The Effect of Priming Solutions and Storage Time on Plasticizer Migration in Different PVC Tubing Types—Implications for Wet Storage of ECMO Systems

Abstract

The wet priming of extracorporeal membrane oxygenation systems and storage of these systems for rapid deployment is common practice in many clinical centers. This storage policy is, however, seen by many to be controversial due to the potential adverse effects associated with the migration of the di(2-ethylhexyl) phthalate plasticizer (DEHP) from the polyvinyl chloride (PVC) circuit tubing and issues surrounding the maintenance of sterility. This study was performed to evaluate the effects of both short and long-term storage and priming fluid type on plasticizer migration from four commonly used PVC tubes in extracorporeal membrane oxygenation therapy circuits. The four tubes incorporating three plasticizers, two DEHP, one tri(2-ethylhexyl) trimellitate (TOTM), and one dioctyl adipate (DOA) were exposed to each of the three priming fluids for a period of 28 days. Samples were taken at time intervals of 1, 4, 8, 24, and 48 hours, followed by samples at 7, 14, and 28 days. Each sample was processed using a spectrophotomer and the concentration of plasticizer leaching into each solution at each time-point determined. There was a time dependent increase in plasticizer leached from each tube. The migration was greatly affected by both the priming fluid and tubing type. The migration of DEHP was higher than that of TOTM and DOA over both the short and long-term exposure levels. Plasticizer migration occurs from all of the tubes tested over the long term. The TOTM and DOA tubes performed better than the DEHP counterparts in the short term. Selection of priming fluid has a major bearing on plasticizer migration with significant lipid and protein containing fluids promoting higher migration than simple sodium chloride .9% solution prime. The results suggest that DOA tubing and sodium chloride. 9% solution priming fluid should be selected if wet primed perfusion circuits are to be used over short terms of storage.