Improving patient experiences by understanding infusate properties and their effects on vasculature—WoCoVA 2021 symposium

The 6^th WoCoVA congress, held virtually for the first time in April of this year, welcomed vascular access (VA) specialists from all around the world to exchange knowledge and best practices.

As part of the BD mission to champion for better vascular care, we were proud to sponsor the event and present several symposia, scientific posters and educational training sessions.

One of the symposia was presented by Marc Stranz, PharmD:  Improving patient experiences by understanding infusate properties and their effects on vasculature.

Stranz has worked with the methodology and pharmacology of drug compounding for 46 years. He speaks frequently on the correlation of drug pH, osmolality and cytotoxicity, with complications such as phlebitis and extravasation as well as interventions to prevent these complications. 

Three interlacing factors: device, patient and drug

In this talk, Stranz discusses the three interlacing factors to be considered in infusion therapy: the patient, the device and the drug. 

Properties associated with drug solutions like pH and osmolarity and other factors such as endothelial cell toxicity need to be considered for the risk assessment of phlebitis. However, Stranz states that a comprehensive list of drugs that can cause phlebitis does not exist and any list created can only be based on theoretical risk.

He proposes that the patient and design of the therapy are also significant components of assessing risk of injury.  He advocates that patient-related predisposing factors such as underlying disease, gender, vessel size and blood flow are influential. 

The study

Stranz discusses a study he co-authored with Ryder et al: “Investigation of the role of infusate properties related to midline catheter failure in an ovine model”, which is a review of the most current animal model studying vascular injury from infusates.¹

Due to the lack of research on modelling drug damage in human vasculature, sheep have been identified as a good model of the human vasculature system, including their reactions to vascular damage.

The purpose of this trial was to verify the potential for vascular damage by pH, osmolarity and cytotoxicity in sheep veins.  

The chemical properties of the infusates used in the study came from four categories: non-oncologic cytotoxic, parenteral nutrition, antibiotic and antiviral; relatively common concentrations were used.

The objective was to look for evidence of catheter failure determined by swelling, pain, observable leakage at the catheter site, and unresolved catheter occlusion (inability to infuse and withdraw on two attempts).  

Study results

Drug properties including pH, osmolarity and cytotoxic potation—as well as the duration of therapy and the choice of the most appropriate vascular access device—remain relevant in preventing vessel injury and patient harm. 

Clinical symptoms of thrombotic events and extravasation and/or infiltration are significant indicators of potential irreversible venous damage. Infusates with varied pH, osmolarity, and cytotoxicity tested in this study resulted in severe vascular injury and premature catheter failure.¹

What does this say about patient care? 

To Stranz’s mind, it validates what’s been talked about since 2002—that there is risk associated with drugs. However, before one starts talking about the acceptable ranges of pH, osmolality and cytotoxicity concentration, it’s important to acknowledge that, in humans, predisposing factors matter. And, as always, choosing the right vascular access device remains critical for patient safety and the best possible clinical outcomes. 

Watch the video

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