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PubMed2006

Infusion pump delivers over-dosage of propofol as a result of missing syringe support.

We describe the malfunction of a common drug infusion pump. The syringe saddle was missing and allowed the syringe barrel to contact the pump case, which decreased the outward displacement of the syringe clamp. Then, the infusion pump falsely detected a smaller syringe size and consequently delivered an increased infusion rate and overdose of propofol to the patient. More commonly, an incorrectly mounted syringe may increase the outward displacement of the syringe clamp so that the infusion pump falsely detects a larger syringe size, with resultant less than expected infusion rate.

Drug Delivery Systems↗

PubMedDate not supplied

Pharmacist ambivalence about sale of syringes to injection drug users.

OBJECTIVE: To examine pharmacists' attitudes and practices surrounding human immunodeficiency virus (HIV) prevention among injection drug users. DESIGN: Focus groups. SETTING: Urban and rural sites in Colorado, Connecticut, Kentucky, and Missouri. PATIENTS OR OTHER PARTICIPANTS: Eight focus groups, with 4 to 11 pharmacists participating in each group. INTERVENTIONS: Transcripts of focus group discussions were evaluated for common themes by the authors and through the use of NUD*IST. MAIN OUTCOME MEASURES: Willingness to sell syringes to all customers, views on syringe exchange programs (SEPs), knowledge of laws governing syringe sales and racial, ethnic, or gender biases in syringe selling practices. RESULTS: Two pharmacists established their own policies of selling syringes to everyone, and three expressed a willingness to have their pharmacies serve as SEPs. A total of 20% of the pharmacists expressed an interest in learning more about the efficacy of SEPs and distribution of syringes by pharmacists, and were willing to change their views based on this information. Many also indicated a general willingness to work with SEPs or to participate in the effort to curb the spread of HIV. However, a majority of pharmacists opposed having SEPs in their pharmacies and reported selling syringes only within specific limits: to known diabetics, to individuals who looked reasonable, or to individuals who presented a logical explanation. No racial, ethnic, or gender bias was observed. CONCLUSION: Opinions among pharmacists varied across and within sites. While a majority of pharmacists would not establish SEPs in their own pharmacies, nearly all would participate in other HIV-prevention programs. Educational programs for pharmacists may be valuable in HIV-prevention efforts.

Attitude of Health Personnel↗

PubMedDate not supplied

Pharmacist support for selling syringes without a prescription to injection drug users in Rhode Island.

OBJECTIVE: To examine pharmacists' attitudes and obstacles to syringe sales to IDUs without prescriptions in Rhode Island, around the time that such sales became legal in the state. DESIGN: Self-administered written survey. SETTING: Rhode Island. PARTICIPANTS: 400 randomly selected pharmacist members of the Rhode Island Pharmacists Association. MAIN OUTCOME MEASURES: Responses to survey items. RESULTS: Of the 400 pharmacists contacted, 131 (33%) completed and returned the survey; of these, 101 (77%) were pharmacists who worked in stores that provided direct nonprescription syringe sales to the public. The majority of these 101 pharmacists were willing to sell syringes to a suspected IDU without a prescription (65%), favored providing free sharps containers for disposal (68%), and supported providing pamphlets on safer injection practices (88%). Willingness to sell syringes to IDUs without a prescription was significantly correlated with various beliefs about possible consequences of sales. CONCLUSION: The high level of support for nonprescription syringe sales to IDUs is promising. The correlation between the willingness to sell syringes to IDUs without a prescription and various beliefs suggests that future educational interventions might encourage pharmacists to sell syringes to this population without a prescription to decrease HIV and hepatitis transmission.

Adult↗

PubMedDate not supplied

More pharmacists in high-risk neighborhoods of New York City support selling syringes to injection drug users.

OBJECTIVE: To document changes in pharmacists' opinions and practices from the time of passage to implementation of a law permitting selling syringes without a prescription (the Expanded Syringe Access Demonstration Program [ESAP]). DESIGN: Two cross-sectional randomized telephone surveys. SETTING: High-risk neighborhoods of New York City. SUBJECTS: Pharmacists. MAIN OUTCOME MEASURES: Support for selling syringes without a prescription to injection drug users (IDUs). RESULTS: We completed 130 surveys at baseline (BL) in August 2000, from neighborhoods with high numbers of injection-related acquired immunodeficiency syndrome (AIDS) cases and 231 surveys at law change (LC) in January 2001. To correct for differences in sampling, we limited the analysis to pharmacies in ZIP Codes represented in both samples and weighted results to adjust for the median income level of those postal codes. From BL (n = 83) to LC (n = 84), law awareness increased (43% to 90%, P < .001), as did personal support for selling syringes without a prescription to IDUs (36% to 63%, P < .001). From BL to LC, a larger proportion of supporters believed that selling syringes was an important part of human immunodeficiency virus (HIV) prevention and would help decrease HIV transmission, and a smaller proportion was concerned about customer discomfort and increased drug use. A total of 40% of respondents were ESAP registered at LC but registration was not associated with support for selling syringes to IDUs. CONCLUSIONS: Support for ESAP among pharmacists increased in high-risk neighborhoods as the program was implemented. The finding that some pharmacists were ESAP registered but did not support selling syringes to IDUs and others were supportive, but not ESAP registered, may have program implications.

Attitude of Health Personnel↗

PubMed2001

Use of glass capillaries avoids the time changes in high blood PO(2) observed with plastic syringes.

STUDY OBJECTIVES: In adults, arterial blood samples are usually drawn using plastic syringes. In contrast to glass syringes, plastic syringes let oxygen diffuse through their wall. This results in PO(2) changes during storage, especially when PO(2) is high. An alternative to glass syringes is the Microsampler (Roche Diagnostics; Schaffhausen, Switzerland), a commercially available device consisting of a heparinized glass capillary fitted with a 26-gauge needle and used to collect arterial blood in the same way as a plastic syringe fitted with a needle. DESIGN: We evaluated the performance of the Roche Microsampler for storing arterial blood in view of PO(2) measurement, comparatively with glass and plastic syringes. Five approximate initial PO(2) levels (650, 400, 200, 130, and 80 mm Hg) and two storage temperatures (ambient temperature and 4 degrees C) were studied. SETTINGS: Bench study. RESULTS: Plastic syringes allowed reliable measurement of PO(2) values when initial PO(2) was too low to ensure complete hemoglobin oxygen saturation, but were associated with time-dependent underestimation of PO(2) at higher initial PO(2) values. No such underestimation occurred with the Roche Microsampler stored at 4 degrees C for up to 1 h for all PO(2) levels studied. CONCLUSION: The Roche Microsamplers appeared to be reliable devices in preventing oxygen diffusion.

Blood Specimen Collection↗

PubMed1982

Insulin syringes: dangers of dead space.

To assess the accuracy and reproducibility of various U100 insulin syringes in the hands of diabetics, we devised a method to measure individual insulins injected from the syringe. We found alarming inaccuracies with dead-space-containing syringes when two insulins were mixed in the syringe before injection; these errors exceeded 100% with low doses. Reproducibility of dose was also poor with dead-space syringes. Syringes with minimal dead space overcome these problems and we recommend that all diabetics who mix insulins should use these syringes.

Humans↗

PubMed2002

A 'membrane in syringe' technique that allows identification of the epidural space with saline while avoids injection of air into the epidural space.

BACKGROUND: The 'MEMBRANE IN SYRINGE' technique is, in principle, a modification of the loss of resistance technique for identifying the epidural space in epidural anaesthesia. A plastic membrane is placed halfway inside a syringe dividing the syringe into two compartments. The saline compartment encompasses the nozzle of the syringe (the distal compartment). The plunger is installed in the opposite half of the hallow cylinder. Air is trapped in the space between the membrane and the rubber plunger (air compartment). METHODS: There were altogether 20 epidural procedures to put to the test for this technique. The time spent in the undertaking of the procedure, the amount of normal saline injected, whether there was a feel of loss of resistance with wrinkling of the membrane in the syringe, inadvertent puncture of the dura, the level of epidural block and the insertion depth of epidural needle were recorded. RESULTS: The procedure took less than 4 minutes to complete in most of the cases. There was no inadvertent dural puncture. The average amount of normal saline injected was less than 1 ml. In 3 cases, despite the absence of the feel of loss of resistance the epidural space was still successfully identified by visible wrinkling of the membrane in the syringe. All catheters were inserted smoothly through the epidural needle and appropriate level of anesthesia was achieved in all the cases. CONCLUSIONS: The advantage of this technique is twofold. Firstly when the syringe is filled with both normal saline and air, it can prevent injection of the air into the epidural space during identification while at the same time it does not molest the feel of compressibility. Secondly, with the membrane separating the normal saline and air, correct placement of the needle tip can also be ascertained with loss of resistance while, as will be seen, the plastic membrane will wrinkle when saline is released into the epidural space.

Adolescent↗

PubMedDate not supplied

Radiation dose to the operator during vertebroplasty: prospective comparison of the use of 1-cc syringes versus an injection device.

BACKGROUND AND PURPOSE: Percutaneous vertebroplasty procedures require relatively long durations of fluoroscopic guidance, which might lead to substantial radiation dose to operators. Specialized injection devices have been proposed to limit operator exposure. Our purpose was to compare the radiation dose to the operator's hands during vertebroplasty when using 1-cc syringes versus that when using an injection device. METHODS: Radiation dosimeters were worn on the left wrist during 39 vertebroplasty injection procedures in 25 patients. Cases were alternated between the use of 1-cc syringes (19 procedures) and the use of an injection device (20 procedures). For each procedure, one dosimeter was worn throughout the procedure, both during needle placement and injection, and a second dosimeter was worn during the injection phase only. Mean doses for the whole case and mean doses for the injection procedure alone were compared between groups. RESULTS: Mean whole case dose was 128 +/- 161 mrem (range, 0-660 mrem) for the 1-cc syringe group versus 98 +/- 90 mrem (range, 0-340 mrem) for the injection device group (P =.23). Mean dose during injection was 100 +/- 145 mrem (range, 0-660 mrem) for the 1-cc syringe group versus 55 +/- 43 mrem (range, 0-130 mrem) for the injection device group (P =.09). Three of 19 1-cc syringe cases yielded zero dose, compared with four of 20 injection device cases. Duration of injection was markedly different between groups, with mean injection times of 4.2 and 7.5 min for 1-cc syringe and injection device cases, respectively (P <.00002). Mean injection dose per minute of lateral fluoroscopy was 23.6 and 7.3 mrem for the 1-cc syringe and injection device groups, respectively (P =.002). CONCLUSION: The use of an injection device significantly decreased the radiation dose to the operator's extremity per unit time of injection. However, total dose per injection was equivalent between groups because of significantly longer injection duration for the injection device cohort.

Bone Cements↗

PubMed1991

Stability and sterility of biosynthetic human insulin stored in plastic insulin syringes for 28 days.

The stability and sterility of biosynthetic human insulin products stored at refrigerator and room temperatures in two types of plastic syringes and the stability of preservatives in the products were studied. Four types of biosynthetic human insulin were used: regular, isophane, combination, and extemporaneously prepared combination. Samples (0.4 mL) were withdrawn from multiple-dose vials into 39 polypropylene and 39 propylene-ethylene copolymer syringes. Three syringes of each type were analyzed immediately; the remaining syringes were stored in plastic bags, half at room temperature (23 degrees C) and half in the refrigerator (4 degrees C). A vial of each type of insulin was maintained under similar conditions. At days 1, 3, 7, 14, 21, and 28, samples from each syringe were analyzed by high-performance liquid chromatography for insulin potency and m-cresol and phenol concentrations. Samples of each product were also tested for sterility after 1, 2, and 4 weeks of storage at 4 degrees C and 23 degrees C. The potency of insulin in each of the biosynthetic human insulin products did not change significantly during the 28-day study in both types of plastic syringes and at both temperature settings. m-Cresol concentrations decreased in all samples; greater decreases occurred in samples stored at room temperature and in samples stored in polypropylene syringes. Phenol concentrations were less affected than m-cresol concentrations; greater decreases occurred in samples stored at room temperature. No significant decreases in insulin potency or m-cresol or phenol concentrations occurred in control samples stored in vials kept under similar conditions.(ABSTRACT TRUNCATED AT 250 WORDS)

Drug Stability↗

PubMed1988

Stability of amoxicillin trihydrate-potassium clavulanate in original containers and unit dose oral syringes.

The stability of reconstituted amoxicillin trihydrate-potassium clavulanate oral suspension both in original containers and pre-packaged in commercially available oral syringes stored at various temperatures was determined. Amoxicillin trihydrate 125 mg/5 mL-potassium clavulanate 31.25 mg/5 mL and amoxicillin trihydrate 250 mg/5 mL-potassium clavulanate 62.5 mg/5 mL were reconstituted according to the manufacturer's instructions. The reconstituted suspensions in the original containers and in five brands of oral syringes were stored at 5 degrees C and 25 degrees C and -10 degrees C, 5 degrees C, and 25 degrees C, respectively, for 0, 2, 4, 7, and 14 days. The concentrations of amoxicillin trihydrate and potassium clavulanate remaining after storage were assayed in triplicate by reverse-phase high-performance liquid chromatography, using a stability-indicating method. An F statistic was calculated to determine whether different syringe brands had significantly different effects on drug stability. Amoxicillin trihydrate was stable for at least 10 days in the original containers and all types of oral syringes at 5 degrees C. However, potassium clavulanate was stable for 11.1 days in original containers and less than 5 days in all types of oral syringes at 5 degrees C. The effect of syringe brand on the stability of drugs over time at specific storage conditions and temperature was significant for potassium clavulanate at 5 degrees C and for both amoxicillin trihydrate and potassium clavulanate at 25 degrees C. The manufacturer's guidelines for storage of reconstituted amoxicillin trihydrate-potassium clavulanate oral suspension in the original containers should not be applied to dosages repackaged in unit dose oral syringes.

Amoxicillin↗

PubMed1987

Stability of dicloxacillin sodium oral suspension stored in polypropylene syringes.

The stability of dicloxacillin sodium in oral suspension stored in clear polypropylene oral syringes was studied. Commercially available dicloxacillin sodium powder for oral suspension from a single lot was reconstituted according to the manufacturer's instructions and drawn into 5-mL clear polypropylene oral syringes. The syringes were divided into groups and stored at -20, 4, 25, 40, 60 or 80 degrees C. Two additional lots were similarly reconstituted, repackaged, and stored at 80 degrees C only to assess interlot variability. Powder in the original containers was similarly reconstituted according to the manufacturer's instructions, and the containers were divided into groups and stored with the syringes. Immediately after reconstitution and at specified times during storage, three syringes and the original containers at each storage temperature were removed, and their contents were analyzed for dicloxacillin sodium concentration using the Standard USP Iodometric Assay. Dicloxacillin sodium follows a first-order rate of degradation at temperatures of 40, 60, and 80 degrees C. The rate of degradation changes to a zero-order process at temperatures of 25, 4, and -20 degrees C. At all temperatures, degradation occurred more rapidly when the drug was repackaged into unit dose polypropylene oral syringes than in the manufacturer's original container. Dicloxacillin sodium reconstituted from powder as oral suspension and repackaged in clear polypropylene syringes was stable for no longer than 7, 10, and 21 days when stored under ambient, refrigerated, and frozen conditions, respectively.

Administration, Oral↗

PubMed1987

The choice of a syringe for manual cortex aspiration.

The friction force of 5-ml, 2-ml, and 1-ml syringes used for manual aspiration of cortex material in extracapsular cataract extraction (ECCE) were compared. It was found that for a 5-ml syringe the force was 500 g, for a 2-ml syringe it was 250 g, and for a 1-ml tuberculin-type syringe it was only 50 g. The ease and duration of cortex aspiration in 30 cases of ECCE were compared using each of the above syringes partially filled with fluid, connected to a 25-gauge Gill's type cannula, and a closed anterior chamber technique. It was found that with the help of a 1-ml tuberculin syringe, cortex material was removed faster and with less finger fatigue than with the 5-ml or 2-ml syringe.

Cataract Extraction↗

PubMed1985

Microbial contamination potential of sterile disposable plastic syringes.

The contamination potential of sterile disposable plastic syringes was evaluated after subjecting the syringes to both simulated in-use conditions and an intentional microbial challenge. Lots of 20 Luer-lock syringes in 10 or 12-cu cm and 20- or 30-cu cm sizes from three manufacturers were tested. Sampling was conducted using 30-ml vials of sterile aerobic culture media containing 14C-labeled substrates. Microbial contamination was confirmed by both visual observation of the turbidity caused by colonization and instrumental detection of 14CO2 caused by the microbial metabolism of 14C-substrates. No contamination of 120 samples was found after the ribbed plunger shaft was grasped by a bare, unprepared dry hand during five cycles of filling and injecting the medium into the vials without removing the needles from the stoppers. When this sampling technique was applied to the syringes inoculated on the upper piston surface with Bacillus subtilis suspension, a 100% contamination rate was observed in 120 samples each under both positive and negative in-vial pressure. Grasping the ribbed plunger shaft of disposable plastic syringes with a dry bare hand did not compromise the sterility of the syringe contents in this study; however, this practice should be avoided when possible. Personnel should absolutely avoid introducing fluid-borne microbial contaminants into the distal barrel end of these syringes because the contents are readily labile to contamination under these conditions.

Bacillus subtilis↗

PubMed1985

Implementation and cost analysis of a syringe pump system for intermittent i.v. drug delivery.

Implementation of a syringe pump system for delivery of intermittent i.v. drug doses in a 452-bed teaching hospital is described; the system was evaluated for cost effectiveness one year after implementation. Drugs to be administered by syringe pump were diluted to concentrations recommended for i.v. push administration and then administered over 22-30 minutes. For batch preparation of more than 100 syringe doses, an automated dispensing pump was used. Before the syringe pump system was implemented hospitalwide, costs were predicted on the basis of data from the pharmacy's computerized i.v. administration records. In the first year after hospitalwide implementation of the system, 4687 patients received 113,898 doses of intermittent i.v. medications by syringe pump; this represented approximately 73% of all intermittent i.v. doses. The remaining doses were dispensed in minibags, and no substantial problems resulted from concurrent use of both systems. Based on current contract prices, use of the syringe pump system resulted in savings of more than +79,000 during the first year. Implementation of a syringe pump system for administration of most intermittent i.v. medications resulted in substantial cost savings.

Anti-Bacterial Agents↗

PubMed1995

Comparison of costs for reusable and disposable syringes.

The cost for reusable and disposable syringes was studied in Maharaj Nakorn Chiang Mai Hospital, a university hospital in the northern part of Thailand. The cost for operating reusable syringes includes that for cleaning and sterilization. This consists of labour, replacement for defective syringes, tap water, electricity, depreciation of instruments. The cost for disposable items was calculated from the number of syringes used multiplied by the price of the individual size. Results showed that 34,598 syringes were used monthly from August to October 1989. The cost for reusable syringes was 84,714 baht in comparison with 81,874 baht for disposable items. The latter was cheaper by 2,840 baht per month. It is concluded that disposable syringes are cheaper, at least in this university hospital.

Central Supply, Hospital↗

PubMedDate not supplied

A new syringe for fine needle aspiration biopsy.

In order to improve the technique of fine needle aspiration biopsy (FNAB), we developed a disposable syringe that allows one to perform aspiration with one hand while eliminating the need for a classic syringe holder. This study compared the cellularity and diagnostic adequacy of the material obtained with the new syringe and a syringe holder. Moreover, the acceptance of the new technique by physicians in training and by patients was tested. FNAB was performed with a syringe holder and the new syringe on 120 lesions from different body sites. The total number of diagnostic cells and their relative percentage were estimated. The results of the study indicated that the adequacy of a conclusive cytologic diagnosis was similar for both techniques. Moreover, a comparable cellular yield was demonstrated by a linear relationship between the total number of diagnostic cells (r = .84, slope = .83). The new technique was favorably accepted by physicians in training and patients. FNAB with the new syringe can be performed routinely.

Biopsy, Needle↗

PubMed1996

Effect of syringe size on bruising following subcutaneous heparin injection.

BACKGROUND: Bruising and induration associated with subcutaneous heparin injection often result in sustained tenderness and severe ecchymosis at the injection site. Research-based practice guidelines for subcutaneous heparin administration are needed to reduce these adverse effects. OBJECTIVES: The purpose of this study was to investigate the effect of syringe size (1-mL vs 3-mL) on postinjection-site bruising and induration following the administration of subcutaneous heparin. METHODS: A convenience sample of 29 subjects receiving 5000 units of subcutaneous heparin at least twice a day was recruited from a large urban hospital. Subjects received their regularly scheduled subcutaneous heparin injections with a 3-mL or a 1-mL syringe in a randomized sequence using a standardized procedure. Injection sites were assessed for bruises and induration at 24, 48, and 72 hours after injection. RESULTS: The incidence of injection site bruising with 1- and 3-mL syringes was 79% and 69%, respectively. The use of a 3-mL vs 1-mL syringe resulted in significantly smaller bruises at 48 and 72 hours after injection. Induration at the injection site occurred in three patients. CONCLUSIONS: Findings suggest that 3-mL syringes are preferable to 1-mL syringes for heparin administration. The effect of other injection-related variables should be studied with the use of the 3-mL syringe, and tested on various populations.

Adult↗

PubMed1998

Dose from syringe procedures during technetium-99m radiopharmaceutical preparation.

UNLABELLED: We examined the dose from 99mTc contained in syringes and shielded vials to assess in detail the dose burdens in a central pharmacy. METHODS: Absorbed-dose rates at the end of the plunger of a shielded syringe, when 99mTc is contained either in the syringe or in a shielded vial from which the activity would be drawn, were measured with CaF2 dosimeters. The dose rates also were calculated with a Monte Carlo model. RESULTS: When activity was contained in either 3-ml or 10-ml disposable syringes shielded by lead glass, the absorbed-dose rates were 1.35-1.62 mGy hr-1 GBq-1 (5-6 mrad hr-1 mCi-1). When the activity was contained in either a shielded elution or product kit vial, the absorbed-dose rates at the end of the syringe plunger were about 0.40 mGy hr-1 GBq-1 (1.4-1.5 mrad hr-1 mCi-1). These results were reproduced with reasonable accuracy by Monte Carlo simulations. CONCLUSION: The dose burden per unit of activity handled from 99mTc in procedures using syringes is likely to be two to five times larger than the dose burden from calibrating generator eluate. The Monte Carlo simulations suggest that lead K x-rays may be responsible for a significant fraction of the total dose to the fingers and hand of the pharmacist when lead-glass syringe shields are used.

Equipment Design↗