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EJHP Science • Volume 16 • 2010 • Issue 2 • P. 31-37
© 2010 Pharma Publishing and Media Europe. All rights reserved 1781-7595 25
www.ejhp.eu
Evaluation of the dead volume in intravenous short-term
infusion
For personal use only. Not to be reproduced without permission of the publisher ([email protected]).
Herbert Plagge, PhD; Juliane Golmick; Delia Bornand; Stefanie Deuster, PhD
ABSTRACT
Study objectives: To evaluate the extent of the dead volume in IV short-term infusions.
Methods: Literature data were screened by a Medline search using the keywords: intravenous therapy, infusion, short
infusion, infusion system, dead volume and dead space. Short-term infusion solutions that are mainly used and the wards
which frequently order these products from the hospital pharmacy were identified. A survey was performed on six wards
in order to get information about the handling of short-term infusions on the ward. The dead volume was analysed under
laboratory conditions as well as on two wards after administration to the patient.
Results: Depending on the volume of infusion and the manufacturer of the infusion fluid, the dead volume varied in the
laboratory tests between 47% and 24% when the drip chamber was filled to the mark and between 32% and 15% when
the drip chamber was empty. The results of the tests on the ward ranged between 14% and 20% for 100 mL Miniflac
bottles and between 24% and 32% for 50 mL Miniflac bottles.
Conclusion: A considerable amount of the infusion volume and therefore of the active compound is lost at the end of
short-term infusion because of dead volume. The loss of a potential amount of drug can be a problem in regard to patient
safety and effectiveness of the therapy, especially for those drugs where dosage is adjusted to body weight. The nursing
guidelines at University Hospital Basel (USB) concerning the handling of infusions were adapted in line with the results of
this study.
KEYWORDS
Dead volume, hospital pharmacy, intravenous (IV) administration system, medication safety, short-term infusion
INTRODUCTION
Parenteral administration of drugs plays an important role
in the hospital setting; they are frequently administered
by intermittent infusion over a short time. A short infusion is defined as an IV infusion of a small volume (usually
50 mL to 100 mL), which is administered over a period of,
at most, three hours, usually 30 to 60 minutes [1, 2]. In
particular, antibiotics, cytotoxic drugs and analgesics are
administered via short infusion [2].
It is well known that a certain quantity of the drug remains at
the end of the infusion and is not administered to the patient
because of the dead volume [3], which is defined as the
total volume of the intravascular catheter and IV tubing [4].
Contact for correspondence: Herbert Plagge, PhD
Hospital Pharmacy
University Hospital Basel
26 Spitalstrasse
CH-4031 Basel, Switzerland
Tel: +41 61 2657658
Fax: +41 61 2657849
[email protected]
Received: 23 February 2010; Revised manuscript received:
21 April 2010; Accepted: 5 May 2010
Furthermore, a residual volume remains in the infusion bottle
at the end of each infusion. In this paper, the term ‘dead
volume’ describes the total infusion volume remaining in the
IV administration set and the bottle at the end of the infusion.
No literature data were found on research aiming at quantifying this problem. Internal nursing guidelines at University
Hospital Basel (USB) concerning the handling of IV infusions
did not deal with the administration of short infusions and
therefore gave no advice. Furthermore, the hospital pharmacy had no detailed information about the handling of short
infusions on the wards, e.g. whether the infusion system
was flushed after the application or which infusion volume
was preferred. It has been discovered that nursing staff are
using web forums to discuss whether the IV administration
set has to be flushed with the vehicle after the end of the
short infusion or not [5]; no information is routinely available
about the dead volume in infusion bottles or bags.
The question whether lyophilised drugs, which have to be
reconstituted in 50 mL or 100 mL of a vehicle, are overfilled
by the manufacturers to address the problem of a loss of
the drug because of the dead volume is also controversially discussed by nursing staff [5]. Eleven manufacturers
of drugs in powder form to be reconstituted for parenteral
administration were asked for information. The replies
were inconsistent; the amount of powder varies between
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Volume 16 • 2010/2 • www.ejhp.eu • 31
Evaluation of the dead volume in intravenous short-term infusion
Herbert Plagge et al
European Journal of Hospital Pharmacy Science
95% and 110% of that stated on the label. Seven of the
11 manufacturers indicated that the amount of powder
varies between 100% and 103%. Thus, it cannot be
assumed that powders for infusion are generally overfilled.
METHODS
Literature was searched on Medline, for the period
1990–2009, using the keywords: intravenous therapy,
infusion, short infusion, infusion system and dead volume.
There are several papers focusing on IV medication
errors [6-8], but dead volumes were not analysed. Other
authors addressed the phenomenon of dead volume in
IV infusions [4, 9-11], but their focus was on the dynamics of IV drug delivery and on the time lag between the
start of the infusion and the moment when the drug
reached the patient’s bloodstream. Depending on the
flow rate and the size of the dead volume, a delay of
20–30 minutes can occur before any drug enters the
circulation.
The IV fluids listed in the USB formulary that are used as
vehicles for the administration of drugs by short infusion
were identified. Using ERP software (SAP), a 12-month
statistical analysis (July 2007 to June 2008) was performed to determine the number of units delivered from
the hospital pharmacy to the different wards at USB
(see Table 1).
Information was obtained from the pharmaceutical manufacturer B. Braun stating that a residual volume of 3–5 mL
would remain in Ecoflac plus bottles [12]. The filling volume
of Ecoflac plus bottles varies between 54–60 mL in 50 mL
bottles and between 108–120 mL in 100 mL bottles [12].
Therefore, it was necessary to determine the exact filling
volume of each bottle used in the study.
25 wards ordered more than 2,000 units during the study
period; six of the wards (two wards of internal medicine,
one haematological ward, one intensive care unit, an interdisciplinary emergency unit and a surgical ward) were sent
a questionnaire in December 2008 in order to get detailed
information about the following:
• Drugs administered as short infusion
• Frequency of administration (often, seldom)
• Preferred volume of short infusion
• Administration mode (infusion pump, gravity infusion)
• Handling of short infusions, e.g. flushing of the IV
administration system after application or filling degree
of the drip chamber at the end of the infusion
• Estimation of dead volume
At the same time, the drugs listed in the hospital drug formulary, which are available as powder for infusion or concentrate and are to be diluted and administered as short
infusion, were evaluated. A three-month statistical analysis
(August to October 2008) using ERP software (SAP) was
performed and the results compared with the responses
to the questionnaire.
Determination of dead volumes under laboratory
conditions
The measurement of the dead volume of short infusions
took place from December 2008 to February 2009. The
analyses were conducted under laboratory conditions
corresponding to those of short infusions used on the
wards.
In the laboratory, 50 mL and 100 mL short infusion solutions
were analysed. The solutions contained normal saline from
two manufacturers: NaCl 0.9% in Miniflac 50 mL (LOT
8401B15) and 100 mL (LOT 8405A231) containers, (both
manufactured by B. Braun Medical AG, Switzerland),
The wards at USB that most frequently ordered short infuand NaCl 0.9% 100 mL (LOT 1680708, Bichsel AG,
sions from the hospital pharmacy in the 12-month period
Switzerland). The IV administration set used was an Intrafix
mentioned above were then identified. It was found that
Primeline Comfort 180 cm (LOT 8H25018311, B. Braun
Medical AG, Switzerland). Each of
the three products was analysed
Table 1: Intravenous fluids suitable for administration of drugs by short infusion
(12-month period)
fivefold. Furthermore, five tests were
performed with NaCl 0.9% in Miniflac
Product
Volume
Manufacturer
Number of units
100 mL, each after reconstitution of
Glucose 5% Stechampullen
50 mL
B. Braun Medical AG
16,040 vials
Augmentin 2.2 g (GlaxoSmithKline
AG, Switzerland). The density of all
Glucose 5% Miniflac
100 mL
B. Braun Medical AG
11,437 bottles
fluids was analysed.
NaCl 0.9% Miniflac
50 mL
B. Braun Medical AG
15,988 bottles
NaCl 0.9% Miniflac
100 mL
B. Braun Medical AG
135,985 bottles
NaCl 0.9% Ecobag
100 mL
B. Braun Medical AG
5,285 bags
NaCl 0.9%
100 mL
Bichsel AG
6,931 bottles
32 •
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Volume 16 • 2010/2 • www.ejhp.eu
The total weight of each bottle was
measured for an evaluation of the
dead volume. For the reconstituted
antibiotic, the weight of the bottle
Evaluation of the dead volume in intravenous short-term infusion
Herbert Plagge et al
European Journal of Hospital Pharmacy Science
before and after reconstitution was determined. After connecting the bottle to the IV administration set the infusion
was started and the fluid was collected in a tared beaker.
The infusion was stopped when the mark in the middle of
the drip chamber was reached. The collected fluid was
weighed and the resulted mass converted into the volume
by means of its density. The dead volume was then determined, using a three-way stopcock and a 60 mL syringe,
by the following steps:
• Drip chamber filled to the mark (centre ring)
• Drip chamber half filled
• Drip chamber emptied
• IV administration set completely emptied
Finally, the fluid remaining in the bottle was drawn up
with a 10 mL syringe and a cannula, and the volume
determined. The weight of an empty bottle was measured and used as a control. The difference between
the total weight and the weight of the empty bottle was
recorded and converted into the volume by means of
the density, and compared with the experimentally determined volume.
Determination of dead volumes of short infusions
prepared on the ward
In addition, observational tests were performed on
two internal medicine wards to determine whether the
dead volume of short infusions under real-life conditions was comparable with the results of the laboratory
findings. The study was performed with the predominantly used NaCl 0.9% Miniflac 50 mL (LOT 8401B15)
and 100 mL (LOT 8405A231), both manufactured by B.
Braun Medical AG, Switzerland. On one ward, 10 Miniflac 50 mL and seven Miniflac 100 mL infusions were
examined, and on the other ward, which only administered 100 mL short infusions, nine Miniflac 100 mL infusions were examined. In all cases, antibiotic drugs were
reconstituted in the appropriate vehicle. The antibiotics
observed were: Tazobac 4.5 g (Wyeth Pharmaceuticals
AG, Switzerland), Augmentin 1.2 g (GlaxoSmithKline AG,
Switzerland), Garamycin 40 mg (Essex Chemie AG, Switzerland), Rocephin 2 g (Roche Pharma AG) and Meronem
1 g (AstraZeneca AG, Switzerland). A subgroup analysis of each antibiotic was not performed because of the
small number of samples.
The nurses on the two wards were instructed by the
researchers how to record the relevant information and
were given consecutively numbered and labelled Miniflac
bottles for the tests after the total weight of each bottle
had been determined. Furthermore, the density of each
possible combination of antibiotic and short infusion (50 mL
and 100 mL) was determined in the laboratory beforehand,
as well as the additional weight of the reconstituted antibiotic. The nurses were asked to use only the labelled
bottles together with the standard IV administration set
(Intrafix Primeline Comfort 180 cm, B. Braun Medical AG,
Switzerland) and to collect the Miniflac bottles together
with the connected IV administration set after the end of
the short infusion at a designated place on the ward. The
names of individual nurses responsible for the administration of the infusions to the patients were not recorded.
The determination of the dead volume was then calculated as described earlier. The infusion solution remaining
in the IV administration line and the drip chamber was
discharged using a three-way stopcock and a 60 mL
syringe. The actual volume of liquid in the drip chamber
was recorded as well as the antibiotic drug which was
reconstituted in the vehicle by the nursing staff. The final
steps involved emptying the fluid remaining in the bottle
using a 10 mL syringe and a cannula, and determining
the volume as well as the weight of the empty bottle. The
additional weight of the antibiotic reconstituted in the short
infusion was added to the weight of the labelled bottle in
order to get the total mass. The difference between total
weight and weight of the empty bottle was converted into
the filling volume by means of the density.
RESULTS
The responses to the questionnaire, which took place in
December 2008, did not reveal a consistent handling of
short infusions on the wards, and the dead volume was
underestimated in part. No standards exist concerning
the right moment for stopping short infusions, so it cannot
be assumed that the drip chamber is usually empty at the
end of administration of short infusions. The responses
concerning the preferred volume of short infusions were
largely consistent with the 12-month statistical analysis
performed using ERP software (see Figure 1). A small
discrepancy between the responses given in the questionnaire and the statistical analysis was found only on
the surgical ward and concerned the use of 50 mL infusions. For the most part, 100 mL infusions were used,
but on one internal medicine ward, 50 mL infusions were
used almost exclusively.
The three-month statistical analysis of drugs that are
commonly administered as short infusions is illustrated in
Figure 2. On most wards, antibiotics and IV additives are
given in this way. The latter were not mentioned by the
nursing staff in the survey, probably because IV solution
additives are usually added to long-term IV infusions with
a volume of 500–1,000 mL rather than administered as a
•
Volume 16 • 2010/2 • www.ejhp.eu • 33
Evaluation of the dead volume in intravenous short-term infusion
Herbert Plagge et al
European Journal of Hospital Pharmacy Science
Figure 1: Infusion solutions delivered from the hospital
pharmacy during a 12-month period
14,000
Infusion bottles 100 mL
Infusion bottles 50 mL
12,000
Number of units
10,000
8,000
6,000
4,000
2,000
0
Internal
Med. 1
Internal
Med. 2
Haematology
ICU
Emergency
unit
Surgical
ward
Participants in the survey
short infusion. Thus, the responses to the questionnaire
were widely consistent with the three-month statistical
analysis shown in Figure 2.
The results of the determination of dead volumes
assessed in the laboratory tests (normal saline) are given
in Table 2. Depending on the manufacturer of the infusion fluid, the dead volume varied between 24 mL and
27 mL when the drip chamber was filled to the mark and
between 15 mL and 19 mL when the drip chamber was
empty. When the IV administration set was completely
empty, only the residue in the infusion bottle contributed
to the dead volume. Depending on the manufacturer,
this residue varied between 6.4 mL and 6.9 mL for
Miniflac bottles, and 4.4 mL for bottles manufactured
by Bichsel. Compared with the 100 mL Miniflac bottles,
the percentage of the dead volume doubled using 50 mL
Miniflac bottles.
Figure 2: Drugs for short infusion delivered from the hospital
pharmacy during a 3-month period
6,000
Vitamins
PPIs
IV solution additives
Immunosuppressives
Corticosteroids
Antiviral drugs
Antithrombotics
Antimycotic drugs
Antibiotics
Number of units
5,000
4,000
3,000
2,000
1,000
0
Internal
Med. 1
Internal
Med. 2
Haematology
ICU
Emergency
unit
Participants in the survey
34 •
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Volume 16 • 2010/2 • www.ejhp.eu
Surgical
ward
The results for 100 mL Miniflac bottles were comparable
with those after reconstitution of Augmentin 2.2 g.
The results of the observational tests on the two wards are
summarised in Table 3. On one ward (internal medicine 2),
100 mL Miniflac bottles were used exclusively. In each case,
the infusion had been stopped when the drip chamber was
empty. Five out of the nine infusions had been performed
with Tazobac 4.5 g, two with Augmentin 1.2 g, one with
Rocephin 2 g and one with Meronem 1 g. The average of
the dead volume amounted to 15% ± 0.72% standard deviation (SD).
On the other ward (internal medicine 1), 50 mL Miniflac bottles were used as well as 100 mL infusions. The
infusions were either stopped when the drip chamber
was empty, or the drip chamber was half-filled or filled to
the mark, respectively. Depending on the actual volume of
liquid in the drip chamber, the dead volume varied between
24% and 32% for 50 mL Miniflac bottles, and between
14% and 20% for 100 mL Miniflac bottles.
DISCUSSION
It is well known that some drug solution remains in the
IV administration set and the bottle at the end of infusion because of the dead volume of the IV administration set [3]; up to the present time and as far as is
known, no systematic research has been carried out to
quantify this phenomenon. It has been discussed, for
example, controversially on web forums, whether the
dead volume is of significant relevance and whether the
IV administration set has to be flushed with the vehicle
after the end of the short infusion as a consequence
[5]. According to the findings of this study, the amount
of short-infusion dead volume is mostly underestimated
by the nursing staff. The study was able to demonstrate
that parenteral drugs that are marketed in a lyophilised
form are not generally overfilled by the manufacturer.
Thus, it cannot be expected that a loss of the reconstituted drug because of vehicle residue at the end of the
infusion would be routinely compensated.
A volume of 6.4 mL ± 0.55 mL SD remaining in Ecoflac
plus bottles at the end of the infusion was determined;
this exceeded the volume of 3–5 mL indicated by the
manufacturer [12]. The results of the laboratory tests
showed that, depending on the volume of infusion and
the manufacturer, the total dead volume in the bottle and
the IV administration set varied between 47% (50 mL)
and 24% (100 mL) when the drip chamber is filled to the
centre ring, and between 32% and 15% when the drip
chamber is empty.
Evaluation of the dead volume in intravenous short-term infusion
Herbert Plagge et al
European Journal of Hospital Pharmacy Science
carried out on the internal
medicine 1 ward resulted in
more heterogeneous data with
a wider SD compared with
the internal medicine 2 ward.
Therefore, it is possible that the
observed differences between
the tests on this ward and the
laboratory tests with 50 mL
Miniflac bottles resulted from a
less accurate handling by the
nursing staff, but this aspect
was not explored.
Table 2: Dead volume in 50 mL and 100 mL normal saline from laboratory tests
Type of infusion
(manufacturer)
[n]
Drip
chamber
NaCl 0.9% Miniflac
50 mL (B. Braun)
5
a
b
NaCl 0.9% Miniflac
100 mL (B. Braun)
5
Total volume
(mL) ± SD
Dead volume
(mL) ± SD
Dead volume
(%) ± SD
58.0 ± 0.61
27.3 ± 0.39
47.0 ± 0.55
58.0 ± 0.61
22.9 ± 0.41
39.5 ± 0.61
c
58.0 ± 0.61
18.6 ± 0.30
32.0 ± 0.34
d
58.0 ± 0.61
6.9 ± 0.31
11.9 ± 0.55
a
111.3 ± 0.42
27.4 ± 0.55
24.6 ± 0.54
b
111.3 ± 0.42
23.7 ± 0.45
21.3 ± 0.39
c
111.3 ± 0.42
19.4 ± 0.55
17.4 ± 0.53
d
111.3 ± 0.42
6.4 ± 0.55
5.8 ± 0.50
As mentioned above, the filling
volume of Ecoflac plus bottles
b
111.2 ± 0.59
22.7 ± 0.76
20.4 ± 0.70
can range from 54–60 mL
Admixture with
c
111.2 ± 0.59
18.9 ± 0.55
17.0 ± 0.49
for 50 mL bottles and from
Augmentin 2.2 g
108–120 mL for 100 mL bottles.
d
111.2 ± 0.59
5.9 ± 0.55
5.3 ± 0.49
Therefore, the percentage of the
NaCl 0.9% 100 mL
5
a
103.6 ± 0.42
24.4 ± 0.37
23.6 ± 0.40
dead volume depends on the
(Bichsel)
b
103.6 ± 0.42
19.9 ± 0.42
19.2 ± 0.44
effective volume in the bottle.
The total volume of the 100 mL
c
103.6 ± 0.42
15.5 ± 0.36
14.9 ± 0.36
Ecoflac plus bottles used in
d
103.6 ± 0.42
4.4 ± 1.28
4.2 ± 1.22
the study was nearer the lower
SD: standard deviation; a: drip chamber filled to the mark (centre ring); b: drip chamber half filled; value (see Table 2). Assuming
c: drip chamber empty; d: IV administration set completely empty (only residue in the bottle contributes the maximal total volume of
to the dead volume)
120 mL, the percentage of
the total volume would slightly
In order to compare the results of the laboratory tests and
decrease from 21.3–19.8% (drip chamber half-filled) and
real-life conditions, observational tests were performed on
from 5.8–5.3% (IV administration set completely empty).
two wards, one of them using 50 mL infusion solutions.
Therefore, the effective volume in the infusion bottle has
The preliminary tests were conducted on two internal
only a little influence on the percentage of the dead volume
medicine wards. It was decided not to include further
and on the loss of drug.
wards and waived the registration of nurses administering
As stated previously, both the residue in the IV administhe short infusions. The number of samples on each ward
tration set and the residue in the infusion bottle contribute
was limited (internal medicine 1: ten tests with 50 mL
to the dead volume at the end of infusion and to the loss
and seven tests with 100 mL infusion solutions; internal
of vehicle and drug. The residual volume in the bottle
medicine 2: nine tests with 100 mL infusion solutions).
depends on the manufacturer of the vehicle. The differBecause of the lack of internal guidelines, the infusions
ences between the products of the two manufacturers
were stopped at different time points with the consetested were small (B. Braun: 6.9 ± 0.31 mL or 6.4 ± 0.55 mL
quence of varying residual volumes in the drip chamber,
respectively versus Bichsel: 4.4 ± 1.28 mL). Therefore, the
depending on the type of ward and the nurse performing
preferred use of products from a specific manufacturer
the administration. Therefore, the groups of tests had to
would not help. Moreover, the percentage of residue in
be divided into subgroups according to the actual volume
the bottle has only minimal influence on the total dead
of liquid in the drip chamber at the end of the infusion. The
volume. In contrast, the residual volume in the infusion
findings of the 15 tests performed on the two wards with
line is twice as large as the residue in the bottle when the
100 mL Miniflac bottles with an empty drip chamber were
drip chamber is empty, and three times the volume when
comparable with those of the laboratory tests (14–15%
the drip chamber is half filled. From this observation, a
vs 17%), but there were differences for the 50 mL Miniflac
change of the infusion set could have a major effect on
bottles (24.4% vs 32%, drip chamber empty and 32% vs
the dead volume. In any case, only the Intrafix Primeline
39.5%, drip chamber half-filled, respectively). The tests
NaCl 0.9% Miniflac
100 mL (B. Braun)
5
a
111.2 ± 0.59
26.8 ± 0.57
24.1 ± 0.55
•
Volume 16 • 2010/2 • www.ejhp.eu • 35
Evaluation of the dead volume in intravenous short-term infusion
Herbert Plagge et al
European Journal of Hospital Pharmacy Science
Table 3: Dead volume in 50 mL and 100 mL normal saline from clinical practice
tests
Type of infusion
antibiotic
Drip
Total
[n] chamber volume
(mL) ± SD
Dead
volume
(mL) ± SD
3
b
58.4 ± 1.42
18.8 ± 1.26 32.2 ± 1.86
7
c
59.1 ± 0.91
14.4 ± 1.13 24.4 ± 1.86
NaCl 0.9% Miniflac 100 mL 1
Rocephin
a
111.6
22.0
NaCl 0.9% Miniflac 100 mL 6
Augmentin, Garamycin,
Rocephin, Tazobac
c
113.0 ± 1.18 15.8 ± 2.25 13.9 ± 1.93
c
111.3 ± 1.08 16.7 ± 0.66 15.0 ± 0.72
Internal medicine ward 1
NaCl 0.9% Miniflac 50 mL
Augmentin, Rocephin,
Tazobac
NaCl 0.9% Miniflac
50 mL Augmentin,
Garamycin, Tazobac
Internal medicine ward 2
NaCl 0.9% Miniflac 100 mL
9
Augmentin, Meronem,
Rocephin, Tazobac
Dead
volume
(%) ± SD
19.7
of dead volume. As a consequence, there
is no standardisation in terms of quantity of the infusion volume and the handling at the end of the infusion, and both
50 mL infusion solutions and 100 mL
infusions are used on various wards. This
could cause a problem regarding patient
safety, especially for those drugs whose
dosage is adjusted to body weight, e.g.
aminoglycoside antibiotics or antiepileptic drugs. For example, in the case of
a 70 kg patient prescribed gentamicin
therapy and a once-daily dose of 5 mg/
kg body weight, 350 mg of gentamicin
is to be administered. A loss of around
30% would result in the administration of
only 245 mg of gentamicin to the patient.
However, it was not the aim of this study
to deal with clinical consequences; further investigations would be necessary
to quantify the clinical relevance of such
potential under-dosing.
SD: standard deviation; a: drip chamber filled to the mark (centre ring); b: drip chamber
half filled; c: drip chamber empty.
Comfort 180 cm administration set was used in the
study, because it is the standard IV administration set at
USB and used almost exclusively. A change of infusion
set should be considered in future.
Generally, at USB the IV administration set is neither disconnected nor flushed at the end of infusion, which is in
accordance with the hygiene guidelines in the hospital and
with the guideline for prevention of catheter-associated
infections published by the German Robert Koch Institute
[13]. In this regard, the use of the Soluset administration
set could be a further solution to address the problem of
dead volume. Administration of IV medicines via Soluset
enables flushing of the administration set at the end of
a short infusion without disconnecting the administration set and the bottle. Thus, a loss of drug solution at
the end of the infusion could be avoided. Compared with
the Intrafix Primeline system, the Soluset system is much
more expensive and is therefore only used on the haematological ward and intensive care units.
The study demonstrated that a significant amount of infusion volume and thus of the active compound is lost at
the end of infusion because of dead volume, particularly
for 50 mL short infusions. Primarily, this is a problem of
missing guidelines at USB and about a lack of awareness
36 •
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Volume 16 • 2010/2 • www.ejhp.eu
Therefore, it seems to be important to
address the problem of dead volume by
internal guidelines and nurse training. Particularly in the
paediatric setting, the problem arising from dead volume
has been acknowledged and a standard operating procedure for the administration of IV medicines to paediatric
patients has been implemented [14]. For this reason,
the results of the investigations undertaken in this study
were discussed with the nursing staff and the committee
responsible for internal nursing guidelines. As a first consequence, the guideline concerning the handling of IV
infusion was supplemented with a chapter referring to IV
short infusions. Where possible, the volume of short infusions is now recommended to be 100 mL as a minimum,
and the infusion should be stopped only when the drip
chamber is empty. Furthermore, the nursing staff and the
physicians were informed about this recommendation
through an article in the quarterly bulletin of the hospital
pharmacy.
CONCLUSION
Medicinal products marketed as powders for injection or
infusion are not generally overfilled by the manufacturer
and thus do not compensate a possible loss of drug
because of dead volume in a short infusion. A considerable amount of the infusion volume and therefore of the
active compound is lost because of dead volume in the
administration set and the bottle. This bears a potential
risk regarding medication safety.
Evaluation of the dead volume in intravenous short-term infusion
Herbert Plagge et al
European Journal of Hospital Pharmacy Science
We recommend that the volume of short infusions should
be 100 mL as a minimum and that the infusion should be
stopped only when the drip chamber is empty. For the
future, there should be discussion whether or not special
IV administration sets such as Soluset should be used for
potentially critical drugs in order to flush the system at the
end of short infusion. In this context, it will be necessary to
define the drugs that are potentially critical and the maximal percentage rates of loss that can be accepted.
ACKNOWLEDGEMENTS
The authors would like to thank all nurses who took time
to respond to the questionnaire and participated in the
study.
CONFLICT OF INTERESTS
The authors declare no conflicts of interest.
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