The effect of manual bulb pump infusion systems on venous luminal pressure and vein wall integrity

Anecdotal case reports have suggested a risk of extravasation injury with pressurized intravenous (i.v.) infusion systems used for rapid fluid administration. This study aims to determine the risk associated with manual bulb pump i.v. infusion sets with which in-line pressures exceeding 1000 mm Hg are possible. In Part I, 34 vein segments prepared from 29 fresh cadavers, designated "thick" or "thin" on visual appraisal, were cannulated in vitro with a 16-gauge i.v. catheter. The samples were further divided into two groups, depending on whether cannulation damaged ("traumatic") or did not damage ("atraumatic") the vein wall. The veins were sealed and pressurized with saline, and the pressure recorded at which leakage occurred. In Part II, the pressure generated by use of the manual bulb pump in forearm veins cannulated with a 16-gauge catheter was measured in 20 adult patients. The measure was repeated with graded external compression to simulate venous obstruction. The mean leakage pressure for thick- and thin-walled atraumatically cannulated veins in vitro was 1433 and 838 mm Hg, respectively (P < 0.0001). After traumatic cannulation, the leakage pressure for thick- or thin-walled veins in vitro was 361 and 260 mm Hg, respectively, and significantly different from atraumatic cannulations (P < 0.001). The mean intraluminal pressure measured during clinical use of the bulb pump was 88 mm Hg (range, 36-206 mm Hg). In some patients this exceeded the pressure needed to cause leakage in traumatically cannulated veins in vitro. The luminal pressure increased in parallel with increasing external compression.(ABSTRACT TRUNCATED AT 250 WORDS)