Box 1 Terms and definitions related to intravenous fluids and medicines used in this review

1. Infusates and Infusion

 The term infusates in this review denotes all solutions administered intravenously, including intravenous (IV) fluids and intravenous medicines [113]

 The term infusion in this review comprises both injection and infusion, whereby injection stands for the IV administration of a limited volume of fluid usually from a syringe and infusion stands for the parenteral administration of a larger volume of infusion fluid over a period of time [93]

2. Intravenous fluids include:

 Glucose (dextrose) -containing solutions at concentrations of 5%, 10%, and 50% as listed on the World Health Organization Model List of Essential Medicines 2023 (WHO EML) [8, 122]. In this review, infusates of dextrose and glucose are both referred to as dextrose

 Solutions of sodium chloride 0.9% also termed as saline 0.9%, normal saline, and sodium chloride. In this review they are referred to as saline and are also included in the WHO EML 2023 [122]

 Neonates and children have unique fluid requirements. The World Health Organization (WHO) recommends 10% dextrose infusions during the first 2 days of life. On day 3 of life, sodium should be added; the recommended infusate is 5% glucose (dextrose) with 0.45% sodium chloride (“half-normal saline–dextrose 5%”), [7] which is listed on the WHO EML for children [8]. For neonates who need IV fluids, the total fluid intake per day ranges between 60 and 100 ml/kg/day [7]. In addition, normal saline–dextrose 5% and Ringer’s lactate—5% dextrose are options for IV therapy in children, e.g. during surgery and resuscitation of burns [7, 8]

 Ringer's lactate (Hartmann’s solution) mentioned in the reference [27] contains sodium, chloride, potassium, calcium, and lactate [7, 93]

 Total parental nutrition (TPN) is a temporary means of providing intravenous nutritional support to patients whose dietary requirements cannot be met enterally. TPN comprises dextrose, proteins, fatty acids, amino acids, electrolytes, and vitamins [132, 133]

3. Premixtures and Admixtures:

 Premixtures are commercially prepared infusates (including mixtures of IV fluids and/or medicines) that are ready to use and do not require reconstitution [134]. They have a fixed composition and a fixed volume

 Admixtures are made in the hospital by mixing two or more IV fluids, or IV fluids and intravenous medicines [135,136,137,138]. They are prepared in the pharmacy or in the clinical area; the risk of contamination is higher in the clinical area [93]

4. Intravenous medicines: vials and ampoules, Water for Injection:

 Intravenous medicines are mostly contained in vials which are sealed by an elastomeric stopper locked in place by means of an aluminum overcap crumped over the stopper and neck of the vial while ampoules are closed by heat sealing (mostly glass fused by heat) [93]. In this review, the term “vial” is used except when referring to articles mentioning ampoule

 Water for Injection is sterile water prepared by distillation or a method of purification equivalent to distillation. It is used to reconstitute IV medicines especially when the active ingredient is poorly soluble in water and other solvents [93, 139]. It is manufactured in 2 ml, 5 ml, and 10 ml quantities [122]

 Reconstitution is the dissolving of powder or the dilution of a concentrate from a vial and withdrawing it in a syringe for administration (in preparation of injection [93]

5. Single dose vials or multi-dose vials:

 Single dose vials (SDV) are designed for a single patient/procedure/injection [106]. They do not have antibacterial substances (“preservatives”)

 Multi-dose or multiple-dose vials (MDV) contain more than one dose of medication and may be used more than once as per manufacturer's recommendation. They have antibacterial preservatives (antibacterial substances) added [93, 106]

 The term "multiple-use single-dose vials (mSDV)" is used in this review to refer to medicine vials designed and manufactured as SDV, which are (incorrectly) used more than once and/or for more than one patient. The term mSDV in this review also applies to IV fluids which are—against the instructions of the manufacturer—used for administration of multiple doses, such as heparinized saline fluid in bags used to flush peripheral intravascular catheters [87]

6. Type of contamination

 Intrinsic or primary contamination occurs during the manufacturing process [113, 140]

 Extrinsic, secondary, or in-use contamination occurs during transport or storage of the infusates, or during the preparation or administration of the infusate [113, 135, 140]

7. Open and closed infusions systems

 Open IV infusion systems include containers that are rigid (glass, burette) or semi-rigid plastic containers that need to be vented during infusion, i.e. ambient air must be entered through needle or air filter to empty the bottle [88, 135, 141]

 Closed IV infusion systems include containers that are fully collapsible plastic containers that do not require or use any form of an external vent (air filter or needle) to empty the fluid. In addition, the injection ports are self-sealing [88, 135, 141]. The closed IV infusion system is associated with a lower frequency of catheter-related bloodstream infections [88, 91, 142]