Polyvinyl chloride (PVC) plastic is used to manufacture a large number of articles for daily life, e.g. toys, building material such as flooring and cables, and medical products. PVC is the second largest commodity plastic after polyethylene with world production currently over 18 million tons per year. Unplasticized PVC is hard and brittle at room temperature. As a result, plasticizers are necessary to impart flexibility to the polymer. Plasticizers are additives, most commonly phthalate ester, which work by embedding themselves between the chains of polymers, spacing them apart, and thus making it significantly softer.
PVC and its toxic breakdown product, di (2-ethylhexyl) phthalate (DEHP), can be found throughout the hospital when patients are exposed to:
- IV and blood bags
- Infusion Administration sets
- Enteral and parenteral feeding bags
- Peritoneal dialysis bags and tubing
- Cardiopulmonary bypass
- Extracorporeal membrane oxygenation
IV containers made with PVC and DEHP can have negative effects on IV medication delivery and can compromise the patient receiving the correct amount of IV medication. This is due to two phenomenon: adsorption and leaching.
This occurs when medications do not stay in suspension, but attach to the sides of an IV bag due to the presence of PVC. The result is that the medication is not evenly distributed throughout the IV fluid and can compromise the patient getting a full or correct dose.
The following drugs adsorb to PVC medical products: 1-2
Drugs that Adsorb to PVC Medical Products
- Chlordiazepoxide HCl
- Isosorbide Dinitrate
- Sufentanil Citrate
- Thiopental Sodium
- Warfarin Sodium
Leaching and Toxic Effects
Leaching is the release of DEHP from PVC containers into the medication contained in the IV bag. DEHP has been shown to produce a wide range of toxic effects, particularly in male neonates where the infant’s reproductive system can be compromised. In fact, the California EPA has identified DEHP as a reproductive toxin.
Products that Exacerbate Leaching
- Chlordiazepoxide HCl
- Lipid Emulsions
1 Bristol-Myers Squibb Company, Oncology Division. Taxol (Paclitaxel) Injection Administration, Equipment, 11/99 Equipment
2 Chemical and Physical Compatibility of Selected Drugs in EXCEL® Container System
3 Glass and Accumed™ IV Delivery Systems Drug Additive and Chemical Physical Compatibility Guide
4 Trissel LA, Pearson SD (2/1994) Storage of lorazepam in three injectable solutions in polyvinyl chloride and polyolefin bags. Am J Hosp Pharm; 1;51(3):368-72.