title: Health risks posed by use of Di-2-ethylhexyl phthalate (DEHP) in PVC medical devices: a critical review.
abstract: BACKGROUND
  Polyvinyl chloride plastics (PVC), made flexible through the addition of di-2-ethylhexyl phthalate (DEHP), are used in the production of a wide array of medical devices. From the late 1960s, leaching of DEHP from PVC medical devices and ultimate tissue deposition have been documented.
  
  
  METHODS
  A critical review of DEHP exposure, metabolism, and toxicity data from human and animals studies was undertaken. A brief analysis of alternatives to DEHP-plasticized PVC for use in medical device manufacture was completed.
  
  
  RESULTS
  DEHP leaches in varying concentrations into solutions stored in PVC medical devices. Certain populations, including dialysis patients and hemophiliacs may have long-term exposures to clinically important doses of DEHP, while others, such as neonates and the developing fetus, may have exposures at critical points in development. In vivo and in vitro research links DEHP or its metabolites to a range of adverse effects in the liver, reproductive tract, kidneys, lungs, and heart. Developing animals are particularly susceptible to effects on the reproductive system. Some adverse effects in animal studies occur at levels of exposure experienced by patients in certain clinical settings. DEHP appears to pose a relatively low risk of hepatic cancer in humans. However, given lingering uncertainties about the relevance of the mechanism of action of carcinogenic effects in rodents for humans and interindividual variability, the possibility of DEHP-related carcinogenic responses in humans cannot be ruled out.
  
  
  CONCLUSIONS
  The observed toxicity of DEHP and availability of alternatives to many DEHP-containing PVC medical devices presents a compelling argument for moving assertively, but carefully, to the substitution of other materials for PVC in medical devices. The substitution of other materials for PVC would have an added worker and community health benefit of reducing population exposures to DEHP, reducing the creation of dioxin from PVC production and disposal, and reducing risks from vinyl chloride monomer exposure.
authors.affiliation: Lowell Center for Sustainable Production, Department of Work Environment, University of Massachusetts, Lowell, MA 01854, USA. joel_tickner@uml.edu
authors.forename: J A
authors.initials: JA
authors.lastname: Tickner
authors.forename: T
authors.initials: T
authors.lastname: Schettler
authors.forename: T
authors.initials: T
authors.lastname: Guidotti
authors.forename: M
authors.initials: M
authors.lastname: McCally
authors.forename: M
authors.initials: M
authors.lastname: Rossi
mesh_terms: D000818:Animals; D001803:Blood Transfusion / Q000295:instrumentation; D002273:Carcinogens / Q000009:adverse effects; D002657:Child Development / Q000187:drug effects; D004051:Diethylhexyl Phthalate / Q000009:adverse effects* / Q000737:chemistry / Q000378:metabolism / Q000633:toxicity; D004058:Diffusion; D005314:Embryonic and Fetal Development / Q000187:drug effects; D004781:Environmental Exposure; D004867:Equipment Design; D004869:Equipment Safety; D004864:Equipment and Supplies; D015386:Hazardous Substances / Q000009:adverse effects; D006801:Humans; D007231:Infant, Newborn; D016273:Occupational Exposure; D010968:Plasticizers / Q000009:adverse effects* / Q000737:chemistry / Q000378:metabolism / Q000633:toxicity; D010969:Plastics / Q000737:chemistry; D011143:Polyvinyl Chloride / Q000737:chemistry; D006435:Renal Dialysis / Q000295:instrumentation; D012307:Risk Factors
chemical_list: D002273:Carcinogens; D015386:Hazardous Substances; D010968:Plasticizers; D010969:Plastics; D011143:Polyvinyl Chloride; D004051:Diethylhexyl Phthalate