IV's make it possible to mainline caffeine. Just sayin.

Stardate: March 10,2014
Sixth day of Lent
Upon which I visited a new friend in the hospital.

I visited a new colleague/friend in the hospital as he prepped for surgery, and as I stepped into the room, I was struck--naturally by this point--by all the plastic.   But as I shared my quirky hellos, I realized that my attitude toward THESE plastics was overwhelmingly one of positive acceptance, and so naturally I was suspicious of myself and vowed to do some homework.  I'd hate to let a plastic get away unexamined.

 My new friend and I make an odd pair--he is a cranky, old Christian curmudgeon...and to my mind, wildly successful-even-inspirational as a commissioned ruling elder*... and I'm, well, me.  On this occasion I made sure to wear my clerical collar to the Very Baptist hospital, where I admit I rather like the jaunty figure I cut, swishing through doors, eye contact that says "Yes.  You saw me right. Cute. Girl. Minister. Nosering. Hipster glasses. The haircolor is natural."  blah blah, something about pride before a fall belongs here.    But I might as well own it all, because you simply cannot make a hospital visit without the collar on, at least not in my experience.  Collar on = I am a professional, albeit not a traditional one.  Collar off = I am nobody.  Collar on = occasional free parking and unquestioned access to patients.  Collar off = "it's not visiting hours."  Oh, you can get into a conversation and talk your way in, but wear all black and look serious and I swear I could waltz into a surgery suite NOT THAT I WOULD EVER DO SUCH AN IRRESPONSIBLE THING.  This reality is hard to describe without sounding flip.  I actually sort of feel trapped by the symbology of it.  Moving on.

I like my friend.  I wish I had permission to use his name, because it suits him fabulously in an old-school country southern way.  In any case, we don't look like we should be friends, but I decided I liked him in the three days we were at the same retreat, and he's got a lifelong fan in me now.  So when I heard that he was going in for a particularly painful surgery, and being a commissioned ruling elder likely didn't have a pastor of his own, I felt I needed to make the call, maybe on behalf of the connectional church, maybe because I just like the guy.  When I approached the room, I could hear the tech talking to him, and his voice was already slurry with the prep-meds.  I poked my head around the corner, hoping he was decent, which he was.  He was already on the gurney in scrubs, with an active IV of fluids and what was undoubtedly the medicine already making him sleepy.  We chatted, I met his son, I prayed for him and the medical team, and darn it all he prayed for me, which was definitely the highlight of my day.  Off he went.  I hope he's ok.

But all of that got me thinking more seriously about medical grade plastic, arguably one of the best uses of plastic--and it's that sort of rosy-colored-glasses blind approval that concerns me.  What kind is it, is it recyclable, and since it touches all that body fluid and stuff, how do they dispose of it?  Do they incinerate it?   And so, focused on the IV line, I started my study.

"Computer, what is medical grade plastic?"
"...You asked."

OH MY GOSH THERE IS TOO MUCH INFORMATION.
1) Apparently this is big business, as the vast majority of the first google hits are all plastics companies, all hawking their amazing, amazing wares.
2). They are all using acronyms I have not encountered, and big scientific words.  Dang.

"Computer, what is IV tubing?"
"Better question."

Thank you goes to WiseGeek for a nice, "IV Tubing for Dummies" style page on the question.

• Polypropylene, nylon and dynaflex are some of the more common materials that intravenous tubing is made from. (ooooh, these are new names).  As plastics, these synthetic materials can be manufactured with particular qualities that make them ideal for this use. These materials used are flexible, strong, leak proof and do not react with the chemicals transported through them. Manufacturers of intravenous tubing can make tubes of various thicknesses and shapes according to the specifications given to them. 
• Advances in intravenous administration of medication in the 1800s led to the development of intravenous tubing. In 1855, Dr. Alexander Wood became the first person to use a hypodermic needle to inject medicine directly into a patient’s vein (fascinating!) . In 1896, a French company, the H. Wulfing Luer Company, developed the Luer connection, allowing the head of a hypodermic needle to be easily attached and detached from a glass syringe. This connection, which is comprised of tapering male and female components, is still used today to attach various pieces in an intravenous line. These interlocking pieces allow doctors to change intravenous bags, add additional drip lines and attach the intravenous tubing to the needle in a patient’s vein with minimal discomfort to the patient. (hooray, science!)

And naturally, answers lead to more questions.   What are these plastics named?  Tell me more about the tubing.
Well,  I learned some random facts.  Enjoy.
1) Tubing seems to work best at the 4mm size; studies show the 3mm size, advantageous for being lighter, smaller and using less material, actually limits the amounts of medicine that can be administered, and so are NOT good or recommended for emergency situations.  I don't know how this plays out in real life.  Any nurses in the audience want to comment on tube gauge? (that sorta sounds dirty, sorry)

2) Unfortunately, at least some IV lines are made of unsavory things.  Thanks, Greenhealth Magazine.  Behold, direct quotes from their website:

• The chemicals in question, polyvinyl chloride (PVC) and di(2ethylhexyl) phthalate (DEHP), have been used for decades. PVC is the most widely used plastic in medical products. A rigid material, PVC requires the addition of materials called phthalates, which are used as plasticizers to make PVC softer and more flexible. DEHP is the most commonly used plasticizer in PVC-based bags and tubes; IV tubing may contain up to 80 percent DEHP by weight. (DEHP has been banned in Europe in the production of toys and cosmetics.)
• When PVC is manufactured or incinerated, it creates dioxin, a known carcinogen and a bioaccumulative, toxic material that is harmful to humans and animals, even at extremely low doses. (I take this to confirm my assumption that medical plastics cannot be recycled and are routinely incinerated.  May I ask, WHERE are they incinerated?  Onsite?  Or do they go somethwere?) According to the World Health Organization, “experiments have shown [dioxins] affect a number of organs and systems.” Because of their chemical stability and the fact that they are absorbed by fat tissue, dioxins stay in the body for a long time, with a half-life estimated to be seven to 11 years.Dioxins tend to accumulate in the food chain. There also is concern about the use of chlorine and other organic compounds in PVC’s production.
• DEHP exposure can harm the developing male reproductive system with permanent deformities and decreased fertility. DEHP may also affect the liver, kidneys, and lungs, as well as heart rate and blood pressure. When DEHP is added to PVC, it is not bound chemically to the plastic and can leach into surrounding fluid, or through lipids or heat, exposing patients to the chemical. Research shows that the DEHP levels in some IV solutions are more than 800 times higher than the levels permitted in U.S. drinking water.

3) PVC is code #3, which obviously deserves its own post about whatever #3 stands for.  

4) I'll cop to my first use of Wikipedia here for Nylon, and these cute facts 

     4a) The plastics industry was revolutionized in the 1930s with the announcement of polyamide (PA), far better known by its trade name nylon. Nylon was the first purely synthetic fiber, introduced by DuPont Corporation at the 1939 World's Fair in New York City.

     4b)  DuPont's work led to the discovery of synthetic nylon fiber, which was very strong but also very flexible. The first application was for bristles for toothbrushes. However, Du Pont's real target was silk, particularly silk stockings.

     4c) Nylon is plastic #7, the "other" label for plastics, which to my mind so far is sort of a catch-all, not really well understood, sorta kinda recyclable but not really.

5) Ask what Dynaflex PLASTIC is, otherwise you'll learn all about Dynaflex nutritional supplements, Dynaflex exercise equipment, and Dynaflex the old-school music record material.  As a plastic, however, it is of this last kind, and does seem to be a trademark name.  

    5a) The DYNAFLEX G2700 and the DYNAFLEX G6700 series are FDA approved for contact with food products with select grades available as USP Class VI, and are therefore ideally suited for medical product applications. These products range in hardness from Shore A 13 to 84. 

     5b) The TPE product series were designed for injection molding and extrusion applications to impart a ‘soft touch’, a rubbery feel to end products, a translucent tubing, or to provide sealing or gasketing  characteristics . Additional features of this material quality are its excellent colorability properties as well as good ozone and UV stability and excellent overmolding adhesion properties to polypropylene substrates.

Best question seemed to be "how do you get rid of medical waste?"
Whoa.
In short:

• Each state has its own rules; you know how to Google, but here is the government page on that! Some of the links don't work though, Arkansas' didn't, but I search and here it is.  
• West Virginia has a nice pdf though. 
• Waste generally gets labeled as infectious or not, and then treated to make it non-infectious before any other actions are taken--this is where incineration (burning!) and autoclaves (baking!) come into play if it IS infectious (meaning it touched blood or other body fluids, so needles, tubes, gauzes, wraps, bandages, all sorts of stuff).  Some plastics, but by no means all, can be autoclaved, but if it's infectious it stands a good chance of encountering enough heat to 'clean' it, which might mean destroying that plastic (and all the joy that creates).
• BUT if it isn't considered infectious medical waste, it will likely be treated like regular waste and end up in a landfill.  This is also what happens to stuff that survives the heat that 'cleans' it, and why sharps can end up in landfills, on beaches, and generally in places that deeply bother you.  It gets treated as regular solid waste after disinfection.
• WHICH leads me to ask, if a plastic has survived the disinfection step (and I don't know how often that occurs)...why not recycle it? 

I've got lots more questions, but now I'm tired.  Good night!
Peacefully,
Marie MO

*Commissioned Ruling Elders have been ordained in the Presbyterian Church to leadership as a Ruling Elder, and then trained and permitted to perform some functions of a Teaching Elder (minister of Word and Sacrament).  They are often used in smaller churches that are unable to call a full time or part time Teaching Elder, and it's a hard job.  They preach and can lead communion, but often without the fancy crutches that "real" ministers get.  Wow, good job, CRE's everywhere.  I have mad respect for you.  You're serious.