This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a colleague Similar articles in this journal Similar articles in Web of Science Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Web of Science (3) Citing Articles via Google Scholar Google Scholar Articles by Lovich, M. A. Articles by Peterfreund, R. A. Search for Related Content PubMed PubMed Citation Articles by Lovich, M. A. Articles by Peterfreund, R. A. Related Collections Equipment Technology Pharmacology

---

TECHNOLOGY, COMPUTING, AND SIMULATION

The Impact of Carrier Flow Rate and Infusion Set Dead-Volume on the Dynamics of Intravenous Drug Delivery

Department of Anesthesia and Critical Care, Massachusetts General Hospital, Harvard Medical School, Boston

Address correspondence and reprint requests to Robert Peterfreund, MD, PhD, Department of Anesthesia and Critical Care, Clinics 3, 55 Fruit St., Massachusetts General Hospital, Boston, MA 02114. Address e-mail to rpeterfreund{at}partners.org.

The dynamics of IV drug delivery resulting from drug infusions connected to main-line crystalloid carriers can be complex and depend on infusion set dead-volume, drug flow rate, and carrier flow rate. While the concept of dead-volume is intuitive, a lack of appreciation of the interaction with the carrier and drug flow rates can lead to unintended clinical effects resulting from large variations in the delivery rate of potent drugs. We derived mathematical models to quantify these interactions. Experimental simulation with methylene blue infusions tested these predictions. The models predict a lag in response time to changes in carrier or drug flow, which is proportional to the dead-volume and inversely related to the total flow rate. Increasing the carrier rate provides an acute drug bolus. Temporary reduction or cessation of carrier flow decreases the rate of drug delivery, potentially for prolonged periods. Furthermore, a drug bolus results from restoration of the carrier flow. The method of connecting an infusion to a carrier and the use history affects the dynamics of drug delivery. Thus, although complex, the impact of infusion set architecture and changes in carrier and drug flow rates are predictable. These quantitative studies may help optimize the safe use of IV drug infusion systems.

This article has been cited by other articles:

				D. R. Moss, K. Bartels, G. L. Peterfreund, M. A. Lovich, N. M. Sims, and R. A. Peterfreund An In Vitro Analysis of Central Venous Drug Delivery by Continuous Infusion: The Effect of Manifold Design and Port Selection Anesth. Analg., November 1, 2009; 109(5): 1524 - 1529. [Abstract] [Full Text] [PDF]

				B. Decaudin, S. Dewulf, D. Lannoy, N. Simon, A. Secq, C. Barthelemy, B. Debaene, and P. Odou Impact of Multiaccess Infusion Devices on In Vitro Drug Delivery During Multi-Infusion Therapy Anesth. Analg., October 1, 2009; 109(4): 1147 - 1155. [Abstract] [Full Text] [PDF]

				K. Bartels, D. R. Moss, and R. A. Peterfreund An Analysis of Drug Delivery Dynamics via a Pediatric Central Venous Infusion System: Quantification of Delays in Achieving Intended Doses Anesth. Analg., October 1, 2009; 109(4): 1156 - 1161. [Abstract] [Full Text] [PDF]

				M. A. Lovich, M. E. Kinnealley, N. M. Sims, and R. A. Peterfreund The delivery of drugs to patients by continuous intravenous infusion: modeling predicts potential dose fluctuations depending on flow rates and infusion system dead volume. Anesth. Analg., April 1, 2006; 102(4): 1147 - 1153. [Abstract] [Full Text] [PDF]