Potential Impact of Infusion Technique on Drug Delivery.

Background: Infusion practices have been modified, especially for antineoplastic drugs, through the use of specific infusion devices with postadministration rinsing (PAR) so as to decrease occupational exposure to drugs. The aim of this study was to highlight how such infusion devices may impact the drug delivery of injectable drugs.
Materials and Methods: Drug infusions were simulated with a radiotracer (99mTc) for 30 minutes to assess nine different infusion lines: 2 infusion methods without PAR (1 gravity-fed infusion and 1 pump infusion), 2 extension lines to be connected to standard infusion devices to allow PAR, and 5 specific infusion sets allowing a PAR. 99mTc was compounded in 250 or 100 mL of 0.9% NaCl solution. From the continuous recording of drug concentrations at device outlets, the areas under the drug concentration-time curve (AUC) were computed and divided in 2 parts: the AUCadm corresponding to the administration phase and the AUCrin corresponding to the rinsing phase. Their comparison to the initial activity led to compute the drug delivery. Results between groups were compared using a Kruskal-Wallis test (P < 0.05).
Results: Using standard infusion devices leads to administer only 91% and 88% when the drug is diluted in 250 and 100 mL, respectively. During the administration phase with the extension lines connected to infusion sets, between 90.8 ± 6.9% and 94.2 ± 1.8% of the drug is infused for 250 mL dilutions and 87.7 ± 2.0% for 100 mL dilutions. For specific infusion sets, the proportion of infused drug varied between 88.6 ± 6.0% and 95.3 ± 1.5% for dilutions in 250 mL and 71.2 ± 3.1% and 90.4 ± 2.8% for dilutions in 100 mL. Rinsing the lines means the remaining drug is administered a rinsing volume ranging between 47.0 ± 6.6 and 92.2 ± 8.9 mL according to the device and drug dilution.
Conclusions: This study shows that drug delivery may differ according to infusion line and dilution volume. Further study is required to assess the impact of these devices on pharmacokinetics.