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Can Permanent Marker Leach into IV Infusion Bags?

You are resuscitating a hypotensive patient with severe sepsis and have just hung your 4th liter of crystalloid. On the fluid bags, you wrote the numbers 1 through 4 in permanent marker to help keep track of your resuscitation. As you finish placing your central line the charge nurse enters the room. He informs you that according to the Institute for Safe Medical Practices (ISMP), writing directly on IV bags with permanent marker is not recommended due to concerns that the ink will leach into the bag and potentially cause harm to your patient [1-4].

This situation raises several questions:

Should we write on IV bags in permanent marker?
Is there a possibility of ink diffusing through polyvinylchloride (PVC) bags?
If so, is there potential harm to the patient?

These are valid questions, but unfortunately the answers may be unclear, contradictory, or even non-existent. Are there theoretical concerns with writing on IV preparations? What do the manufacturers say?

According to IV bag manufacturers Baxter, Hospira, and B Braun the absence of ink leaching from permanent markers cannot be guaranteed and writing on bags with permanent marker is not recommended, especially since there are many different ink, marker, and pen manufacturers with varying types and styles of ink [7-11].

If we cannot get a definitive answer from the manufacturers, let’s take a look at some literature that has attempted to identify possible ink contamination in IV bags. A PubMed search was done with search criteria including “PVC and ink”, “IV bag and ink”, “IV bag and marker”, “PVC and marker”, “ink and leaching”.

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