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Sulfur hexafluoride and perfluoropropane do not escape from a plastic syringe closed with a stopcock.

PURPOSE: To evaluate during various intervals of time the escape of long-acting gases contained in a plastic syringe closed with a stopcock or a plastic cap. METHODS: A 60-ml plastic syringe was filled or partially filled with a long-acting gas, either sulfur hexafluoride or perfluoropropane. The tip of the syringe was closed with either a stopcock or the syringe's plastic cap. After various intervals of time, the concentration of the long-acting gas in the syringe was measured by gas chromatography. RESULTS: The concentration of both long-acting gases was higher than 98% at 24 hours after filling when the syringe was closed with a stopcock; however, it was less than 41% when the syringe was filled and capped tightly with its plastic cap. CONCLUSION: The proportion of long-acting gases escaping in 24 hours from a filled syringe capped with a stopcock is clinically insignificant.

Chromatography, Gas↗

A syringe adapter to facilitate aspiration at amniocentesis.

BACKGROUND: Syringes were developed for injection, not aspiration. We describe an adapter that attaches to a standard syringe and aspirates by advancement rather than withdrawal. TECHNIQUE: The adapter consists of a syringe barrel extension and an attachable finger grip. The adapter attached to a standard syringe allows aspiration by advancement rather than withdrawal, with the same hand motion used as with injection. EXPERIENCE: In a comparison of timed in vitro fluid aspiration by 10 practitioners, mean times for aspiration of 15 mL were 32.4 seconds (range 24-45) with standard technique and 25.3 seconds (range 24-30) with the adapted syringe (P < .003, paired t test). Thirteen of 14 physicians who used the adapted syringe in vivo reported that much less effort was required, and one physician reported that a little less effort was required. Overall, eight practitioners reported that the adapted syringe made amniocentesis much easier and six found no difference between the two devices. CONCLUSION: This adapter converts a standard syringe to one permitting aspiration by advancement rather than withdrawal. Practitioner feedback was positive with regard to ease of use, degree of effort, and overall satisfaction.

Amniocentesis↗

Radio-iodination of neurotrophins and their delivery in vivo: advantages of membrane filtration and the use of disposable syringes.

This paper reports two simple improvements for the radio-iodination of neurotrophins and their delivery in vivo. (1) Neurotrophins can be effectively separated from free iodide by using membrane filtration devices. Seven methods for the separation of free iodide are compared, including dialysis, gel filtration, and membrane filtration. Membrane filtration of the iodinated protein has several important advantages over dialysis or gel filtration. These include the precise control over the final concentration; excellent recovery of the neurotrophin; easy and inexpensive procedure; performance of the entire procedure in a fume hood; and reduced volume of radioactive waste. (2) Disposable, inexpensive syringes are suitable for the delivery of small volumes of radio-iodinated or non-radioactive neurotrophins. Plastic disposable insulin syringes are compared with Hamilton syringes. The ejection volume of the disposable syringes is surprisingly reliable in the dose range 2-15 microl. Their in vivo performance was tested by injections in the eyes of chick embryos in ovo. The amounts remaining in the eye varied significantly less with the disposable syringes. Leakage into the surrounding eye-muscles after intraocular injection was significantly more frequent with Hamilton syringes than with the disposable syringes. Thus, disposable syringes can be a reliable and cost-effective alternative for drug delivery of 2-15 microl volumes.

Animals↗

Stability and sterility of meglumine gadoterate injection repackaged in plastic syringes.

The analytical and microbiological stability of meglumine gadoterate (Dotarem) repackaged in polypropylene syringe for 3 months at either +4 degrees C or room temperature was studied. For analytical study: six polypropylene syringes (20 ml) were filled with 15 ml of meglumine gadoterate. Three syringes were stored at 4+/-2 degrees C and three at 25+/-2 degrees C, all syringes were kept upright and protected from daylight. Samples were taken on days 0, 6, 14, 30, 45, 60, 75 and 90. Meglumine gadoterate and its degradation product (free Gd3+) concentrations were obtained using a specific HPLC assay. Osmolality and pH determination were made on days 0, 14, 45 and 90. For microbiological study: 28 plastic syringes (5 ml) were filled with 2.5 ml of meglumine gadoterate. Syringes were stored at 25+/-2 degrees C and protected from daylight. At each day of analysis (0, 15, 35, 45, 60, 75 and 90), four syringes were tested as described in European Pharmacopoeia. After 90 days the concentration of gadoterate remained unchanged and no free Gd3+ were detected. The injectable solution of this gadolinium contrast agent was sterile according to European Pharmacopoeia guidelines. The meglumine gadoterate repackaged in polypropylene syringe was stable for 3 months at all the temperatures studied.

Contrast Media↗

Quality evaluation of radiographic contrast media in large-volume prefilled syringes and vials.

RATIONALE AND OBJECTIVES: The authors compared the particle contaminations of radiographic contrast media packaged in large-volume prefilled syringes and vials. MATERIALS AND METHODS: Particle counting was performed for four contrast media packaged in large-volume prefilled syringes (iohexol, ioversol, ioversol for angiography, and ioxaglate) and three contrast media packaged in vials (iohexol, ioversol, and ioxaglate). X-ray emission spectrometry was performed to characterize the individual particles. The amount of silicone oil in the syringe was quantified with infrared spectrophotometry. RESULTS: The particle contamination in syringes containing ioversol was higher than that in syringes containing iohexol or ioxaglate. Particle contamination in the vials was relatively low, except with ioxaglate. X-ray emission spectrometry of the components of the syringe and vial showed that the source of particles was internal material released from the rubber stopper or inner surface. CONCLUSION: The particle counts for contrast media packaged in syringes and vials varied considerably among the different contrast media and were related to the amount of silicone oil on the inner surface and rubber piston of the syringe.

Contrast Media↗

Introducing safety syringes into a UK dental school--a controlled study.

AIM: How an appropriate safety syringe was chosen, how the change-over to it was achieved and what outcome measures were used to measure the effectiveness of this change. INTRODUCTION: One third of all reported sharps injuries in dental practice are due to the use of non disposable dental syringes with most injuries being sustained during removal and disposal of the disposable needle from the non-disposable syringe. METHOD: After evaluation of all available disposable safety syringes they were introduced into a dental school after appropriate education of all staff and students. Risk management provided data on all reported needle-stick injuries in the dental school and a control unit using non disposable syringes for a period of two years. RESULTS: Avoidable needle stick injuries reduced from an average of 11.8 to 0 injuries per 1,000,000 hours worked per year as compared with a control unit who reduced their frequency from 26 to 20 injuries per 1,000,000 hours worked. The cost of safety syringes is comparable to non-disposable syringes but the reduction in cost of management of needle stick injuries including the psychological effects are significant. CONCLUSION: Education plays a vitally important role in the effective implementation of the change to safety syringes which is advocated for all dentists.

Accidents, Occupational↗

Use of safety dental syringes in British and Irish dental schools.

AIM: The aim of the present study was to determine what types of dental syringes were being used in British dental schools and whether recent studies on the use of safety syringes had had any impact. INTRODUCTION: In 2001 a controlled trial showed that avoidable needlestick injuries could be reduced with the introduction of safety syringes which did not require the re-sheathing or removal of a needle from its syringe. METHOD: A self complete questionnaire asking about safety syringe use was distributed through the deans of all 16 dental schools in the UK and Ireland. RESULTS: Fifteen schools formally replied and data are available for the missing one. Two schools have totally converted to the use of safety syringes and in seven schools some departments are using them. Six schools are not considering a change, four others are hoping to change and four are undecided as to whether they are going to change. Five schools had tried them previously. All acknowledge that extensive training is essential, there is also considerable staff resistance and the safety syringes currently available are still not ideal. CONCLUSION: All dental schools should determine their avoidable needlestick injuries rates, reconsider their views on the use of safety syringes and contribute to the development of the ideal model.

Dental Instruments↗

[Feasibility and optimization of the combined injection of contrast medium and normal saline with a single-syringe CT injection system].

PURPOSE: To optimize the technique of injecting contrast medium followed by saline flush with a single-syringe CT injection system. MATERIALS AND METHODS: A CT injection system with a single syringe was filled with 100 ml of contrast medium (Iopromide 300 or Iomeprol 400) and 50 ml of normal saline solution. The following variables were evaluated: filling sequence, filling rate, syringe position during filling, ejection rate and delay before ejection. In consecutive portions of 10 ml, the whole volume was continuously ejected into test tubes that were subjected to CT densitometry on these test tubes. Each experiment was performed three times. RESULTS: Filling the syringe first with saline solution and subsequently with contrast medium resulted in no substantial mixing, whereas filling in the reverse order caused noticeable mixing of both solutions. Manual filling at a rate < or = 1 ml/s gave the best results. At faster filling rates (4 ml/s, 10 ml/s), substantial mixing of contrast agent and saline solution was observed. The separation of the two liquids was optimal when the syringe nozzle was pointed downward. Ejection rate (3 ml/s, 4 ml/s) and time delay between filling and ejection (0 min, 10 min) did not influence the distribution of density. The maximum iodine concentration using this approach was 235 mg/ml for Iopromide 300 and 327 mg/ml for Iomeprol 400. This indicates a reduction of the maximum iodine concentration of up to 28 % even when using the optimal technique for controlling mixing of both liquids. CONCLUSION: Manual filling of the CT injection syringe with saline solution followed by contrast media with the syringe nozzle pointed downward provides the best separation between contrast medium and normal saline solution but reduces the maximum iodine concentration by up to 28 %. For examinations requiring a high iodine concentration, such as CT-angiography, an iodine concentration of 400 mg/ml should be selected for the combined injection of contrast medium and normal saline solution with a single-syringe CT injection system.

Contrast Media↗

Survival of human immunodeficiency virus type 1 after rinsing injection syringes with different cleaning solutions.

Bleaching of syringes has been advocated to prevent HIV transmission among injection drug users (IDUs). Several reports indicate that IDUs use household products to disinfect syringes instead of bleach. To test their disinfection efficacy, we performed syringe-rinsing simulations with a range of agents used by IDUs trying to disinfect their syringes. No viable HIV-1 was recovered from syringes rinsed with bleach diluted 1:10. Bleach stored at 37 degrees C and rubbing alcohol performed better than water and the other liquids tested, but less well than bleach 1:10. Rinsing syringes with the other liquids was similar to rinsing with water alone. Increasing the rinsing volume did not always increase the effect of rinsing, but the addition of a second rinse consistently increased rinsing efficacy. Bleaching remains the most effective disinfectant among those tested. It is important that IDUs learn the proper techniques for bleach storage and syringe decontamination. Other household products are not effective disinfectants and should be avoided. Because access to sterile syringes may be restricted by laws, public policy, and police practices, bleach retains its importance in the control of the HIV-1 epidemic among IDUs.

Disinfectants↗

New needle and syringe use, and use of needle exchange programmes by street recruited injection drug users in 1993.

BACKGROUND: Needle exchange programmes (NEP) provide injection drug users (IDU) with sterile injection equipment and receive used needles in exchange. In this paper we describe the use of new syringes and NEP by IDU and characteristics associated with using NEP in 1993. METHODS: Street-recruited IDU were interviewed in five US locations: Atlanta, Philadelphia, Chicago, New York City, and Los Angeles (LA) county. RESULTS: Most (75-95%) reported it was easy to get a new syringe and for their last injection, 45-77% used a new syringe and 2-18% used a syringe previously used by another IDU. Use of NEP ranged from 8% to 16% in Chicago, Philadelphia, and LA County. In LA County not having injected 'speedball' in the last 30 days, last injection with a new syringe, and reporting it was very easy to get a new syringe were associated with NEP use. In Philadelphia, NEP use was associated with 'speedball' injection in the last 30 days, and in Chicago, not injecting with 'speedball' and injecting with cocaine were associated with NEP use. CONCLUSIONS: In 1993, most street-recruited IDU in Chicago, Philadelphia, and LA County had not used NEP. Factors associated with NEP use were not consistent across sites. Dispersion of NEP and removal of legal barriers restricting access to sterile syringes may be more important in increasing the use of sterile syringes and NEP than client characteristics.

Adult↗

Sterility of anesthetic and resuscitative drug syringes used in the obstetric operating room.

UNLABELLED: Because of the constant threat of emergent cesarean delivery, anesthetic induction and resuscitation drugs are often drawn into syringes and stored in the obstetric operating room (OR). This study investigated the potential for bacterial and fungal contamination of six drugs (thiopental, succinylcholine, ephedrine, atropine, lidocaine, and oxytocin) often prepared in the obstetric OR. A total of 756 drug syringes were prepared and stored in the obstetric OR for 8 days using normal clinical practices. Starting on Day 0, and subsequently on Days 4 and 8 of the experiment, 42 syringes of each drug were randomly selected from the pool, filtered through a 0.45-microm porosity sterile cellulose filter, and cultured on 5% sheep blood agar. Of the 756 syringes tested, none grew organisms of any type, which indicates a probability of drug sterility of > or = 0.9961 (95% confidence interval [CI]). The data from the cultures performed on syringes on Day 0 indicate a probability of initial contamination of < or = 0.018 (95% CI). This study demonstrates a high probability of sterility in drugs drawn into sterile syringes and stored at room temperature in an OR environment for up to 8 days. IMPLICATIONS: Drug syringes stored in emergency operating rooms are discarded after 24 h because of possible contamination. We searched for microorganisms in drug syringes stored in the operating room for up to 8 days. No microbes were detected using standard sterility testing techniques. Adopting longer storage periods could result in significant cost savings.

Anesthesia, Obstetrical↗

Syringe HIV seroprevalence and behavioural and demographic characteristics of intravenous drug users in Sydney, Australia, 1987.

The contents of needles and syringes returned by intravenous drug users to two Sydney needle and syringe exchange centres were analysed for HIV antibodies by the enzyme-linked immunosorbent assay (ELISA). Reactive and borderline samples were further tested by the Western blot method. Basic demographic and needle sharing data were also collected from the clients of the exchanges. Of a sample of 1544 returned syringes, 48 (3%) were confirmed as containing HIV-infected blood. The proportion of infected syringes at exchange 2 was 6% (33 out of 545), which was significantly greater (P less than 0.05) than the proportion of exchange 1 at 1.5% (15 out of 999). The difference in seroprevalence between the two centres may be related to the behavioural characteristics of the client populations that attended each of the exchanges. The maintenance of a low syringe HIV seroprevalence (1-1.5%) over a 7-month period at one exchange may indicate that the availability of sterile needles and syringes prevented transmission of HIV among the clients of that exchange. HIV antibody testing of the contents of used syringes is a potentially valuable method of monitoring HIV infection among intravenous drug users. In this study, syringe exchange schemes have proved to be suitable venues for investigating the demographic characteristics and risk-taking behaviours of this population.

Adult↗

The legal environment impeding access to sterile syringes and needles: the conflict between law enforcement and public health.

This article examines the legal environment for programs to prevent transmission of HIV and other blood-borne diseases among injection drug users (IDUs). Cost-effective public health programs often have questionable legal authority, and health professionals, community activists, and IDUs may be subject to arrest and prosecution. Legal impediments to the sale and distribution of syringes exist in every state: 47 states have drug paraphernalia statutes, 8 states have syringe prescription statutes, and 23 states have pharmacy regulations or practice guidelines. The Mail Order Drug Paraphernalia Act permits federal enforcement against individuals who knowingly sell or distribute syringes to IDUs. Congress has prohibited the use of federal funds for syringe exchange programs (SEPs). Legal restrictions on access to sterile syringes present formidable obstacles to public health prevention. These restrictions render it much more difficult for pharmacists to sell syringes over the counter or for physicians to prescribe syringes, create a chilling effect on IDUs seeking to comply with medical advice and protect themselves and their partners from disease, and place significant obstacles on the lawful establishment and operation of SEPs. Public health authorities have only sometimes creatively circumvented legal restrictions through judicial declarations of lawfulness, municipal declarations of a "state of emergency," and by use of the "necessity" defense. I recommend repeal of syringe prescription statutes and reform of drug paraphernalia statutes and pharmacy regulations.

Blood-Borne Pathogens↗

Model projections on the required coverage of syringe distribution to prevent HIV epidemics among injecting drug users.

BACKGROUND: Although syringe distribution is effective in preventing HIV transmission among injecting drug users (IDUs), there is little evidence on the required coverage to substantially reduce HIV transmission. METHODS: A mathematical model is developed to explore the relationship between the endemic HIV prevalence among IDUs and the coverage of syringe distribution. Data from IDU populations in the United Kingdom and Belarus are used to explore the implications of increasing coverage and the effect of changes in other behaviors. RESULTS: Projections suggest that there is a coverage threshold, which, if reached, could lead to substantial decreases in HIV prevalence. The threshold largely depends on the frequency that IDUs inject and (safely) reuse their syringes, and corresponds to less than 4 syringe-sharing events per IDU per month. Other factors, such as the injecting cessation rate and efficacy of syringe cleaning, only have substantial impact near threshold coverage levels. CONCLUSIONS: Our results support a policy of increasing the coverage of syringe distribution but highlight the difficulty in producing a universal coverage target. Great public health benefit could be conferred by encouraging the safe reuse of an IDU's own syringes and small stable injecting groups. Policies that discourage this will negate the impact of syringe distribution interventions.

HIV Infections↗

Microbial contamination on disposable hypodermic syringes prior to sterilization by ionizing radiation.

A large number of syringes were taken from the production lines of three independent manufacturers; the numbers and types of microorganisms contaminating these randomly sampled syringes were assessed in the laboratories maintained by each of these manufacturers for routine sterility testing, according to a standard protocol devised by the Research Committee of the UK Panel on Gamma and Electron Irradiation, which coordinated the investigation and analyzed the results. Items produced by a manufacturer were assessed for microbiological contamination both in their own laboratories and in the laboratories of the other manufacturers. The level of "false-positive" results was determined independently for each laboratory by the testing of "known sterile" items which had been subjected to the radiation-sterilization process. Both the percentage of syringes initially sterile and the average number of organisms per contaminated syringe differed among the three manufacturers. When corrected for interlaboratory differences, the number of syringes initially sterile ranged from 16 to 48%, and the mean number of organisms per contaminated syringe was 20 to 70. Of 964 syringes tested by all three laboratories, only one contained over 1,000 aerobic organisms (1,133). The most common organisms found were coagulase-negative, gram-positive cocci. Two manufacturers assessed contamination by anaerobic organisms; of 610 syringes, 1 contained 4,275 organisms and 3 more had 100 to 1,000 organisms, but 488 (80%) were uncontaminated by anaerobes. The results are discussed in the context of the choice of radiation dose necessary for the sterilization of medical products manufactured under controlled hygienic conditions.

Bacteria↗

Source of error on A-aDO2 calculated from blood stored in plastic and glass syringes.

We studied the effects of time delay on blood gases, pH, and base excess in blood stored in glass and plastic syringes on ice and the effects of resulting errors on calculated alveolar-to-arterial PO2 difference (A-aDO2). Matched samples of dog whole blood were tonometered with gas mixtures of 5% CO2-12% )2-83% N2 (mixture A), 10% CO2-5% O2-85% N2 (mixture B), and 2.88% CO2-4% O2-93.12% N2 (mixture C). Tonometered blood samples were transferred to 5-ml glass (5G), 5-ml plastic (5P), and 3-ml plastic (3P) syringes and stored on ice. Blood gases were measured every 1 h up to 6 h. In 5G, PO2 progressively decreased in blood tonometered with mixture A but rose in blood tonometered with mixtures B and C. O2 saturation progressively fell in all cases. In 5G, blood PCO2 progressively rose regardless of which gas mixture was used, and pH as well as base excess progressively fell. The rise in PO2 was faster in plastic than in glass syringes, and O2 saturation always rose in plastic syringes. Differences between storage in plastic and glass syringes on PO2 change were greatest when initial blood PO2 was highest (mixture A). At the highest PO2, O2 exchange was faster in 3P than in 5P. The rise of PCo2 was just as fast in plastic as in glass syringes, but in both the rise in PCO2 was faster at a higher initial PCO2 (mixture B) than in lower initial PCO2 (mixtures B and C). Rates of PO2 and PCO2 change in matched samples were significantly faster in 3P than in 5P. Errors due to rises in PCO2 and PO2 cause additive errors in calculated A-aDO2, and when blood is stored in plastic syringes for > 1 h significant errors result. Errors are greater in normoxic blood, in which estimated A-aDO2 decreased by > 10 Torr after 6 h on ice in plastic syringes, than in hypoxic blood.

Animals↗

A comparison of syringes to collect blood for analysis of gases, electrolytes and glucose.

We studied the interchangeability of two blood gas syringes (Johns, Hardie Health Care Products Pty Ltd and Marksman, Martell Medical Products Inc) for the collection of blood for the analysis of PCO2, PO2, pH, sodium, potassium and glucose in 71 intensive care unit patients. The interchangeability of these two syringes with a specially designed syringe (Radiometer, Radiometer A/S) for the collection of blood for the analysis of ionized calcium was also studied. Analysis of pH, sodium, potassium and glucose showed no clinically significant differences between samples collected with Johns and Marksman syringes. However, differences in PCO2 and PO2 in samples collected with these syringes may be clinically significant if the PO2 is less than 100 mmHg. There were no clinically significant differences in ionized calcium levels in blood samples collected with Johns, Marksman and Radiometer syringes. We conclude that Johns and Marksman syringes are interchangeable for the collection of blood for the analysis of PCO2, PO2, pH, sodium, potassium and glucose and they are also interchangeable with Radiometer syringes for the collection of blood for ionized calcium analysis.

Adolescent↗

The incidence of extravasation of vinca alkaloids supplied in syringes or mini-bags.

STUDY OBJECTIVE: The aim of this retrospective study was to determine the incidence of vinca alkaloid extravasation following administration via syringes or mini-bags. METHODS: An electronic survey was sent to pharmacy departments at hospitals throughout Australia. The survey was designed to collect data on the administration methods of vinca alkaloids (vincristine, vinblastine, vinorelbine) and the corresponding documented incidence of extravasation. The questionnaire requested the following information: how the drugs were prepared for administration (syringe or mini-bag); volume of each product; number of items supplied; and the number of cases of extravasation reported for each product. RESULTS: Questionnaires were sent to 228 hospital pharmacy departments in Australia. Sixty-eight questionnaires were received (29.8%), including responses from most major cancer centres. Data represented a range of 3 to 120 months (mean: 38 months) of clinical experience. The reported incidence of vincristine extravasation from syringes was 0.03% (11/37 084) and 0.041% (3/7255) with mini-bags. One case of vinblastine extravasation was reported with syringes 0.013% (1/7913), none from mini-bags (0/1421). Vinorelbine data were difficult to interpret as cases may represent phlebitis rather than extravasation. The reported incidence from vinorelbine syringes was 0.029% (2/6914) and 0.146% (8/5475) with mini-bags. Excluding vinorelbine data, the reported vinca alkaloid extravasation episodes from syringes (0.027%) and mini-bags (0.035%) were found to be similar and infrequent. CONCLUSION: The data suggest that vinca alkaloids can be given safely as low volume, short infusions via mini-bags. Policies and practices that ensure the same careful monitoring of infusional therapy as is recommended with administration by syringe may further reduce the incidence of untoward effects. Mini-bags should be used for the administration of vinca alkaloids and this practice will prevent the inadvertent intrathecal administration of vinca alkaloids via syringes.

Antineoplastic Agents↗