Modern approaches to infusion therapy in pediatrics and chemotherapy
Authors: Mozharivska A.A. 
Published: July 2021

Background. Systems for intravenous administration of blood products and drugs are divided into the systems for transfusion (pore diameter – 114-200 μm) and systems for infusion (pore diameter – 15-75 μm). Gravity delivery systems consist of a drip chamber, an infusion rate regulator, a needle connector, a system tube, an injection needle, and a system fixation patch.

Objective. To describe modern approaches and devices for infusion therapy.

Materials and methods. Analysis of the literature on this issue.

Results and discussion. If the needle is integrated into a drip chamber, it should contain two channels at different levels: a channel for the drug and an air channel with a built-in antibacterial filter. This is important because air is always considered a non-sterile environment. The use of antibacterial filter systems for injection of drugs into the vial is prohibited. Filter materials are able to absorb on its surface from 10 to 90 % of the drug. In addition, drying of some solutions make the filter impermeable to air. Another important filter in infusion systems is the drip chamber filter, which prevents insoluble particles of the drug, particles of ampoule glass, plastic or rubber stopper from entering the bloodstream. Typical characteristic of infusion from plastic vials is the absence of need for an air needle or opening of the ventilating chamber. During the infusion, air does not enter the vial, so it deforms. On an additional inverted scale you can see the amount of drug infused. The main materials for the systems are polyvinyl chloride, diethylhexyl phthalate, and thermoplastic elastomers. The most modern and safe systems are made of thermoplastic elastomers or neutral polyurethane, however, imperfect cheap systems made of polyvinyl chloride and diethylhexyl phthalate are still widespread in Ukraine. Parenteral uptake of phthalates has antiandrogenic, antiestrogenic, antithyroid, carcinogenic, and mutagenic effects. This increases the risk of reproductive problems, diabetes, obesity. Special care should also be taken when using latex-containing systems, as 3-17 % of inpatients are allergic to latex. Anaphylactic shock can develop even 4 hours after surgery. Ukrainian company “Yuria-Pharm” produces modern phthalate-free systems, including a system for the introduction of light-sensitive solutions. There are also closed non-drop level systems designed for both gravity infusion and use with volumetric infusion pumps of open type. Automatic filling of the system due to the use of a purge filter with a hydrophobic membrane allows to reduce drug losses when filling the system, to reduce the risk of chemical contamination, and significantly save time to fill the system. The nurse also does not have to look for a drain tray when filling the system. The drip system filter with non-drop level function allows not to lose the required fluid level during massive infusion therapy, significantly save the nurse’s time spent on monitoring the fluid level in the vial and refilling the system, reduce the number of “alarm” staff calls, reduce risk and chemical contamination of the vial. In turn, closed systems with a graduated regulator are designed for the infusion of drugs that require accurate dosing and careful rate control throughout the infusion period (Flow Set).

Conclusions. 1. Systems for intravenous administration are divided into systems for transfusion and systems for infusion. 2. The most modern and safe systems are made of thermoplastic elastomers or neutral polyurethane. 3. There are closed systems with non-drop level, designed for both gravity infusion and the use with volumetric infusion pumps. 4. Closed systems with a graduated regulator are designed for the infusion of drugs that require accurate dosing and careful rate control throughout the infusion period.