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Computer-controlled delivery versus syringe delivery of local anesthetic injections for therapeutic scaling and root planing.

BACKGROUND: The authors conducted a study to compare administration of local anesthetic using a computer-controlled delivery device with an aspirating syringe for therapeutic scaling and root planing. The anterior middle superior alveolar, or AMSA, injection was compared with other maxillary injections. METHODS: Twenty healthy adults with moderate periodontal disease participated in this single-blind crossover study. Subjects were evaluated by a trained examiner and were treated by experienced dental hygienists. Subjects provided written and verbal pain ratings via a visual analog scale, or VAS, and a verbal rating scale, or VRS. AMSA injections were compared with syringe-delivered injections--greater palatine, or GP, and nasopalatine, or NP, blocks, and anterior superior alveolar and middle superior alveolar injections--in maxillary quadrants. Bleeding and changes in attachment were evaluated after one month. RESULTS: VAS and VRS scores for AMSA were significantly lower for computer-controlled delivery when compared with NP injections and combined maxillary injections (VAS scores) and with GP and combined maxillary injections (VRS scores). Mean injection times were similar for both groups. Mean gains in attachment were equal, 0.19 millimeters for quadrants anesthetized using computer-controlled injections and 0.22 mm for syringe injections. CONCLUSIONS: Subjects reported having less pain with GP and NP injections delivered using the computer-controlled device, and total injection time was similar to that required for syringe injections. Both techniques provided adequate anesthesia for therapeutic scaling and root planing. Clinical Implications. The two anesthetic delivery techniques were therapeutically equivalent for mandibular injections, and the AMSA injection has clinically significant advantages for maxillary injections.

Adult↗

[Reutilization of disposable syringes: frequency and costs for the administration of insulin at home].

The present survey has the purpose to analyze the frequency and costs of the re-utilization of disposable syringes for insulin administration at home. One hundred and thirteen patients with diabetes assisted by a public hospital in a city in the interior São Paulo State, Brazil, were interviewed. The findings showed that regarding the studied population, the frequency of needles re-utilization varied from 1 to 20 times, and syringes re-utilization from 1 to 60 times. The greatest frequencies in the use of the same syringe or needle were of four times followed by three times. Re-utilizing the same syringe four times resulted in a cost reduction of 74.68%. The results pointed out the need for a legislation review as well as for new studies on the risks and benefits arising from this practice.

Costs and Cost Analysis↗

Implementation of an enteral nutrition and medication administration system utilizing oral syringes in the NICU.

NICU patients are at particularly high risk of harm and even death from medical error. In one NICU, a process change was undertaken to minimize the risk of errors resulting in the intravenous (IV) administration of enteral formulas and oral medications. In addition, a double-check system for medication doses was introduced to reduce the likelihood of medication errors. The previous practice was to deliver enteral formulas via syringe pump using TV syringes and tubing and to dispense medications in bulk bottles, drawing up patient-specific doses at the bedside. Converting to oral syringe delivery of medications and enteral formulas utilizing enteral-only tubing eliminated the necessity for Luer-Lok IV tubing and syringes, thereby reducing the potential for wrong-route error. Converting from dispensing medications in bulk to a unit-dose system permitted establishment of a double-check system in which doses are first checked by a pharmacist and then checked by the nurse before they are administered. This article describes the planning, implementation, and postimplementation process required to make this change in practice a success.

Administration, Oral↗

Multilevel community-based intervention to increase access to sterile syringes among injection drug users through pharmacy sales in New York City.

OBJECTIVES: Research has indicated that there is minimal use of pharmacies among injection drug users (IDUs) in specific neighborhoods and among Black and Hispanic IDUs. We developed a community-based participatory research partnership to determine whether a multilevel intervention would increase sterile syringe access through a new policy allowing nonprescription syringe sales in pharmacies. METHODS: We targeted Harlem, NY (using the South Bronx for comparison), and disseminated informational material at community forums, pharmacist training programs, and counseling or outreach programs for IDUs. We compared cross-sectional samples in 3 target populations (pre- and postintervention): community members (attitudes and opinions), pharmacists (opinions and practices), and IDUs (risk behaviors). RESULTS: Among community members (N = 1496) and pharmacists (N = 131), negative opinions of IDU syringe sales decreased in Harlem whereas there was either no change or an increase in negative opinions in the comparison community. Although pharmacy use by IDUs (N=728) increased in both communities, pharmacy use increased significantly among Black IDUs in Harlem, but not in the comparison community; syringe reuse significantly decreased in Harlem, but not in the comparison community. CONCLUSIONS: Targeting the individual and the social environment through a multilevel community-based intervention reduced high-risk behavior, particularly among Black IDUs.

Adolescent↗

Syringe vending machines for injection drug users: an experiment in Marseille, France.

OBJECTIVES: This study evaluated the usefulness of vending machines in providing injection drug users with access to sterile syringes in Marseille, France. METHODS: Self-administered questionnaires were offered to 485 injection drug users obtaining syringes from 32 pharmacies, 4 needle exchange programs, and 3 vending machines. RESULTS: Of the 343 respondents (response rate = 70.7%), 21.3% used the vending machines as their primary source of syringes. Primary users of vending machines were more likely than primary users of other sources to be younger than 30 years, to report no history of drug maintenance treatment, and to report no sharing of needles or injection paraphernalia. CONCLUSIONS: Vending machines may be an appropriate strategy for providing access to syringes for younger injection drug users, who have typically avoided needle exchange programs and pharmacies.

Adolescent↗

Aspiration in local anesthesis. Comparison between disposable self-aspirating and usual syringes.

The positive aspirations obtained with a self-aspirating syringe (Astra, Sweden) were compared with those obtained when aspiration was performed manually (Uniject syringe, Hoechst, West Germany). The subjects were 1186 army recruits, to whom 2348 injections of local anesthetic were given in connection with dental treatment. When aspiration was performed manually, the results were positive in 4.7% of the cases; with the self-aspirating syringe, they were positive in 1.1% of the cases. The total frequency of positive aspirations was significantly higher (P less than 0.001) with the manual aspiration technique than with the self-aspirating syringe was due to the fact that the value did not include aspiration occurring when the injection needle ruptured small blood vessels.

Adolescent↗

Syringes versus minibags as an intravenous admixture system: a comparison of cost and nursing preference.

The implementation of centralized intravenous admixture programs in Canadian hospitals has been hindered by the high costs associated with such programs. The most popular system uses minibags as an admixture base but other less expensive alternatives are being investigated. This study examines the material and labour costs associated with preparing admixtures in either minibags or polypropylene syringes. The minibag admixtures were administered by nursing staff using secondary medication administration sets. Standard volume-control sets were used for diluting and administering the intravenous admixtures supplied in syringes. The results indicated a major cost advantage for the syringe-based program. Furthermore, evaluation of the two systems by nursing staff indicated a strong preference for the syringe-based system.

Attitude of Health Personnel↗

Monitoring of presterile disposable syringes and needles marketed in Pune.

Out of hundred syringes and hundred needles (both presterile, disposable) tested, 41 syringes (41%) and 6 needles (6%) showed aerobic growth. Forty of the above syringes were tested simultaneously for fungi and anaerobes. Fungi isolated were 5.7% and no anaerobe was grown. Fifty glass syringes and fifty needles autoclaved in the departmental laboratory served as controls and did not show any growth. As a preventive measure, proper disposal of used disposable material should be made mandatory so that it does not find its way into the market. Or has the time come to switch back to the former conventional practice of using in house autoclaved articles?

Disposable Equipment↗

[Effectiveness of syringe shieldings using radionuclides in radiation synovectomy].

AIM: The radiation exposure in radiation synovectomy was investigated for technician and therapist using Erbium-169, Rhenium-186 and Yttrium-90 with and without syringe shieldings. METHODS: Dose rates were measured in relation to the distance of the syringe containing the radionuclide. Measurements were repeated using syringe shieldings which consist of plastic surrounded by a lead layer. RESULTS: The most relevant radiation exposure arises from Yttrium-90. Using syringe shieldings radiation exposure can be reduced by a factor of thousand. CONCLUSION: This kind of radiological protection is completely sufficient for the therapist. Concerning the technician preparing the radiopharmaceutics, the limit of the official German dosimetry service (500 mSv) might be exceeded if no special radiological protection is established. Thus, special dosimetry is recommended.

Humans↗

Stability of ceftazidime in plastic syringes and glass vials under various storage conditions.

The stability of ceftazidime solutions (100 and 200 mg/mL) in plastic syringes and glass vials under various storage conditions was examined. Solutions of ceftazidime 100 and 200 mg/mL in sterile water were placed in polypropylene plastic syringes or glass vials and stored (1) at 21-23 degrees C for up to 8 hours, (2) at 4 degrees C for up to 96 hours, (3) at -20 degrees C for 28 days and then 21-23 degrees C for up to 8 hours, (4) at -20 degrees C for 28 days and then 4 degrees C for up to 96 hours, (5) at -20 degrees C for 91 days and then 21-23 degrees C for up to 8 hours, or (6) at-20 degrees C for 91 days and then 4 degrees C for up to 96 hours. Samples were withdrawn from each syringe and vial at designated times and assayed by high-performance liquid chromatography. Solutions were judged to be stable if drug concentrations remained above 90% of the initial values. The number of particles in each container under each storage condition was also evaluated. Ceftazidime was stable under all storage conditions. In all containers, particulate matter was within USP specifications for small-volume injections, with no change in particle count as a result of the freezing and thawing. Ceftazidime in sterile water in either glass vials or plastic syringes is stable for 8 hours at room temperature or 96 hours at 4 degrees C when such storage occurs (1) immediately after constitution, (2) after 28 days of frozen storage, or (3) after 91 days of frozen storage.

Ceftazidime↗

Explaining the relationship between race/ethnicity and pharmacy purchased syringes among injection drug users in New York City.

OBJECTIVE: Pharmacy syringe sales without a prescription became legal in New York State on January 1, 2001 through the Expanded Syringe Access Demonstration Program (ESAP). At the same time, Pharmacy use among Black and Hispanic injection drug users was found to be significantly lower when compared to Whites. The purpose of this study was to assess the factors that could explain the relationship between race/ethnicity and pharmacy use. DESIGN: Data were combined from 2 on-going injection drug user (IDU) studies in 2 New York City neighborhoods. Social and behavioral factors independently associated with ever purchasing a nonprescription syringe in the past 6 months and examined using cross-sectional logistic regression. RESULTS: Of 337 IDUs, the majority were male (79%), Hispanic (73%) and had a mean age of 35 years. In bivariate analysis, IDUs who reported pharmacy use were less likely to be Black or Hispanic, older, and to have reported recent syringe exchange program (SEP) attendance compared to non-pharmacy users. Additionally, pharmacy users were more likely to have knowledge of ESAP, and report discrimination by police in the past year compared to non-users. After adjustment for recent SEP attendance (adjusted odds ratio [AOR]=0.27; 95% confidence interval [CI]=0.14-0.55), ESAP knowledge (AOR=13.11; 95% CI=6.54-26.31), discrimination by police (AOR=3.56; 95% CI=1.73-7.35), and discrimination due to race (AOR=0.25, 95% CI=0.11-0.58), race/ethnicity was not a significant predictor of pharmacy use. CONCLUSIONS: Race/ethnicity may not be an important determinant of ESAP when more salient social circumstances, such as past discrimination, are considered. Educational efforts should be enhanced to reach those who continue to perceive barriers to ESAP.

Adult↗

Bacterial biofilm: a source of contamination in dental air-water syringes.

This study examined the bacteriology of dental air-water syringes, and found that the water delivered by these syringes can be persistently contaminated with bacteria. Flushing of the water line reduced but did not eliminate this contamination. Even after six minutes' flushing, some water samples still contained more than 10(4) viable bacterial cells per milliliter, although coliform counts were less than two per 100 milliliters as measured by a Most Probable Number assay. Sterilization of the tip or the entire syringe did not eliminate this contamination. Scanning electron microscopy revealed bacterial biofilms on the inner wall of the plastic tubing supplying water to the air-water syringe, but not on the air line or on new, unused tubing. Such biofilms probably can be found in any tubing which supplies water to components of dental units. The inoculum for these biofilms comes from ubiquitous environmental aquatic bacteria, some of which can cause disease in compromised patients. Biofilms can be held in check by regular flushing of the water lines with a biocide, and the authors affirm the use of the ADA guidelines for treatment of contaminated dental-unit water lines to control possible cross-infection.

Communicable Disease Control↗

[Ampicillin concentration in the blood when administered by jet injection and needle-syringe methods].

The studies were carried out on 50 persons. Ampicillin was administered with the help of a jet injector B1-2 and needle syringe in doses of 250 or 500 and 500 mg respectively. When the drug was administered by infusion, its maximum blood levels were achieved earlier than after needle-syringe administration of the drug and were higher (22.83+/-4.10 and 6.3+/-0.09 gamma/ml respectively). Even when ampicillin was administered with the help of the injector in a dose of 250 mg its blood levels were much higher than those after needle-syringe administration in a dose of 500 mg. After jet infusion the prolongation of the drug retention time in the blood at therapeutical levels was observed as compared to the needle-syringe administration.

Adult↗

Stability and availability of cyclosporine stored in plastic syringes.

The stability and availability of cyclosporine from the oral dosage form when stored in plastic syringes were examined. Solutions of cyclosporine were stored in plastic syringes for 28 days at 25 degrees C. Half of the solutions remained in room light, and samples were obtained at 3, 6, and 12 hours and 1, 2, 3, 4, 5, 6, 7, 14, 21, and 28 days. The remaining samples were protected from light, and samples were obtained at 1, 3, 5, 7, 14, 21, and 28 days. Samples stored in plastic were compared with control solutions stored in the original amber bottle. All samples were analyzed for unchanged cyclosporine by high-pressure liquid chromatography. Cyclosporine was stable and completely available from the oral dosage form when stored in plastic syringes for up to 28 days. There was no difference in the stability of cyclosporine between the solutions exposed to room light and those protected from light. Solutions of the oral dosage form of cyclosporine may be stored in plastic syringes without protection from light for up to 28 days.

Chromatography, High Pressure Liquid↗

Postinfusion phlebitis associated with a syringe system versus minibags.

The incidence of postinfusion phlebitis was compared in patients receiving i.v. drugs in 50- and 100-mL minibags of 5% dextrose injection or 0.9% sodium chloride injection versus 20- and 50-mL quantities of sterile water for injection or 0.45% sodium chloride injection in plastic syringes used with a venting administration set. Patients 16-75 years of age receiving one or more i.v. drugs and a concurrent maintenance i.v. fluid through a Teflon catheter in a peripheral vein were included. Patients receiving antineoplastic drugs, drugs that require a minimum diluent volume greater than 50 mL, or i.v. heparin sodium in doses of greater than or equal to 500 units/hr were excluded. For the syringe system, the type and amount of diluent were selected to achieve a solution osmolarity of approximately 300 mOsm/L. Patients' i.v. sites were examined every eight hours for 72 hours, and phlebitis was assessed according to predetermined criteria. There were 47 patients in the minibag group and 46 in the syringe group. There were no significant differences between the groups in demographic characteristics, catheter size, duration of infusion, number of doses, number or type of i.v. drugs, or incidence or severity of phlebitis. Administration of i.v. drugs with controlled solution osmolarity via this syringe infusion system was not associated with an incidence of postinfusion phlebitis different from that for i.v. drugs diluted in minibags.

Adolescent↗

Stability of meperidine hydrochloride, promethazine hydrochloride, and atropine sulfate in plastic syringes.

The stability of a combination of meperidine hydrochloride 50 mg, promethazine hydrochloride 25 mg, and atropine sulfate 0.4 mg in plastic syringes at room temperature was studied. The samples were tested for each drug after 0.5, 1, 3, 6, and 24 hours in the syringes. Freshly prepared mixtures of the drugs in glass containers were used as controls, and three trials using separate test mixtures were performed. A gas chromatography procedure was used; atropine was separated from the mixture and assayed alone for greater accuracy. Drug concentrations in the plastic syringes were not significantly different from controls at any of the test times. A mixture of meperidine hydrochloride, promethazine hydrochloride, and atropine sulfate in dosages commonly administered as a preoperative medication was stable for 24 hours in plastic syringes.

Atropine↗

Stability of an analgesic-sedative combination in glass and plastic single-dose syringes.

The stability of a combination of chlorpromazine hydrochloride (6.25 mg/mL), hydroxyzine hydrochloride (12.5 mg/mL), and meperidine hydrochloride (25 mg/mL) in glass and plastic syringes was studied. Syringes (glass 1.5 mL, plastic 3.0 mL) containing the combination drug solution were stored at 4, 25, and 44 degrees C. At 0,7,30,60,90,180, and 366 days after preparation, samples were visually inspected and tested for pH. Drug concentrations were determined by gas chromatography. No significant changes in drug concentration were apparent in any of the samples stored at 4 degrees C or 25 degrees C. Samples in both glass and plastic syringes stored at 44 degrees C turned yellow by day 30 and continued to darken throughout the study period. At the concentrations tested, chlorpromazine hydrochloride, hydroxyzine hydrochloride, and meperidine hydrochloride combined in glass or plastic syringes are stable for 366 days when stored at 4 degrees C and 25 degrees C. Degradation occurs at higher temperatures.

Chlorpromazine↗

Stability of carbenicillin and oxacillin frozen in syringes.

The stability of carbenicillin disodium and oxacillin sodium following storage in syringes for three months at -20 C was studied. Employing a spectrophotometric assay, it was found that carbenicillin (2500 mg/ml) and oxacillin (200 mg/ml) remained stable in both glass and plastic syringes for three months when frozen at -20 C. Stability was not altered by storage in either glass or plastic, nor by the size of the syringe used. Although the results were favorable, additional evidence is necessary before the practice of freezing reconstituted carbenicillin and oxacillin in syringes is advocated.

Carbenicillin↗