Sir,It has been frequently observed that in preparing intravenous (iv) infusion by junior residents or nursing staff in operating room before surgery and in wards, there are many times leakage from plastic bottle of iv fluids after spike of iv set is inserted into the bottle. It accounts for approximate 5%-6% of the wastage of iv fluids depending upon the experience of person doing it and also on quality of material of plastic bottles and iv sets. It causes a host of problems like financial loss (increasing overall cost of treatment), iv fluid spillage on operation theatre floor (mechanical and electrical hazards), and above all error in calculating administered iv fluid (more critical in pediatric patients) because of parallel leakage. We have tried to search literature using PubMed/Google search engine and could not found gravity of problem and any satisfactory solution to this problem. This problem is more rampant in developing countries where often patient workload outnumbers the available resources and quality controls are not so stringent. In a recent report from Japan, leakage from infusion bag when removing spike from iv container has been reported in patients undergoing anticancer chemotherapy while evaluating a new anticancer chemotherapy administration system. Here, cost of treatment and toxic exposure carries additional risk.[1]We are writing this letter not only to sensitize anesthesia fraternity, but also to invite suggestions from colleagues which can be incorporated in our day to day usage. Grossly, it seems that area for change can be either technique of iv infusion preparation or at manufacturing level, where some modifications can be done either in the plastic bottle or in iv set. Over the years with our experience, we have found that if there is gentle pushing of spike with screw action into the iv bottle, it usually results in a leak-free connection. We have few suggestions to solve this problem:We should use plastic infusion bags as they have proper rubber seal through which iv set spike can be introduced.In conventionally available plastic infusion bottles, there female port can be provided with a breakable membrane which can be easily pierced by spike of iv set.We can suggest changes in iv set spike tip like making it screw type with metallic tip so that piercing the infusion bottle is easy and leak-free.Use of PhaSeal infusion adaptor [Figure 1]. In near future, this product may be commercialized and tested but again this will result in some additional cost to patient. It has features like double membrane structure resulting in leak-free system and helps in connecting iv bag and dedicated iv set.
Figure 1