While the syringe pumps should produce a relatively accurate flow rate, it has been suggested that the physical properties of the other components in an infusion setup may still cause an instable and seemingly unpredictable flow rate. Thirdly, the total infusion setup consists of several components, many of which are disposable medical devices. This principle of joining multiple infusion pumps on one central line has been named multi-infusion or co-infusion and may be the source of considerable flow rate variability. Consequently, multiple pumps are combined on this single catheter, causing the flows originating from each individual pump to interact with each other due to pressure differences and mixing effects. Usually, only one catheter is used for multiple IV drug delivery. Secondly, IV access sites should be limited for reasons of infection risk. First of all, patients, especially those on the intensive care, often need very concentrated pharmaceuticals (drugs) that are delivered with flow rates as low as 0.1 ml/h to minimize excess fluid delivery. These clinical effects can be classified as either insufficient efficacy (underdosing) or increased toxicity (overdosing). Variability in flow rate leads to dosing errors, which may lead to adverse clinical effects. Intravenous (IV) drug administration by infusion is especially challenging for critical applications because stable infusion flow rates are necessary. Infusion technology is among the most frequent sources of technology-related medical errors. Mechanical compliance caused longer flow rate start-up times (from several minutes up to approximately 70 min) and delayed occlusion alarm times (up to 117 min). The syringe was indicated as the most important source of mechanical compliance in syringe pump setups (9.0×10 -9 to 2.1×10 -8 l/Pa). Mechanical compliance, flow resistance, and dead volume of infusion systems were stated as the most important and frequently identified physical causes of flow rate variability. We included 53 studies, six of which were theoretical models, two articles were earlier reviews of infusion literature, and 45 were in vitro measurement studies. We aimed to extract from literature the component with the highest mechanical compliance in syringe pump setups. Special focus was given to syringe pump setups, which are typically used if very accurate drug delivery is required. We aimed to systematically review the available biomedical literature for in vitro measurement and modeling studies that investigated the physical causes of flow rate variability. These dosing errors may lead to adverse effects. When administering pharmaceuticals by means of infusion, dosing errors can occur due to flow rate variability. Infusion therapy is medically and technically challenging and frequently associated with medical errors.
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