In vitro measurement of flow rate variability in neonatal IV therapy with and without the use of check valves

A.C. van der Eijk∗, A.J. van der Plas, C.J.N.M. van der Palen, J. Dankelman, B.J. Smit | JNPM 2014;

Abstract. BACKGROUND: In multi-infusion IV therapy, the actual volume delivered to the neonate can vary over time. To reduce flow rate variability, check valves can be used. A check valve allows flow through the valve in only one direction. OBJECTIVE: To evaluate flow rate variability in a low flow dual-infusion setup with and without check valves. METHODS: The effect of changing the height of and adding syringes to the IV-administration set was tested with and without check valves in an in vitro dual-infusion setup with in-line flow meters. The pre-programmed flow rates were 2.5 and 0.1 ml/h. RESULTS: Twenty-four tests of 90 minutes were performed. Time to reach 75% of the pre-programmed 0.1 ml/h flow rate was >20 minutes. The highest total delivered volume during a test was (mean ± SD) 56 ± 8% of the expected delivery for tests without check valves, and diminished to 12 ± 24% of the expected delivery for check valves with a higher opening pressure. CONCLUSIONS: The actual flows and the total delivered volume in low flow dual-infusion setups are less than expected on the pre-programmed flow-rate. These findings emphasize the need for the development of more accurate delivery systems for drugs and fluids in neonatology. Caregivers should be aware of these findings, and optimise the delivery of IV substances by making use of check valves with low opening pressures and by minimising compliance and volume of the IV-administration set. Furthermore, changes in the relative height between pumps and catheter tip should be minimized.

*Corresponding Author: 

Dr. Anne Catherine van der Eijk, Department of Neonatology, Erasmus MC, Sophia Children’s Hospital, University Medical Center Rotterdam, Rotterdam, Dr. Molewaterplein 60, 3015 GJ Rotterdam, The Netherlands. Tel.: +31 (0)10 7037008; Fax: +31 (0)10 7036811;