Understanding IV antimicrobial drug losses: the importance of flushing infusion administration sets

BACKGROUND: IV drugs are commonly prescribed for inpatient treatment. Where administered as infusions, drug dose loss is incurred if the infusion line is not flushed. Underdosing of IV antimicrobials is of particular concern as reduced treatment efficacy increases the risk of patient deterioration (including sepsis) and development of antimicrobial resistance. OBJECTIVES: To quantify drug loss, raise awareness and provide recommendations to address this patient safety risk effectively. METHODS: Percentage drug loss of 39 IV antimicrobials was calculated for a theoretical patient case scenario, using residual volumes for IV infusion lines utilized within this acute healthcare setting. An adult male patient (70 kg) with good renal function was assumed for drug dosing. Infusion volumes and doses are based on a widely used IV administration guide. RESULTS: Data revealed the scope and extent of antimicrobial drug losses where infusion lines were not flushed as ranging from 2% to 33%. More than 10% of the drug would be lost for 26 of the 39 antimicrobials assessed, with five of these yielding over 20% loss. CONCLUSIONS: The authors suggest that unintentional antimicrobial underdosing is going unnoticed in clinical practice. Where IV infusion is necessary, flushing of the infusion line to ensure total dose administration is strongly recommended. Risks associated with flushing lines (fluid overloading, bolus dosing, etc.) can be managed with simple measures. The authors call for a national body-led approach to effectively influence healthcare organizations in review of IV administration protocols, ensuring patient safety and care in the NHS.