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Polyvinylchloride infusion lines expose infants to large amounts of toxic plasticizers
1Departments of Pediatric Surgery and Pediatrics, Fakultät für Klinische Medizin Mannheim der Universität Heidelberg, Mannheim, Germany.
Insights
Plastic infusion lines leach significant amounts of diethylhexyl-phthalate (DEHP) during total parenteral nutrition (TPN), posing risks to vulnerable neonates. Further research is needed to confirm the link between DEHP exposure and TPN-induced liver dysfunction.
Area of Science:
- Neonatal care
- Clinical toxicology
- Medical device safety
Background:
- Long-term total parenteral nutrition (TPN) is critical for neonates unable to receive enteral nutrition.
- Polyvinylchloride (PVC) infusion lines are commonly used for TPN delivery.
- Concerns exist regarding the potential leaching of plasticizers from PVC medical devices into patient circulation.
Purpose of the Study:
- To quantify the leaching of diethylhexyl-phthalate (DEHP) from PVC infusion lines during TPN.
- To assess the potential for DEHP to cause hepatotoxic effects in neonates receiving long-term TPN.
Main Methods:
- TPN solutions, blood products, and common neonatal drugs were infused through PVC lines.
- Gas chromatography/mass spectrometry was used to measure DEHP concentrations before and after perfusion.
- DEHP doses were calculated for typical preterm neonates undergoing TPN and additional therapies.
Main Results:
- Significant DEHP leaching occurred from PVC infusion lines, with daily doses reaching 10-20 mg/day in preterm neonates.
- Lipid emulsions and propofol infusions resulted in the highest DEHP transfer.
- Blood products also contributed substantially to the total DEHP dose.
Conclusions:
- The substantial DEHP leaching from PVC infusion lines is concerning for vulnerable neonatal populations.
- A biological effect of these DEHP doses is plausible, based on existing literature.
- The relationship between TPN-induced DEHP exposure and hepatobiliary dysfunction requires further investigation.
Purpose:
The purpose of this study was to evaluate whether infusion lines are able to leach plasticizers in substantial amounts and thus be a candidate substance for hepatotoxic effects during long-term total parenteral nutrition (TPN).
Methods:
TPN solutions, blood products, and selected drugs typical for preterm infants concerning amount, content, and infusion time were perfused through common polyvinylchloride (PVC) infusion lines. Concentration of diethylhexyl-phthalate (DEHP) before and after perfusion was determined by gas chromatography/mass spectrometry.
Results:
Daily quantities of DEHP by 24-hour infusions were Lipid emulsion 20%: 10185.6 microg; aminoacid/glucose-solution: 116.2 microg; midazolaminfusion for sedation: 26.4 microg; fentanyl for sedation: 132.5 microg; propofol for sedation: 6561.0 microg. The amount of DEHP by single doses of blood products (20 mL) were packed red blood cells: 144-608 microg; platelet rich plasma: 928 microg; and fresh frozen plasma: 552-8108 microg. The dose of DEHP for a typical preterm neonate requiring TPN and additional therapy like sedation or blood products is at minimum 10 mg and can easily reach 20 mg/d.
Conclusion:
This large amount of DEHP is especially disturbing, because it effects the most vulnerable patients (neonates). Whether there is a relation to TPN-induced hepatobiliary dysfunction remains to be elucidated and is under investigation. With respect to recent literature, a biological effect of these doses must be assumed.