Re-using residual drug during intravenous infusion treatment

To minimize drug loss residual drug from an intravenous infusion are sometimes used on multiple patients. The non-return valves in the infusion system should in theory prevent the rest of the system from being contaminated. There are currently no Swedish guidelines for if this is appropriate or not.


What scientific studies are there on the use of residual drug from an intravenous infusion for more than one patient?

Identified literature

Table 1 Included studies.
The primary studies have not been assessed for risk of bias by SBU enquiry service.
Study design Setting Outcome
Azevedo et al
Experimental, in vitro Radiology, contrast fluid Bacterial migration
Goebel et al
Experimental, in vivo Radiology, contrast fluid Bacterial migration
Nandy et al
Experimental, in vitro Component testing Bacterial migration
Cona et al
Experimental, animal Radiology, contrast fluid Radiotracer migration
Ellger et al
Experimental, in vitro Intensive care unit Bacterial migration
Sikora et al
Mathematical modelling Radiology, contrast fluid Blood-born transmission
Radke et al
Experimental, in vitro Anasthesia, propofol Bacterial migration
Buerke et al
Experimental, in vitro Radiology, contrast fluid Bacterial migration
Experimental, in vitro Anasthesia, propofol Bacterial migration
Garcia et al
Experminental, in vivo Radiology, contrast fluid Bacterial migration
Turner et al
Experimental, in vitro Pain, opioid analgesia Retrograde flow
Trépanier et al
Experimental, human Anasthesia Blood detection


  1. Azevedo MPF, Monteiro RM, Castelani C, Bim FL, Bim LL, Macedo AP, et al. Biosafety of Non-Return Valves for Infusion Systems in Radiology. Sci Rep 2020;10:9574.
  2. Goebel J, Steinmann J, Heintschel von Heinegg E, Hestermann T, Nassenstein K. Bacterial contamination of automated MRI contrast injectors in clinical routine. GMS Hyg Infect Control 2019;14:Doc05-Doc05.
  3. Nandy P, Young M, Haugen SP, Katzenmeyer-Pleuss K, Gordon EA, Retta SM, et al. Evaluation of one-way valves used in medical devices for prevention of cross-contamination. Am J Infect Control 2017;45:793-798.
  4. Cona MM, Bauwens M, Zheng Y, Coudyzer W, Li J, Feng Y, et al. Study on the microbial safety of an infusion set for contrast-enhanced imaging. Invest Radiol 2012;47:247-51.
  5. Ellger B, Kiski D, Diem E, van den Heuvel I, Freise H, Van Aken H, et al. Non-return valves do not prevent backflow and bacterial contamination of intravenous infusions. J Hosp Infect 2011;78:31-35.
  6. Sikora C, Chandran AU, Joffe AM, Johnson D, Johnson M. Population risk of syringe reuse: estimating the probability of transmitting bloodborne disease. Infect Control Hosp Epidemiol 2010;31:748-54.
  7. Radke OC, Werth K, Borg-Von-Zepelin M, Saur P, Apfel CC. Two serial check valves can prevent cross-contamination through intravenous tubing during total intravenous anesthesia. Anesth Analg 2010;111:925-928.
  8. Buerke B, Mellmann A, Stehling C, Wessling J, Heindel W, Juergens KU. Microbiologic contamination of automatic injectors at MDCT: experimental and clinical investigations. AJR Am J Roentgenol 2008;191:W283-7.
  9. Eichler W, Schumacher J, Ohgke H, Klotz KF. Reuse of a set for total intravenous anaesthesia: safe against bacterial contamination? Eur J Anaesthesiol 2004;21:501-3.
  10. Garcia M. Preliminary report: biosafety analysis of one-way backflow valves for multiple patient use of low osmolar intravenous contrast solution. Can Commun Dis Rep 1996;22:28-31.
  11. Turner GA, Murphy DF. Antireflux valves in intravenous opioid analgesia: are they necessary? Anaesthesia 1991;46:1064-5.
  12. Trépanier CA, Lessard MR, Brochu JG, Denault PH. Risk of cross-infection related to the multiple use of disposable syringes. Can J Anaesth 1990;37:156-9.

SBU Enquiry Service Consists of structured literature searches to highlight studies that can address questions received by the SBU Enquiry Service from Swedish healthcare or social service providers. We assess the risk of bias in systematic reviews and when needed also quality and transferability of results in health economic studies. Relevant references are compiled by an SBU staff member, in consultation with an external expert when needed.

Published: 4/29/2021
Report no: ut202109
Registration no: SBU 2021/122