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PubMed2006

[Pharmacy syringe exchange program for injection drug users].

OBJECTIVES: To demonstrate that a syringe exchange program can reduce syringe re-use, to encourage HCV screening by injection drug users (IDUs), and to provide a new harm reduction tool through the pharmacy network. METHODS: Staff at the volunteer pharmacies were trained before participating in this decentralized syringe exchange program based on making the Steribox (with its single-use Sterifilt filter) injection kit available free to IDUs. They were asked but not required to return used material to a waste container in the pharmacy. Pharmacists also informed them of the risk of HCV contamination and encouraged screening. RESULTS: The number of Steribox kits dispensed by the involved pharmacies quadrupled 6 months after the study began, although the number of IDUs using the pharmacy did not increase and kit sales in other local pharmacies did not decease. The disposal rate was almost 80%. The relationship between pharmacists and users clearly improved, and the dispensing of kits has become an opportunity for dialogue. Four participants who injected Subutex accepted referrals to a methadone maintenance treatment program and began treatment. The pharmacists demonstrated their ability to manage this new harm reduction tool. DISCUSSION: The 400% increase in the number of kits dispensed is an indicator of the effect of price on use of sterile injection material. Cost is undoubtedly a factor in syringe re-use. Paid syringes were reused nearly ten times each, compared with 4 times for the free ones. Appropriate disposal was a responsible act that most IDUs performed. The improvement of the relationship between IDUs and pharmacists increased the access of the former to the healthcare system and enhanced the local healthcare network. Referral to the methadone maintenance treatment program was an unexpected and happy result. The dialogue established around injection tools allowed the pharmacists to provide advice as they dispensed Sterifilt and to promote its use by IDUs.

Adult↗
PubMedDate not supplied

NPL secondary standard radionuclide calibrator. Syringe calibration factors for radionuclides used in nuclear medicine. National Physical Laboratory.

The measurement of the activity of a radiopharmaceutical administration to a patient is normally achieved via the use of a radionuclide calibrator. Although these radionuclides are normally measured initially in a standard glass vial, an aliquot of the solution is then usually withdrawn into a syringe prior to the administration. Both for general quality assurance good practice and for additional guarantees for patient safety, a confirmatory measurement of the syringe is almost obligatory Because of the different geometries and elemental compositions between plastic syringes and glass vials, the calibration factors for syringes may well be significantly different from those for the glass containers. The magnitude of these differences depends on the energies of the emitted photons. A variety of syringes typically used in hospital administrations, and covering a range of volumes and manufacturers, were obtained. The results obtained were compared to those for glass vials and show the large errors that can be produced by ignoring these differences in container format.

Glass↗
PubMed1999

Comparative study of different syringes in positive aspiration during inferior alveolar nerve block.

OBJECTIVE: The purpose of this study was to evaluate the detection of intravascular injection or hematic aspiration in relation to (a) the particular combination of syringe system and needle (there being 3 different syringe systems [2 self-aspirating and 1 non-self-aspirating] and 3 different needles); (b) the anesthetic technique used (direct or indirect) to induce inferior alveolar nerve block; (c) patient sex; and (d) the operator performing the block. STUDY DESIGN: Two operators performed 246 inferior alveolar nerve blocks (on 90 male and 156 female patients) using 3 syringe systems (1 non-self-aspirating (Uniject K) and 2 self-aspirating (Aspiject and Inibsaject)) and 3 types of needle in terms of length and gauge combination (30G/25 mm, 27G/25 mm, and 27G/35 mm) for conventional and surgical extractions of lower third molars. Three aspirations were made at each of 3 different times in each block. Hematic aspiration was accepted only if a blood jet rose forcefully along the cartridge on aspiration. In each block, the age and sex of the patient was recorded, along with the latency or time elapsed from introduction of the anesthetic solution to onset of the anesthetic effect, the depth of the needle at contact with the mandibular ramus, and the operator performing the block. RESULTS: Significant differences (P <.05) were observed with respect to hematic aspiration and the syringe system used, the Uniject K system yielding higher percentage hematic aspirations (5.69%) than either of the self-aspirating systems, Inibsaject (2.03%) and Aspiject (1. 21%). However, no significant differences (P >.05) were observed with respect to number of aspirations, needle length, needle gauge, anesthetic technique performed, patient's sex, or operator performing the inferior alveolar nerve block. The incidence of hematic aspirations was 8.9%. The mean latency time was 39.03 seconds, and the mean needle depth at contact with the mandibular ramus was 20.72 mm. CONCLUSIONS: The Uniject K non-self-aspirating syringe system was associated with a higher number of hematic aspirations than the self-aspirating systems (Inibsaject and Aspiject). However, the detection of hematic aspirations was not dependent on length or gauge of the needles used, anesthetic technique performed (direct or indirect), patient's sex, or operator who performed the block.

Adolescent↗
PubMed2000

A clinical comparison of pain perception to the Wand and a traditional syringe.

OBJECTIVES: This study compared the pain response of a group of 40 volunteers to the Wand with the response to syringe injections. STUDY DESIGN: Of 240 total injections given, 120 were with the Wand system, and 120 were with the traditional aspirating syringe. Three injections were evaluated: injections to the middle superior alveolar (MSA) of the maxillary right first premolar and the maxillary left first premolar; palatal injections of the maxillary right first premolar and the maxillary left first premolar; and inferior alveolar nerve injection (IAN) of both the right and the left sides. Each volunteer received 6 injections, 3 on one side with the Wand and 3 on the opposite side with the syringe (control). All injections were given by the primary investigator without the use of a topical anesthetic. Pain perception levels were recorded with a 4-point visual analog scale: no pain, mild pain, moderate pain, and severe pain. The results were evaluated statistically by using an unpaired t test. RESULTS: The results showed injections with the syringe were statistically more painful than injections with the Wand in 4 of 18 evaluations: MSA of the maxillary left first premolar, female volunteers responses to MSA of the maxillary left first premolar, IAN left side injections, and male responses to IAN left injections (P =.01, P =.05, P =.05 and P =.05, respectively). CONCLUSIONS: The Wand generally seemed to provide less painful injections; however, the mean ratings of pain were mostly mild pain for both injections. Therefore, the clinical significance of the results should be interpreted with caution. The operator technique and tactile skill in syringe injections and site of injection (right or left) could be important factors that were not evaluated in this study.

Adult↗
PubMed2003

Public health interventionists, penny capitalists, or sources of risk?: assessing street syringe sellers in Hartford, Connecticut.

Improved access to sterile syringes decreases risks related to blood-borne transmission of HIV and hepatitis among injection drug users (IDUs). While syringe exchange programs and pharmacy sales of over-the-counter syringes have received considerable attention from researchers and interventionists during the past decade, little is known about informal economy street syringe sellers. In Hartford, CT. as well as other regions throughout the United States a large percentage of IDUs utilize street sellers to facilitate their injection activities. A qualitative and ethnographic study was conducted in Hartford between 1999 and 2001 to help elucidate the public health risks and benefits of street syringe sellers.

Blood-Borne Pathogens↗
PubMed2003

Stability of multidose, preserved formulation epoetin alfa in syringes for three and six weeks.

The integrity and biological activity of multidose, preserved formulation epoetin alfa stored in syringes at 2-8 degrees C were studied. Three independent 1.0-mL hubless syringes of epoetin alfa 20,000 units/mL were aseptically prepared and refrigerated for three and six weeks (a total of six syringes). Protein integrity was assayed by SDS-polyacrylamide gel electrophoresis (SDS-PAGE), immunoblotting, and glycoprotein detection. Biological activity was determined through a cell-based proliferation assay. The presence or absence of microbial contamination was observed after a one-week culture. A multidose, preserved formulation of epoetin alfa that was opened only at the time of assay served as the reference standard. SDS-PAGE silver-stained gels and immunoblots demonstrated no evidence of erythropoietin degradation after three and six weeks of storage when compared with the reference standard. In addition, SDS-PAGE, immunoblotting, and direct glycoprotein detection found that protein glycosylation was unaffected by the storage. Student's t test detected no significant difference between stored samples and the reference standard in biological activity (p > 0.05). A culture of epoetin alfa in bacterial and eukaryotic cell growth media showed no evidence of contamination. The results suggest that epoetin alfa can be dispensed to patients in prefilled syringes every four to six weeks to coincide with their peritoneal dialysis schedule. The integrity and biological activity of 20,000 units/mL epoetin alfa in prefilled syringes remain intact after three and six weeks when stored at 2-8 degrees C.

Cell Division↗
PubMed2004

A multistate trial of pharmacy syringe purchase.

Pharmacies are a potential site for access to sterile syringes as a means for preventing human immunodeficiency virus (HIV), but the type and extent of their utility is uncertain. To examine pharmacy syringe purchase, we conducted a standardized, multistate study in urban and rural areas of four states in which attempts to purchase syringes were documented. Of 1,600 overall purchase attempts, 35% were refused. Colorado (25%) and Connecticut (28%) had significantly lower rates of refusal than Kentucky (41%) and Missouri (47%). Furthermore, urban settings had higher rates of refusal (40%) than rural settings (31%, P < .01). Race and gender did not have a consistent impact on rates of refusal. Despite potential advantages of pharmacies as sites for access to sterile syringes, pharmacy purchase of syringes faces significant obstacles in terms of the practices in different jurisdictions.

Commerce↗
PubMed1998

Injection and syringe sharing among HIV-infected injection drug users: implications for prevention of HIV transmission. Supplement to HIV/AIDS Surveillance Group.

Because HIV-infected injection drug users (IDUs) can transmit HIV infection, we investigated factors associated with sharing of syringes in the past year among IDUs infected with HIV. We analyzed data from an interview survey of 11,757 persons > or = 18 years of age with HIV or AIDS between June 1990 and August 1995 who were reported to 12 state or city health departments in the United States. Of the 1527 persons who had ever shared syringes and reported injecting in the 5 years before the interview, 786 (51%) had injected in the year before interview, and of these, 391 (50%) had shared during that year. IDUs who were aware of their HIV infection for >1 year were less likely to share (43%) than those who were aware of their infection for 1 year or less (65%, adjusted odds ratio=2.15, 95% confidence interval, 1.52-3.03). The only statistically significant time trend was that the proportion of IDUs from Connecticut who shared decreased from 71% in 1992 to 29% in 1995. This trend appears to be related to the 1992 changes in Connecticut laws that allowed purchase and possession of syringes without a prescription. Because many HIV-infected IDUs continue to inject and share, prevention efforts should be aimed at HIV-infected IDUs to prevent transmission of HIV. Early HIV diagnosis and access to sterile syringes may be important methods for reducing syringe sharing by HIV-infected IDUs.

Acquired Immunodeficiency Syndrome↗
PubMed2005

The 50 ml syringe training aid should be utilized immediately before cricoid pressure application.

OBJECTIVE: Cricoid pressure, applied during rapid sequence induction of anaesthesia, should be performed only by trained staff. Recommended training intervals vary from weekly to every 3 months, but this is unrealistic in day-to-day practice. Performance, when assessed, is often shown to be unacceptable before training. Unfortunately, most training aids are either expensive or unavailable. Assessment and training in previous studies was carried out on the same cricoid pressure simulator, introducing learning bias. In our study, we tested whether a 50 ml syringe utilized as a training aid immediately before the assessment of simulated rapid sequence induction on a different cricoid pressure simulator would improve staff performance. METHODS: A total of 64 volunteers were randomly allocated into two equal groups. Group 1 (control group) was assessed on the cricoid pressure simulator only. Group 2 (training group) was pretrained to defined criteria using the 50 ml syringe. Next, the group was assessed on the cricoid pressure simulator. RESULTS: A satisfactory force was applied in only 19% (6/32) of the control group, but in 47% (15/32) of the syringe pretrained group (P=0.03). Both groups applied, on average, excessive force. CONCLUSION: Brief training with a 50 ml syringe will increase the likelihood of satisfactory force application during Sellick's manoeuvre. Applied to clinical practice, this will make cricoid pressure both more effective and reliable, and may improve patient safety. Therefore, the 50 ml syringe should be utilized before any clinical application of cricoid pressure.

Anesthesiology↗
PubMed2004

Injecting equipment sharing among injecting drug users in Togliatti City, Russian Federation: maximizing the protective effects of syringe distribution.

OBJECTIVE: To compare risk factors for injecting equipment sharing among injecting drug users (IDUs) in Togliatti City, Russia. DESIGN: Unlinked, anonymous, cross-sectional community-recruited survey with oral fluid sample collection. METHODS: Between September and October 2001, 426 IDUs completed an interviewer-administered questionnaire and oral fluid samples were tested for HIV. Univariate and multivariate analyses compared potential risk factors for injecting equipment sharing. RESULTS: More than half (56% [234/418]) of the sample were positive for antibodies to HIV. A third (36%) had injected with used needles and syringes in the last 4 weeks. IDUs who reported syringe exchanges or outreach workers as their main sources of new needles and syringes in the last 4 weeks had 0.3 times the odds of sharing compared with those obtaining them from a pharmacy or shop, whereas those whose main source was buying them from the streets or obtaining them from friends, sexual partners, or other drug users had 12 times the odds of receptive needle and syringe sharing. IDUs who reported being last arrested or detained by the police for a drug-related offense had higher odds of sharing. CONCLUSIONS: Findings highlight the delicate balance in HIV prevention between potentially competing strategies of law enforcement and syringe distribution.

Analysis of Variance↗
PubMed2006

Stability of nevirapine suspension in prefilled oral syringes used for reduction of mother-to-child HIV transmission.

OBJECTIVE: To reduce mother-to-child transmission (MTCT) of HIV, we assessed the stability of nevirapine suspension in an oral dosing syringe over a range of storage conditions. DESIGN: A mother-to-child transmission dosing kit, containing a maternal nevirapine tablet and infant nevirapine suspension in an oral syringe that can be dispensed to the pregnant woman to use at delivery. However, the manufacturer only packages nevirapine in 240 mL, multidose containers and there are no published stability data for nevirapine suspension repackaged in an oral syringe. METHODS: Nevirapine suspension 6 mg/0.6 mL in 3 mL amber BAXA Exacta-Med Oral Dispensers (Baxa Corporation, Englewood, CO) were stored under the following conditions: 26 degrees C/high relative humidity (RH), 40 degrees C/low RH, 40 degrees C/high RH, refrigerated and frozen -30 degrees C for 6 months. The samples were assayed monthly for nevirapine by HPLC-UV. At 3, 4, and 6 months the samples were cultured for pathogens. RESULTS: : There were no significant decreases in nevirapine concentrations in the prefilled syringes compared with baseline. Nevirapine became more concentrated in syringes incubated at 40 degrees C/low RH due to evaporation resulting in the suspension becoming more viscous. No pathogens were cultured. CONCLUSIONS: Nevirapine suspension is stable and pathogen free at varying conditions for 6 months in Baxa Exacta-Med Oral Dispensers.

Administration, Oral↗
PubMed1988

A comparison of different methods of lubrication of glass syringes used to identify the epidural space.

Measurement of loss of resistance in glass syringes is a method widely used to locate the epidural space in epidural anaesthesia. Static and dynamic forces were measured under four experimental conditions in new glass syringes: unpolished, dry; polished, dry; unpolished, saline lubricated; and polished, saline lubricated. The unpolished saline lubricated syringes had a mean (SD) static force of 53.18 (15.0) g and dynamic force of 40.88 (15.2) g. These values were significantly greater than for polished dry syringes where the values were 5.27 (2.1) g and 4.38 (0.94) g, respectively. The results show that the least amount of resistance to plunger movement is obtained by dry polishing glass syringes.

Anesthesia, Epidural↗
PubMed2000

Impact of infusion line compliance on syringe pump performance.

To determine the impact of infusion line compliance on the time to occlusion alarm (occlusion time) and the size of the subsequent occlusion release bolus, we studied three different infusion lines in combination with a 50-ml and 10-ml syringe. The mean occlusion time of the 50-ml syringe amounted to 20.3 +/- 0.28 min and increased to 26.2 +/- 0.19 min with the infusion with the infusion line yeielding the largest compliance (P<0.0001). The mean occlusion time of the 10-ml syringe was 2.5 +/- 0.75 min and showed a 2.7-fold variation with the three infusion lines (2.6+/-0.08, 5.6 +/- 0.28 and 6.9 +/- 0.35 min, respectively; P<0.0001). Occlusion times correlated strongly to be calculated estimated compliance of the syringe-infusion line assembly (Pearson's r=0.998, P<0.0001). Infusion line compliance has an important impact on time to occlusion, particularly when using small, low compliant infusion pump syringes.

Compliance↗
PubMed1986

Prospective survey of re-used plastic syringes for diabetics.

In a 1 year prospective survey of the safety and economy of re-used plastic insulin syringes 9843 syringes were used 93,867 times with one possible injection site infection. On average syringes were used 5.7 days before changing. Re-use of plastic syringes would produce an annual saving of about ł15 per patient when compared with glass syringes.

Costs and Cost Analysis↗
PubMed2005

The increased incidence of pure red cell aplasia with an Eprex formulation in uncoated rubber stopper syringes.

BACKGROUND: The incidence of pure red cell aplasia (PRCA) in chronic kidney disease patients treated with epoetins increased substantially in 1998, was shown to be antibody mediated, and was associated predominantly with subcutaneous administration of Eprex. A technical investigation identified organic compounds leached from uncoated rubber stoppers in prefilled syringes containing polysorbate 80 as the most probable cause of the increased immunogenicity. METHODS: This study investigated whether the incidence of PRCA was higher for exposure to the product form containing leachates than for leachate-free product forms. Antibody-mediated PRCA cases were classified according to indication, product form, and route of administration. Exposure estimates were obtained by country, indication, route of administration, and product form. RESULTS: For 2001 to 2003, the PRCA incidence rate for patients with subcutaneous exposure to Eprex in prefilled syringes with polysorbate 80 and uncoated rubber stoppers (leachates present) was 4.61/10,000 patient years (95% CI 3.88-5.43) versus 0.26/10,000 patient years (95% CI 0.007-1.44) for syringes with coated stoppers (leachates absent). The rate difference was 4.35/10,000 patient years (95% CI 3.44-5.26; P < 0.0001); the rate ratio was 17 (95% CI 3.14-707). A substantial rate difference remained in sensitivity analyses that adjusted for exposure to multiple product forms. CONCLUSION: The epidemiologic data, together with the chemical and immunologic data, support the hypothesis that leachates from uncoated rubber syringe stoppers caused the increased incidence of PRCA associated with Eprex. Currently, all Eprex prefilled syringes contain fluoro-resin coated stoppers, which has contributed to decreased incidence of PRCA with continued surveillance.

Chemistry, Pharmaceutical↗
PubMed1971

Leakage of oxygen from blood and water samples stored in plastic and glass syringes.

Theory and experiment showed that samples of blood and water stored in 2-ml and 5-ml syringes made of polypropylene, polystyrene, or S.A.N. co-polymer exchanged oxygen with their surroundings. In the first hour the exchange was due mainly to equilibration with the plastic of the syringe and only in small degree to permeation through the plastic. With high initial tension or with blood of low haemoglobin concentration the exchange can result in errors in Po(2) of up to 6% in two minutes and 16% in 30 to 60 minutes. With all-glass syringes the exchange was much slower but, even so, after 24 hours was important in all but a few of 18 interchangeable glass syringes. Therefore unless analysis can be started immediately all-glass syringes are to be preferred, and for prolonged storage even these should be selected.

Blood Specimen Collection↗
PubMed2003

Calibration of pneumotachographs using a calibrated syringe.

Pneumotachograph require frequent calibration. Constant-flow methods allow polynomial calibration curves to be derived but are time consuming. The iterative syringe stroke technique is moderately efficient but results in discontinuous conductance arrays. This study investigated the derivation of first-, second-, and third-order polynomial calibration curves from 6 to 50 strokes of a calibration syringe. We used multiple linear regression to derive first-, second-, and third-order polynomial coefficients from two sets of 6-50 syringe strokes. In part A, peak flows did not exceed the specified linear range of the pneumotachograph, whereas flows in part B peaked at 160% of the maximum linear range. Conductance arrays were derived from the same data sets by using a published algorithm. Volume errors of the calibration strokes and of separate sets of 70 validation strokes (part A) and 140 validation strokes (part B) were calculated by using the polynomials and conductance arrays. Second- and third-order polynomials derived from 10 calibration strokes achieved volume variability equal to or better than conductance arrays derived from 50 strokes. We found that evaluation of conductance arrays using the calibration syringe strokes yields falsely low volume variances. We conclude that accurate polynomial curves can be derived from as few as 10 syringe strokes, and the new polynomial calibration method is substantially more time efficient than previously published conductance methods.

Calibration↗
PubMed2001

Multiple access to sterile syringes for injection drug users: vending machines, needle exchange programs and legal pharmacy sales in Marseille, France.

OBJECTIVE: In Marseille, southeastern France, HIV prevention programs for injection drug users (IDUs) simultaneously include access to sterile syringes through needle exchange programs (NEPs), legal pharmacy sales and, since 1996, vending machines that mechanically exchange new syringes for used ones. The purpose of this study was to compare the characteristics of IDUs according to the site where they last obtained new syringes. METHODS: During 3 days in September 1997, all IDUs who obtained syringes from 32 pharmacies, four NEPs and three vending machines were offered the opportunity to complete a self-administered questionnaire on demographics, drug use characteristics and program utilization. RESULTS: Of 485 individuals approached, the number who completed the questionnaire was 141 in pharmacies, 114 in NEPs and 88 at vending machines (response rate = 70.7%). Compared to NEP users, vending machine users were younger and less likely to be enrolled in a methadone program or to report being HIV infected, but more likely to misuse buprenorphine. They also had lower financial resources and were less likely to be heroin injectors than both pharmacy and NEP users. CONCLUSIONS: Our results suggest that vending machines attract a very different group of IDUs than NEPs, and that both programs are useful adjuncts to legal pharmacy sales for covering the needs of IDUs for sterile syringes in a single city. Assessment of the effectiveness and cost-effectiveness of combining such programs for the prevention of HIV and other infectious diseases among IDUs requires further comparative research.

Adolescent↗