anesth Analg 2010;111:925-928.
  8. Buerke B, Mellmann A, Stehling C, Wessling J, Heindel W, Juergens KU. Microbiologic contamination of automatic injectors at MDCT: experimental and clinical investigations. AJR Am J Roentgenol 2008;191:W283-7.
  9. Eichler W, Schumacher J, Ohgke H, Klotz KF. Reuse of a set for total intravenous anaesthesia: safe against bacterial contamination? Eur J Anaesthesiol 2004;21:501-3.
  10. Garcia M. Preliminary report: biosafety analysis of one-way backflow valves for multiple patient use of low osmolar intravenous contrast solution. Can Commun Dis Rep 1996;22:28-31.
  11. Turner GA, Murphy DF. Antireflux valves in intravenous opioid analgesia: are they necessary? Anaesthesia 1991;46:1064-5.
  12. Trépanier CA, Lessard MR, Brochu JG, Denault PH. Risk of cross-infection related to the multiple use of disposable syringes. Can J Anaesth 1990;37:156-9.

Literature search

PubMed via NLM 2021-04-06

Re-using residual drug during intravenous infusion treatment.

The search result, usually found at the end of the documentation, forms the list of abstracts.

[MeSH] = Term from the Medline controlled vocabulary, including terms found below this term in the MeSH hierarchy; [MeSH:NoExp] = Does not include terms found below this term in the MeSH hierarchy; [MAJR] = MeSH Major Topic; [TIAB] = Title or abstract; [TI] = Title; [AU] = Author; [TW] = Text Word; Systematic[SB] = Filter for retrieving systematic reviews; * = Truncation; EED = Economic Evaluations; HTA = Health Technology Assessments
  Search terms Items found
Intervention:
1. “Anesthesia, Intravenous” [mesh] OR “Administration, Intravenous” [mesh] OR Infusion Pumps [mesh] OR (intravenous [TIAB] OR “infusion pump*” [TIAB] OR “infusion system*” [TIAB]) 390 520
2. ((“Equipment Reuse” [mesh] OR “Multi dose” [TIAB] OR multidose [TIAB] OR “single use” [TIAB] OR singleuse [TIAB] OR “single dose” [TIAB] OR singledose [TIAB] OR “multi use” [TIAB] OR “redose” [TIAB] OR “re dose” [TIAB] OR “re use” [TIAB] OR “reuse” [TIAB] OR “multiple patient*” [TIAB]) AND (vial* [TIAB] OR ampoule* [TIAB] OR needle* [TIAB] OR inject* [TIAB] OR equip* [TIAB] OR syringe* [TIAB] OR infus* [TIAB])) 15 193
3. “Drug contamination” [mesh] OR Equipment Contamination OR “cross infection” [mesh] OR contaminat* [TIAB] OR “cross infect*” [TIAB] OR crossinfect* [tiab] OR “drug waste*” [TIAB] OR “patient to patient” [TIAB] 278 602
4. “check valve*” [TIAB] OR (("Anti reflux" OR "non return" OR "one way" OR antireflux OR nonreturn OR “back check”) AND valve* [TIAB]) 1 351
5. 2 AND 3 704
Final 1 AND (4 OR 5) 142

Embase via embase.com 2021-04-06

Re-using residual drug during intravenous infusion treatment.

/de = Term from the EMTREE controlled vocabulary; /exp = Includes terms found below this term in the EMTREE hierarchy;/mj = Major Topic; :ab = Abstract; :au = Author; :ti = Article Title; :ti,ab = Title or abstract; * = Truncation; ’ ’ = Citation Marks; searches for an exact phrase
  Search terms Items found
Intervention:
1. 'intravenous drug administration'/exp OR 'intravenous anesthesia'/exp OR 'intravenous anesthetic agent'/exp OR 'infusion pump'/exp OR 'infusion system'/exp OR (intravenous OR “infusion pump*” OR “infusion system*”):ti,ab,kw 716 286
2. ((“Multi dose” OR multidose OR “single use” OR singleuse OR “single dose” OR singledose OR “multi use” OR redose OR “re dose” OR “re use” OR reuse OR “multiple patient*”) AND (vial* OR ampule* OR needle* OR inject* OR equip* OR syringe* OR infus*)):ti,ab,kw 22 322
3. 'drug contamination'/exp OR 'cross contamination'/exp OR 'cross infection'/exp OR 'medical device contamination'/exp OR (contaminat* OR 'cross infection' OR crossinfection OR “drug waste” OR “patient to patient”):ti,ab,kw 279 500
4. ((Check OR “Anti reflux” OR “non return” OR “one way” OR oneway OR antireflux OR nonreturn OR “back check”) NEAR/3 valve) 726
5. 2 AND 3 1 160
Final 1 AND (4 OR 5) 158
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