A finite element model for insulin adsorption in ICU infusion sets

Insulin adsorption has been observed in ICU delivery lines, and is especially problematic in the delivery of insulin within the neonatal ICU. This paper presents a two state model with adsorptive loss described as a predator-prey term with parameters Ki and Beq. This model is discretized to N sub volumes along the length of an infusion set. The model was found to converge to a solution for N>~100-150. The model was fit to literature data, and it was found that the total adsorptive capacity of a material (Beq, U/m2) was hyperbolically related to flow rate. If the average rate constant Ki was used with the hyperbolic relationship, the model was able to describe adsorption dynamics at all 3 examined flow rates for a polyethylene line.

[1]  J. Aschner,et al.  Effect of flow rate and insulin priming on the recovery of insulin from microbore infusion tubing. , 1998, Pediatrics.

[2]  J. Chase,et al.  Corticosteroids and insulin resistance in the ICU , 2009 .

[3]  J. Geoffrey Chase,et al.  Impact of variation in patient response on model-based control of glycaemia in critically ill patients , 2013, Comput. Methods Programs Biomed..

[4]  Rinaldo Bellomo,et al.  The impact of early hypoglycemia and blood glucose variability on outcome in critical illness , 2009, Critical care.

[5]  A. Malhotra,et al.  Stress-induced hyperglycemia. , 2001, Critical care clinics.

[6]  J. R. Oliver,et al.  Insulin infusions in the neonatal unit: Delivery variation due to adsorption , 2000, Journal of paediatrics and child health.

[7]  N. Medlicott,et al.  Intravenous drug delivery in neonates: lessons learnt , 2014, Archives of Disease in Childhood.

[8]  M. Brook,et al.  The stability of insulin solutions in syringes is improved by ensuring lower molecular weight silicone lubricants are absent , 2017, Heliyon.

[9]  K. Nolph,et al.  Influence of temperature and time on insulin adsorption to plastic bags. , 1983, American journal of hospital pharmacy.

[10]  J. Geoffrey Chase,et al.  Impact of glucocorticoids on insulin resistance in the critically ill , 2011, Comput. Methods Programs Biomed..

[11]  E. Adrario,et al.  Glycaemic variability, infections and mortality in a medical-surgical intensive care unit. , 2014, Critical care and resuscitation : journal of the Australasian Academy of Critical Care Medicine.

[12]  L. Berghem,et al.  Adsorption of Insulin by Infusion Materials , 1978, Acta anaesthesiologica Scandinavica.

[13]  J. Bukrinsky,et al.  Adsorption of human insulin and AspB28 insulin on a PTFE-like surface. , 2005, Journal of colloid and interface science.

[14]  Insulin Adsorption to Catheter Materials Used for Intensive Insulin Therapy in Critically Ill Patients: Polyethylene Versus Polyurethane - Possible Cause of Variation in Glucose Control? § , 2014 .

[15]  F. Ovalle Hypoglycemia and Outcome in Critically Ill Patients , 2010 .

[16]  Stefan Seeger,et al.  Understanding protein adsorption phenomena at solid surfaces. , 2011, Advances in colloid and interface science.

[17]  S. Tzannis,et al.  Adsorption of a Formulated Protein on a Drug Delivery Device Surface , 1997 .

[18]  Lutz Heinemann,et al.  Insulin Concentration in Vials Randomly Purchased in Pharmacies in the United States: Considerable Loss in the Cold Supply Chain , 2018, Journal of diabetes science and technology.

[19]  K. Taylor,et al.  Adsorption of insulin onto infusion sets used in adult intensive care unit and neonatal care settings. , 2008, Diabetes research and clinical practice.

[20]  P. D’arcy Drug Interactions with Medical Plastics , 1983, Drug intelligence & clinical pharmacy.

[21]  Thomas Desaive,et al.  Variability of insulin sensitivity during the first 4 days of critical illness : implications for tight glycemic control , 2012 .

[22]  K. Taylor,et al.  The Impact of Insulin Adsorption onto the Infusion Sets in the Adult Intensive Care Unit , 2009, Journal of diabetes science and technology.

[23]  Stanley Lemeshow,et al.  Glucose variability and mortality in patients with sepsis* , 2008, Critical care medicine.

[24]  Christopher E. Hann,et al.  Tight glycemic control in critical care - The leading role of insulin sensitivity and patient variability: A review and model-based analysis , 2011, Comput. Methods Programs Biomed..

[25]  J. Caldwell,et al.  Insulin Adsorbance to Polyvinylchloride Surfaces with Implications for Constant-infusion Therapy , 1976, Diabetes.

[26]  J. Krinsley Glycemic Variability and Mortality in Critically 111 Patients: The Impact of Diabetes , 2009, Journal of diabetes science and technology.

[27]  S. Podolsky,et al.  Adsorption of Insulin to Infusion Bottles and Tubing , 1968, Diabetes.

[28]  Michael Bailey,et al.  Hypoglycemia and outcome in critically ill patients. , 2010, Mayo Clinic proceedings.