Table 1 Characteristics of the included studies

Zahid et al. [1]

PVC

0.4

0.1

1

Actrapid 100 U/mL

Non-priming

HPLC-UV

Not investigated

t_{200 min} = 54.9

t_{400 min} = 65.7

t_{600 min} = 74.4

t_{800 min} = 79.8

t_{1000 min} = 85.1

t_{1200 min} = 86.0

t_{1400 min} = 90.0

➢ Lower flow rate: more adsorption of insulin to neonatal line

➢ Maximum loss off insulin to neonatal line: at start of infusion, with higher insulin recovery when neonatal line was saturized

➢ After 24 h neither flow rates reached a 100% insulin recovery

0.5

t_{200 min} = 72.8

t_{400 min} = 80.2

t_{600 min} = 84.4

t_{800 min} = 87.7

t_{1000 min} = 89.4

t_{1200 min} = 91.5

t_{1400 min} = 91.5

Simeon et al. [2]

Not reported

5 inch

0.5

0.5

Humulin R 100

7 mL priming vs non-priming

Lowry protein assay

t_{0–2 h} = 55.9 (5.7)

t_{2–4 h} = 62.3 (6.7)

t_{4–6 h} = 72.1 (2.1)

t_{6–8 h} = 71.9 (8.4)

t_{0–2 h} = 67.2 (5.7)

t_{2–4 h} = 65.8 (4.0)

t_{4–6 h} = 74.1 (5.4)

t_{6–8 h} = 78.3 (1.1)

➢ Priming prior to infusion resulted in a more predictable amount of insulin delivered over time

➢ A 2-h delay in insulin recovery with a non-primed line compared to a primed line.

➢ No significant difference in insulin recovery between concentrations of 0.5 and 0.25 U/mL when administered over a primed line.

0.25

t_{0–2 h} = 70.9 (5.8)

t_{2–4 h} = 63.0 (3.2)

t_{4–6 h} = 71.4 (5.8)

t_{6–8 h} = 75.9 (5.6)

Fuloria et al. [3]

PVC

0.3

0.05

0.2

Novolin R 100 U/mL

Priming vs non-priming

IMx immunoassay

t_{1 h} = 71.5

t_{2 h} = 77.6

t_{4 h} = 69.4

t_{8 h} = 88.3

t_{18 h} = 85.7

t_{24 h} = 93.1

t_{1 h} = 16.9

t_{2 h} = 10.9

t_{4 h} = 27.8

t_{8 h} = 55.6

t_{18 h} = 54.4

t_{24 h} = 95.0

➢ Priming prior to infusion vs non-priming resulted in a higher insulin recovery

➢ Non-priming of lines resulted in problematic low insulin recovery during the first 2 h (up to 8 h)

➢ Higher flow rates resulted in faster insulin recovery in both PE and PVC lines.

➢ A stable higher insulin recovery in PE lines (after 1 h,80%) compared to PVC lines

0.2

t_{1 h} = 43.4

t_{2 h} = 85.9

t_{4 h} = 92.6

t_{8 h} = 92.1

t_{18 h} = 98.8

t_{24 h} = 100

t_{1 h} = 22.6

t_{2 h} = 38.6

t_{4 h} = 68.1

t_{8 h} = 76.7

t_{18 h} = 70.9

t_{24 h} = 84.2

PE

1

0.2

t_1h = 80.7

t_2h = 77.1

t_4h = 72.5

t_8h = 59.3

t_18h = 76.5

t_24h = 49.4

t_{1 h} = 20.2

t_{2 h} = 13.1

t_{4 h} = 22.8

t_{8 h} = 65.8

t_{18 h} = 82.1

t_{24 h} = 85.6

Hewson et al. [4]

PVC

4

1

0.2

Actrapid 200 mU/mL

Non-priming, 60 min pre-conditioning, 20 mL priming, albumin 2.4 g%, Preconditioning and priming

Radioimmunoassay

60 min preconditioning

t_{0.05 h} = 40.4

t_{0.25 h} = 47.1

t_{0.50 h} = 39.1

t_{1 h} = 49.7

t_{2 h} = 64.9

t_{6 h} = 79.1

t_{22 h} = 73.3

t_{0.05 h} = 34.4

t_{0.25 h} = 73

t_{0.50 h} = 76

t_{1 h} = 75.5

t_{2 h} = 71.8

t_{6 h} = 71.4

t_{22 h} = 80

➢ Preconditioning followed by priming of the neonatal line or adding of albumin to insulin solution resulted in the highest insulin recovery

20 mL priming

t_{0.05 h} = 60.4

t_{0.25 h}= 52.9

t_{0.50 h} = 58.2

t_{1 h} = 66.67

t_{2 h} = 82.2

t_{6 h} = 84

t_{22 h} = 83.1

albumin 2.4 g%

t_0.05h = 34.4

t_{0.25 h} = 73

t_{0.50 h} = 76

t_{1 h} = 75.5

t_{2 h} = 71.8

t_6h = 71.4

t_{22 h} = 80

Preconditioning and priming

t_{0.05 h} = 51.2

t_{0.25 h} = 53.6

t_{0.50 h} = 52.4

t_{1 h} = 53.6

t_{2 h} = 64

t_{6 h} = 64.4

t_{22 h} = 62.8

0.5

0.2

60 min preconditioning

t_{0.05 h} = 58.8

t_{0.25 h} = 68.0

t_{0.50 h} = 67.6

t_{1 h}= 64.4

t_{2 h} = 60.4

t_{6 h} = 82.0

t_{22 h} = 54.8

t_{0.05 h} = 26.3

t_{0.25 h} = 23.3

t_{0.50 h} = 15.8

t_{1 h} = 15.0

t_{2 h} = 15.8

t_{6 h} = 48.3

t_{22 h} = 64.6

1

0.05

Preconditioning and priming

t_{0.05 h} = 24.4

t_{0.25 h} = 12.0

t_{0.50 h} = 10.4

t_{1 h} = 11.6

t_{2 h} = 15.6

t_{6 h} = 52.4

t_{22 h} = 62.8

t_{0.05 h} = 33.3

t_{0.25 h} = 11.7

t_{0.50 h} = 0.8

t_{1 h} = 3.3

t_{2 h} = 0.4

t_{6 h} = 0.8

t_{22 h} = 52.1

0.5

0.05

Goldberg et al. [5]

PVC

100 inch

N.A.

1

Novolin R 100

0 mL priming

10 mL priming

20 mL priming

30 mL priming

40 mL priming

50 mL priming

Double antibody insulin radioimmunoassay

t_{0 h} = 84.2

t_{0 h} = 93.4

t_{0 h}= 96.6

t_{0 h} = 98.7

t_0h = 97.9

t_{0 h} = 100

Not investigated

➢ 20 mL priming volume is sufficient to minimalize effect of insulin adsorption loss in neonatal line

Thompson et al. [6]

polypropylene

100 inch

N.A.

0.1

Novolin R U-100

Preconditioning (different times 0–1 h)

Double antibody radioimmunoassay

Preconditioning

t_{0 h} = 82 (7)

t_{0.25 h} = 84 (2)

t_{0.5 h} = 79 (5)

t_{1 h} = 83 (6)

➢ Preconditioning time does not affect insulin adsorption

Higher concentration of insulin, higher recovery

1

t_{0 h} = 92 (10)

t_{0.25 h} = 97 (12)

t_{0.5 h} = 103 (9)

t_{1 h} = 105 (7)

10

t_{0 h} = 98 (11)

t_{0.25 h} = 101 (6)

t_{0.5 h} = 97 (11)

t_{1 h} = 103 (8)