Structural under-administration in oncology: impact of infusion system dead volume on relative dose intensity
DOI:
https://doi.org/10.30968/jhphs.2026.172.1500Abstract
Objective: To evaluate the impact of intravenous infusion system dead space on the fraction of drug effectively delivered and its potential implications for relative dose intensity (RDI) in oncology. Methods: This descriptive study used theoretical modeling in a private oncology clinic. Dead space volumes of infusion systems were experimentally measured in triplicate. A total of 69 intravenous drugs (30 cytotoxic agents and 39 biologics) were included, comprising 76 dose-dilution scenarios. Drug retention was estimated based on final concentration and dead space volume, and its percentage impact relative to the prescribed dose was calculated. Results: Dead space varied across devices, with higher values observed in infusion pump sets and PVC-free systems. Retention ≥5% of the prescribed dose occurred in 94% of biologic scenarios and 60% of cytotoxic scenarios, while retention ≥10% was observed in 46% and 40%, respectively. Infusions ≤100 mL showed the highest impact (17.5% ±5.3), compared to 101–250 mL (7.1% ±1.7) and >250 mL (3.4% ±0.75). Retention was more pronounced in lower absolute dose scenarios. Simulation of line flushing substantially reduced residual drug in most scenarios. Conclusion: Infusion system dead space may represent a systematic source of underdosing in oncology, particularly in low-volume infusions. This phenomenon may cumulatively impact RDI in an unrecognized manner, highlighting the importance of operational factors in therapeutic exposure variability.
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