Rx Update: July 2005

In-Line-Filtration of Intravenous Medications

Joan Murhammer, R.Ph., Mary Ross, R.Ph., M.B.A., Kevin Bebout, R.Ph.
Peer Review Status: Internally Reviewed

In-line filters are used during the infusion of intravenous medications to prevent the administration of any particulate matter, air, or microorganisms that may be in the IV line. Particles of 5 to 20 microns size and larger have the capability of obstructing blood flow through pulmonary capillaries , which could lead to complications such as pulmonary embolism. Foreign particles can also cause phlebitis at the injection site and filters may help to reduce the incidence of phlebitis. Microprecipitates can form in intravenous solutions over time which can potentially cause catheter occlusion and patient harm. Certain medications may more easily precipitate or form protein fibers upon sitting and require in-line filtration during administration. The use of a 0.22 micron filter can remove microorganisms from the solution that may have been introduced during preparation or manipulation of the IV product, particularly solutions that support growth (e.g., TPN). The proper size of in-line filter should be used because using a smaller size than is recommended could filter out the active medication and prevent it from being delivered to the patient. Using a filter that is too large may not filter out the precipitates that can form over time and allow them to be administered to a patient.

The use of in-line filters can cause decreased flow rates, clogs, or air locks. It is important to recognize that a clogged filter is a potential sign of a precipitate and it is not appropriate to simply remove a clogged filter to allow the solution to infuse without a filter.

Medications are listed below that require an in-line filter during administration under the appropriate size filter that is recommended. Contact the Pharmacy in your area for any questions on the choosing the appropriate in-line filter for administering a medication.

0.22 micron

• Albumin (>=0.22 micron; some brands have an in-line filter set, in general, filtration is not required) #
• Amiodarone (Cordarone ^®)
• Anti-Thymocyte Globulin (Thymoglobulin ^®)
• Cetuximab (Erbitux ^®) (LPB)
• Diazepam Continuous Infusions #
• Digoxin Immune Fab (Digibind ^®)
• Etoposide Infusions (>0.4 mg/ml) #  
• Fluorouracil #
• Imiglucerase (Cerezyme ^®) (LPB) #
• Laronidase (Aldurazyme ^®)
• Lorazepam Continuous Infusions #
• Paclitaxel (Taxol ^®) (non-PVC tubing)
• Phenytoin
• Total Parenteral Nutrition (do not filter lipids)

0.2 to 5 micron

• Abciximab (Reopro ^®) (LPB)
• Mannitol (>15%)

0.2 to 1.2 micron

• Anti-Thymocyte Globulin, Lymphocyte Immune Globulin (Atgam ^®)
• Gemtuzumab (Mylotarg ^®) (LPB)
• Infliximab (Remicade ^®) (LPB)

1.2 micron

• Lansoprazole (Prevacid I.V. ^®)

5 micron

1. Asparaginase (Elspar ^®) #  
2. Immune Globulin, Intravenous (Polygam S/D ® ) (pediatric syringe doses)

15 micron

• Cytomegalovirus Immune Globulin (CytoGam ^®)
• Immune Globulin, Intravenous (Polygam S/D ^®) (other brands of IVIG do not require filtration)

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# In-line filter is not required, but may be preferred.

LPB - low-protein binding filter

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