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PubMed1992

Comparison of a new pressurized saline canister versus syringe irrigation for laceration cleansing in the emergency department.

STUDY OBJECTIVE: Studies have documented the efficacy of normal saline irrigation in decreasing wound infection rates. Wounds traditionally are irrigated using a syringe and needle with manual injection of fluid, a time- and labor-intensive method. We compared irrigation times and infection rates for wounds cleansed with syringe irrigation versus a new, single-use canister of pressurized (8 psi) sterile normal saline. DESIGN: Prospective, randomized, controlled. SETTING: Two Level I emergency departments in tertiary care hospitals, both with emergency medicine residency programs. PARTICIPANTS: Patients with lacerations requiring closure were eligible. Exclusion criteria were wounds above the clavicle more than ten hours old, wounds below the clavicle more than six hours old, insulin-dependent diabetes mellitus, or antibiotic or steroid therapy. Patients (550) were entered between August 1, 1990, and January 31, 1991. Characteristics of the two treatment groups were similar for patient age, age of the wound, size and depth of the laceration, and number of sutures. INTERVENTIONS: Lacerations were irrigated with 250 mL saline in a syringe or 220 mL saline in a pressurized canister for each 5 cm of laceration. At follow-up or suture removal, patients were evaluated for signs of wound complications (cellulitis, ascending lymphangitis, purulent discharge, or dehiscence). MAIN RESULTS: The mean irrigation time for the pressurized canister group (281) was 3.9 minutes versus 7.3 minutes in the syringe irrigation group (254) (P < .0001). The complication rate for the pressurized canister group was 5.0% compared with 3.6% for the syringe irrigation group (not significant, P = .50). Only three of the 20 total complications required antibiotics (two in the pressurized canister group, one in the syringe irrigation group). CONCLUSION: Syringe irrigation times were nearly twice as long as the pressurized canister irrigation times. Use of the pressurized canister facilitates ease of irrigation and markedly decreases the time involved in this traditionally labor-intensive activity. In addition, delivery of the saline is no longer operator dependent, ensuring generation of pressures appropriate for wound cleansing. The pressurized canisters may be useful in standardizing irrigation in wound management research.

Adult↗
PubMed2001

Unsafe injecting practices among attendees of syringe exchange programmes in France.

AIMS: To describe syringe exchange programme attendees and their injection practices. DESIGN: Cross-sectional study (one week in 1998). Data were collected through a standardized questionnaire. SETTING: 60/74 syringe exchange programmes (SEPs) in France. PARTICIPANTS: Clients requesting syringes in 60 SEPs. MEASUREMENTS: Self-reports of drug use, injecting behaviour, sexual behaviour, serological status (HIV, HBV, HCV). Prevalence of unsafe injecting practices in the previous month such as: syringe sharing; and sharing other injection paraphernalia. FINDINGS: 1004 questionnaires were collected (response rate: 50%). The mean age of respondents was 30 years, and 70% were males. Among individuals tested, HIV reported prevalence was 19.2%, HCV 58.4% and HBV 20.8%. The mean duration of drug use was 11 years. Eighty-five percent were polydrug users and buprenorphine high-dosage was the substance most used (73%). In the previous month, 45% of the participants had re-used a syringe, 93% injected at least daily (mean 3.6 injections per day), 18% shared a syringe and 71% shared injection paraphernalia. In multivariate analyses, unsafe injecting practices were associated with heroin and cocaine use and with living in a couple. The cluster analysis identified five categories of IDUs: users of buprenorphine-HD (45% of the responders), morphine-sulphate (17%), benzodiazepines and other legal drugs (13%), methadone associated with other legal drugs (13%) and crack-cocaine (13%). The buprenorphine-HD group had better social status and safer injection practices. CONCLUSIONS: In France, despite an increase in the accessibility to syringes and substitution treatments, unsafe injecting practices persist among SEP attenders. Interventions should stress the importance of using sterile material for each injection, even with a steady sex partner.

Adult↗
PubMed2005

Injection risk behavior among women syringe exchangers in San Francisco.

Women who inject drugs in cities where syringe exchange programs (SEPs) are well established may have different risks for HIV infection. In 1997, we interviewed 149 female syringe exchangers in San Francisco, CA, a city with high rates of injection drug use that is home to one of the largest and oldest SEPs in the United States. In this report, we describe their sociodemographics, health, and risk behavior, and we examine factors associated with recent syringe sharing. Fifty percent of respondents were women of color and the median age was 38 years. Most (86%) injected heroin and nearly half were currently homeless or had recently been incarcerated. One-third of all women reported needle sharing in the prior month. This was higher than the rate of needle sharing reported by a mixed gender sample of San Francisco exchangers in 1993, although it resembled the rate reported by a mixed gender sample in 1992. In a multivariate analysis, syringe sharing was associated with age, housing status, and sexual partnerships. Syringe sharers were more likely to be young, homeless, or have a sexual partner who was also an injection drug user. While wide access to sterile syringes is an important strategy to reduce HIV transmission among injection drug users (IDU), syringe exchange alone cannot eradicate risky injection by female IDU. Additional efforts to reduce risky injection practices should focus on younger and homeless female IDU, as well as address selective risk taking between sexual partners.

Adult↗
PubMed2006

Secondary syringe exchange as a model for HIV prevention programs in the Russian Federation.

Effective prevention of syringe-borne transmission of HIV and the hepatitis viruses can be undermined if contact between injection drug users and the staff of prevention programs is impeded by police harassment, limited program resources, and the absence of an open "drug scene." All these are commonplace in the Russian Federation. In response, "Project Renewal," the harm reduction program of the AIDS Prevention and Control Center of the Tatarstan Ministry of Health in Kazan, has created a hybrid syringe exchange program that as its primary focus recruited and trained volunteers to provide secondary syringe exchange. To compensate for operational barriers, the program staff identified private venues and trained responsible individuals to work through their own and related networks of injectors to provide clean syringes, other harm reduction supplies, and educational materials, while facilitating the collection and removal of used and potentially contaminated syringes. Program staff developed a detailed set of tracking instruments to monitor, on a daily and weekly basis, the locations and types of contacts and the dissemination of trainings and materials to ensure that the secondary distribution network reaches its target audience. Data show that these secondary exchange sites have proven more productive than the primary mobile and fixed-site syringe exchanges in Kazan. Beginning in 2001, Project Renewal has trained other harm reduction programs in the Russian Federation to use this model of reaching injectors, identifying and training volunteers, and monitoring results of secondary syringe exchange.

Adult↗
PubMed2004

Public funding of US syringe exchange programs.

Although there has been no federal government funding of syringe exchange, there is substantial state and local government funding. We report here on program characteristics associated with receiving state and local government funding. Annual telephone surveys were made of program directors of syringe exchange programs known to the North American Syringe Exchange Network. The number of syringe exchange programs known to this network has increased from 63 in 1994-1995 to 127 in 2000. Approximately 80% of programs participated in each of the surveys. Approximately 50% of programs receive state and local government funding, and this has remained constant from 1994 to 2000. Receiving state and local government funding was associated with larger numbers of syringes exchanged per year and providing more on-site services. Among programs that received state or local government funding, this funding accounted for a mean of 87% of the budget for syringe exchange services. In the absence of federal funding, state and local government support is associated with better syringe exchange performance.

Financing, Government↗
PubMed2006

Sterile syringe access and disposal among injection drug users newly enrolled in methadone maintenance treatment: a cross-sectional survey.

BACKGROUND: We sought to assess injection practices, means of acquiring and disposing of syringes, and utilization and knowledge of harm reduction resources among injection drug users (IDUs) entering methadone maintenance treatment (MMT). METHODS: Interviews with 100 consecutive patients, including 35 IDUs, entering a MMT program in the Bronx, NY. RESULTS: Utilization of unsafe syringe sources was reported by 69% of IDUs in our sample. Most (80%) IDUs reused syringes, and syringe sharing was also common. Fewer than half knew that non-prescription pharmacy purchase of syringes was possible. The most common means of disposing of injecting equipment were the trash (63%) and syringe exchange programs (49%). CONCLUSIONS: These findings indicate that drug users entering treatment under-utilize sanctioned venues to obtain sterile syringes or safely dispose of used injection equipment. Programs providing services to drug users should adopt a proactive stance to address the safety and health issues faced by injectors.

Journal Article↗
PubMed2000

An audit of subcutaneous syringe drivers in a non-specialist hospital.

The use of syringe drivers as a method of drug delivery to control symptoms in palliative care is a common and accepted practice, but one which has evolved rather than been subject to close multiprofessional scrutiny and guideline formation. There is evidence that adverse incidents may arise as a result of syringe driver use (Medical Devices Agency (MDA), 1998), for example, errors in drug calculations, drug stability, equipment failure (including disconnection) and the wrong rate of infusion. Inadequate user training, poor servicing of equipment and inadequate documentation and record keeping are all thought to be contributing factors (MDA, 1998). In the hospital where this audit was carried out, syringe drivers are used to administer drugs to patients with cancer during the palliative phase of illness. The purpose of this clinical audit was to establish the standard of current practice in wards where syringe drivers were being used. A retrospective study of 13 cases of syringe driver use is presented. The results highlight many areas of unregulated practice with regard to setting up, monitoring and maintenance of syringe drivers. The choice of drugs and doses prescribed, evaluation of treatment responses and review of treatment regimens were also areas of concern. Guidelines for the use of syringe drivers in non-specialist hospitals are put forward.

Adult↗
PubMed1998

Syringe exchange in Germany.

Syringe exchange in Germany is clearly linked to a recent shift of local responses to drug-use(r) associated problem. Since the end of the 1980s, metropolitan communities in Northern and Central Germany-concerned by the emergence of "Open Drug Scenes," increasing HIV and mortality rates among drug users, and drug-use-related property crime-began to favor measures of survival-oriented drug-user help. While the Federal Government still favors repression and law enforcement efforts, they nevertheless made syringe exchange explicitly legal in 1992-some 5 years after the creation of local Syringe Exchange Programs. In general, the new approach of local authorities includes a variety of services, such as housing facilities, crisis intervention centers, primary medical care, maintenance with substitute drugs, and syringe exchange programs. The creation of pilot heroin maintenance programs is planned for Frankfurt and Hamburg. While the established programs are successfully functioning in large cities such as Hamburg, Bremen, and Frankfurt, the demand for sterile needles and syringes remains unmet in smaller cities and in the conservative governed Bundeslander (states), where pharmacies remain the primary and often single legal supply source for syringes. Another major problem continues to be the drug-use situation in prisons. Although injection drug use is common in prisons, injection equipment is not legally available for the 10,000 injecting drug users imprisoned at any given time. Two of Germany's 220 prisons started an experimental syringe exchange in 1996.

Drug and Narcotic Control↗
PubMed1998

Syringe exchange in Canada: good but not enough to stem the HIV tide.

This article provides a historical perspective on the development of syringe exchange in Canada, the Canadian legal and policy context, evaluation and monitoring strategies, and current challenges facing HIV prevention efforts among injecting drug users. Despite the fact that it is legal to sell, exchange, or provide an IDU with a syringe and there are no laws in Canada requiring a physician's prescription to justify possession of a syringe, policy development and programming have not been adequate to hold HIV at bay in several cities across the country. Although there have been concerted efforts by syringe and needle exchange programs to increase the supply of injecting equipment, HIV prevalence continues to rise, provoking a rethinking of the role of syringe exchange. In a coordinated strategy for HIV prevention among drug users in Canada, needle and syringe exchange is not itself in question; however, ghettoization and needle quota systems may have had an adverse impact on prevention programming. A national action plan has been developed which aims to decentralize both methadone maintenance and syringe and needle exchange programs, increase access to detoxification and treatment modalities, and advocate for changes in the criminal justice system and law enforcement practices.

Canada↗
PubMed2005

Update: syringe exchange programs--United States, 2002.

Syringe exchange programs (SEPs) provide sterile syringes in exchange for used syringes to reduce transmission of human immunodeficiency virus (HIV) and other bloodborne infections associated with reuse of contaminated syringes by injection-drug users (IDUs). This report summarizes a survey of SEP activities in the United States for January-December 2002 and compares the results with those of previous surveys. The findings indicate that in 2002, for the first time in 8 years, the number of SEPs, the number of localities with SEPs, and public funding for SEPs decreased nationwide; however, the number of syringes exchanged and total budgets across all programs continued to increase. SEPs can help prevent bloodborne pathogen transmission by increasing access to sterile syringes among IDUs and enabling safe disposal of used syringes. Often, programs also provide other public health services, such as HIV testing, risk-reduction education, and referrals for substance-abuse treatment.

Needle-Exchange Programs↗
PubMed1987

Infusion phlebitis associated with a programmable syringe-pump system versus gravity-feed minibottles.

The occurrence of infusion phlebitis in patients receiving intravenous antibiotics via a gravity-feed minibottle system versus a new syringe-pump system was compared. Patients at least 18 years old who had indwelling intermittent injection sites inserted for medication administration were randomized to either the minibottle system or the syringe-pump system. Antibiotics in minibottles were diluted in 50-100 mL of 5% dextrose injection; in the syringe-pump group, aminoglycoside antibiotics were diluted in 0.9% sodium chloride injection and all other antibiotics were diluted in sterile water for injection. Antibiotics were not piggybacked into running primary infusions in any of the study patients, and no other medications except for 0.9% sodium chloride flushes were administered through the catheters. All catheters were inserted in peripheral veins and evaluated for phlebitis by i.v. nurse specialists using standardized criteria. Catheters were changed upon the occurrence of grade 1 phlebitis or after a period of three days without the development of phlebitis. Over an 18-week period, 85 catheter sites (53 syringe-pump group versus 32 minibottle group) were evaluated in 30 patients (14 syringe-pump group versus 16 minibottle group). The mean +/- S.D. catheter life in both groups was 50.6 +/- 20 hours. Phlebitis occurred in 62% of syringe-group sites versus 66% of minibottle-group sites; the incidence and severity of phlebitis were not significantly different between groups. The majority of catheter sites were infused with cefazolin sodium. The potential for phlebitis using the syringe-pump system in this study appears to be similar to that of the gravity-feed minibottle system when appropriate diluents, diluent volumes, and infusion rates are used.

Adult↗
PubMedDate not supplied

Sex, drugs, and syringe exchange in New York City: women's experiences.

The sex and drug human immunodeficiency virus (HIV) risk factors of drug-injecting women participating in New York City syringe exchange programs were studied and racial/ethnic differences examined. African-American women reported injecting least frequently and had lower rates of injecting with borrowed or used syringes. Women attending syringe exchange reported high levels of sexual risk behavior, and syringe exchange provides an opportunity for a sexual risk reduction intervention. Women were more likely to "always" use condoms with causal partners than with primary partners. About 60% of the women engaging in commercial sex work reported "always" using condoms. Three independent predictors for consistent condom use with primary partners were: knowing one's HIV status, any risky injection during the past 30 days, and being African-American, compared with white or Latina. The profile of African-American women attending syringe exchange in New York City suggests a higher level of stabilization than is found in the other groups of women. White women appear to be more socially isolated and to engage in higher risk behaviors. Although women attending New York City syringe exchange programs have significantly reduced risky drug injection, consistent with other studies, sexual risk behavior has remained at a high level. Syringe exchange and drug treatment programs have a great opportunity to target drug-injecting women for sexual risk reduction interventions.

Adult↗
PubMed1965

THE CLEANING OF INSTRUMENTS AND SYRINGES.

The dangers to the handler of syringes used for routine injections were found to be negligible, but known infected syringes and those contaminated with antibiotics should be autoclaved before handling as a high proportion of these carry pathogenic organisms. Mechanical methods of cleaning syringes and instruments are assessed. The use of an artificial soil for testing purposes is described. Using this soil, ultrasonics by themselves are inadequate for cleaning syringes and instruments. Agitation with ultrasonics is essential for syringes, but is insufficient for instruments. Detergents are therefore an essential adjunct to the cleaning process. For syringes Pyroneg proved to be the most satisfactory, particularly if they had been previously siliconized. The best detergent for instruments contaminated with these types of soil was Penesolve 814 at a temperature of 95 degrees C. but the instruments must be adequately rinsed after this treatment. A number of other detergents and cleaning agents are discussed.

Detergents↗
PubMed1999

Fine-needle aspiration biopsy using a newly-developed pencil-grip syringe holder.

Until now, commercially available syringe holders for fine-needle aspiration (FNA) were designed to be held in a pistol-grip manner. A newly developed, pencil-grip syringe holder, the Tao Aspirator, was tested. The device is equipped with a release button for automatically drawing back the syringe plunger and a regulating knob for adjusting negative pressure for the aspiration. After direct smears were made for on-site examination, the remaining aspirated material was collected by rinsing the needle and syringe with CytoRich red fixative. Hettich cytocentrifuge preparations were then prepared. The quality of the first 150 FNA specimens procured by this device and prepared with liquid fixation was evaluated in terms of adequacy of specimen, amount of obscuring blood, preservation of cells, and ease of screening and interpretation. These 150 specimens included 32 from thyroids; 34 from breasts; 40 from lymph nodes; 24 from subcutaneous nodules; and 20 from salivary glands. There were no unsatisfactory specimens. In Hettich preparations, red blood cells were lysed, making interpretation easier. All cellular elements and tissue fragments were adequately fixed, showing excellent cellular morphology. Specimens fixed in liquid fixative yielded uniform cell suspensions, resulting in cytocentrifuge preparations with evenly distributed cells, and so the screening was also easier. The aspiration techniques using pistol-grip and pencil-grip FNA syringe holders were also compared in terms of control in tissue sampling, ease of use, and safety. The pencil-grip syringe holder allowed greater tactile sensation of the texture of the lesion, and enabled the operator to use a single hand to place a needle into a target lesion with minimal error. This device placed the hand relatively close to the needle tip while the hand was in a position of natural function, imparting more control in tissue sampling. It was more easily manipulated, and could prevent dripping when cystic fluid was aspirated. Specimen collection using the Tao Aspirator and processing with liquid fixation in addition to direct smear preparations allowed the laboratory to consistently produce adequate cytologic preparations and cell blocks.

Biopsy, Needle↗
PubMed1988

Stability of morphine solutions in plastic syringes determined by reversed-phase ion-pair liquid chromatography.

A reversed-phase ion-pair HPLC assay has been developed for quantitating morphine, codeine, apomorphine, and pseudomorphine in aqueous solutions. Using two types of plastic syringes, the effect of light (25 W) and temperature (22 and 3 degrees C) on the stability of morphine, over a 12-week period, has been investigated in the presence and absence of preservative and antioxidant. The leaching of contaminants from the plastic syringes to water stored in them, for a period of up to 12 weeks, has also been investigated. The results indicate that less than 3% of the morphine is degraded in both types of plastic syringes, stored in light at 22 +/- 2 degrees C. The degradation is even less prominent in the dark or at 3 degrees C. Pseudomorphine has been identified as the major degradation product. Using 5% degradation of drug as the criterion for the determination of the shelf-life of morphine, it was found that in one brand of plastic syringes, morphine has a shelf-life of the order of 20 and 33 weeks, in the absence and presence of preservative and antioxidant, respectively. In the other brand of plastic syringe, the drug has a shelf-life of greater than 1 year. Some unidentified leached contaminants have been detected in water stored in both brands of syringes.

Apomorphine↗
PubMed1993

Syringe liposculpture revisited.

Syringe liposculpture was introduced by Fournier almost a decade ago. Recent advances have improved the technique, making it easier for the surgeon to use. To determine the efficacy of the syringe in reducing morbidity, groups of patients who had between 1200 and 1500 mL of adipose tissue removed were evaluated using different infiltration and power source (syringe vs machine) regimens. There was less blood lost when the syringe was used. In addition, syringe-treated patients appeared to heal faster, return to work in a shorter period of time, and have less pain. The advantages of the syringe technique are considerable and increase the safety factor of the liposculpture procedure.

Blood Loss, Surgical↗
PubMedDate not supplied

Syringe pump displacement alters line internal pressure and flow.

PURPOSE: It has been reported that the actual flow from a syringe pump changes due to vertical movement of the pump in vitro, but a direct study of the in vivo effects of fluid delivery irregularities caused by vertical pump displacement has not been performed. The aim of this study was to assess the influence of positional changes of the syringe pump on the internal pressure (IP) and flow from the circuit, and to examine blood pressure changes caused by pump movement in animals with or without hemorrhagic shock. METHODS: To simulate clinical conditions, we used a rabbit model. We first measured the changes in line IP and flow from the syringe pump after moving the pump 50 cm vertically upwards or downwards. With the same animal, we then recorded the blood pressure changes under these conditions during norepinephrine (NE) infusion, using a rabbit hemorrhagic shock (HS) model. RESULTS: Following downward movement of the syringe pump, the IP increased by 37.5 +/- 4.0 mmHg and IP decreased by 37.3 +/- 3.1 mmHg following upward movement of the syringe pump. In the rabbit HS model, movement downwards decreased systolic blood pressure (SBP) by -17 +/- 6.9% (P < 0.001), while upward movement raised SBP by 45.7 +/- 21.5% (P < 0.001) from baseline values. CONCLUSIONS: Vertical displacement of the syringe pump alters the flow due to a change of line IP, and blood pressure can be affected by pump movement during NE infusion.

Animals↗
PubMed2000

Adverse drug errors in anesthesia, and the impact of coloured syringe labels.

PURPOSE: To describe the frequency and pattern of drug errors in clinical anesthesia, and to evaluate whether a change to colour coded syringe labels, along with education, could reduce the problem of drug errors. METHODS: We prospectively recorded anesthesia-related information from all anesthetic cases for 36 mo, totally 55,426 procedures. Intraoperative problems, including drug errors, were recorded. After eighteen months we changed to colour coded syringe labels, and the effect of this change and education on drug errors was assessed. Errors were divided into four groups: syringe swap, ampoule swap, other 'wrong drug' errors, and wrong dose errors. The problems were graded into four levels, according to severity. RESULTS: A drug error was recorded in 63 cases (0.11%). There were 28 syringe swaps, and muscle relaxants were erroneously given in 15. There were nine ampoule swaps. There were eight 'other wrong drug' cases, and 18 cases where a wrong dose of the correct drug was given. Three of the drug errors were classified as serious, and 27 were of moderate severity. We found no differences between the two periods except for decreased number of ampoule swaps (P = 0.04). CONCLUSION: Drug errors are uncommon, and represent a small part of anesthesia problems but still have the potential for serious morbidity. Syringe swaps occurred most often between syringes of equal size, and were not eliminated by colour coding of labels. As muscle relaxant drugs are most commonly involved, and can cause lasting morbidity, special preventive measures should be taken for this group of drugs.

Adult↗