TYK123
A 8 month female with Tetralogy of Fallot is brought to the OR for primary repair. When ordering the infusions for the case and knowing that a patient with this repair is high risk for post operative arrhythmias, you have chosen to order amiodarone. The pharmacist sends the amiodarone infusion along with the "special" tubing for its administration. Which of the following concerning this practice is true?
A. The special tubing is not needed for this patient
B. Normal PVC tubing causes adsorption of the amiodarone infusion and may lower the effective dose delivered
C. Amiodarone in normal tubing may cause fertility issues in this patient later in life
D. Amiodarone is photosensitive and needs special tubing to be shielded from light
Answer
First, the answer is B (A if you want to be a technical about it). This is an interesting question.
First, the wrong answers. Amiodarone[1] does react with normal PVC tubing to release one of the tubings softeners (DEHP) which is suspected/known to cause fertility issues...in males. So, that is not a real problem for this patient (female). However, the tubing usually does contact PVC tubing at some point. This is why some advocate the use of bolus dosing and not continuous infusions (less exposure). Just remember, DEHP is in almost everything. Look in your bag of NS or LR next time. It probably has a symbol near the bottom that says DEHP. Crazy, right.
Amiodarone does adsorb to normal PVC tubing. This will cause a lower effective dosing delivered to the patient. However, the dosing trials done originally were done using PVC tubing, so the dose is probably OK using that tubing. In this patient, this is the reason for the special tubing.
Amiodarone is not light sensitive.
Amiodarone is also similar structurally to thyroxine, which is why it may cause thyroid issues if given long term. It has also been associated with pulmonary fibrosis.
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