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PubMed1993

Syringe and needle exchange programs: Part I.

Syringe and needle exchange (SANE) programs appear to be a pragmatic approach to reducing the rising incidence of human immunodeficiency virus (HIV) infection among intravenous drug users (IVDUs). One purported indication of the effectiveness of SANE programs is lower prevalence rates of cases of AIDS or of HIV seropositivity in cities with SANE programs than in cities without such programs. In each positive comparison cited, however, the lower levels of HIV seropositivity were already present before the establishment of SANE programs. A second indicator of SANE effectiveness is a reduction in prevalence of hepatitis B in SANE program participants. Multiple factors working in concert, not simply the SANE programs, however, account for such progress; such factors include reductions in sharing of uncleaned injection equipment; legal exchange or sale of syringes at pharmacies; regular rinsing of used "works" with bleach; and epidemiologic fluctuations in the prevalence or a saturation level of the hepatitis B virus in IVDUs. A third indicator of the value of SANE programs is that they enable some otherwise unreachable IVDUs to make contact with a social or health facility. SANE programs do not facilitate the induction of new IVDUs or increase the frequency of injection by older addicts. From 60% to 90% of SANE attenders will return borrowed used injection equipment. Most participants reported that they reduced the frequency of lending or borrowing unclean injection equipment. Counterbalancing the above, SANE programs attract only a minority of all IVDUs in most cities, and they fail to attract the youngest subset of IVDUs. The attrition rate is high; only a small percentage of attenders remain with the program for more than a few months. Although many of the initial concerns about SANE programs have not been realized and there have been important public health gains to those who continue to attend them, SANE programs deserve more careful, unbiased, longitudinal research before they are established on a wide scale in the United States.

Age Factors↗
PubMed2002

A simple method for quantifying fentanyl, sufentanil, or morphine in discard syringes from anesthesia procedures.

Fentanyl, sufentanil, and morphine are commonly used in the conduct of anesthesia. Medical staff working with these drugs are at high risk of addiction. To detect and prevent diversion, a method was developed to quantify these drugs in discard syringes using the BioRad REMEDi HS Drug Profiling System. For fentanyl, the lowest concentration detected is 0.1 microg/mL, and the assay is linear to 5.0 microg/mL; the within-run coefficient of variation (CV) is 0.9% (n = 5), and between-run CV is 2.5% (n = 20). For sufentanil, the lowest concentration detected is 0.5 microg/mL, and the assay is linear to 11.0 microg/mL; the within-run CV is 2.0% (n = 5), and the between-run CV is 2.4% (n = 20). For morphine, the lowest concentration detected is 0.5 microg/mL, and the assay is linear to 10.0 microg/mL; the within-run CV is 11.6% (n = 5), and between-run CV is 11.3% (n = 20). Other drugs commonly used in the operating room were checked for cross-reactivity on the REMEDi HS; none cross-reacted. The REMEDi HS can be used for rapid, accurate quantification of fentanyl, sufentanil, and morphine in discard syringes from anesthesia procedures or related medical applications.

Anesthesia, Intravenous↗
PubMed1998

Operation Red Box: a pilot project of needle and syringe drop boxes for injection drug users in East Baltimore.

We assessed the acceptability and the use of a community-based needle and syringe disposal project designed to serve injection drug users. In June 1996, three surplus U.S. mail collection boxes were painted red and used as syringe and needle drop boxes in locations with high drug use in East Baltimore. Acceptance of the drop boxes was measured by focus groups of residents, drug users, and police, held before and after project implementation. Use was measured by weekly counts of needles recovered from the red boxes. A sample of all deposited needles was randomly chosen for needle washing and subsequent HIV antibody testing. Community impact was measured by systematic surveys of needles discarded on public sidewalks, in areas with and areas without drop boxes. Before implementation, members of focus groups expressed concerns that drop boxes could convey mixed messages to youth (e.g., seeming to condone drug use), might result in increased loitering, and could further community stigmatization. After project implementation, all focus groups expressed support of project expansion. In the first 10 months, 2971 needles were collected. Of 156 needles tested, 10.9% were positive for HIV antibody. Needle counts on the street showed no significant change in red box areas compared with control areas. In this pilot project, red boxes were accepted by the community and drug users. Police officers also used the boxes to dispose of confiscated needles. Although limited in the number of drop boxes and follow-up time, this pilot project shows promise as a community-based method of safe needle disposal.

Adolescent↗
PubMedDate not supplied

Prefilled syringe needles versus standard removable needles for intravitreous injection.

PURPOSE: To investigate differences in the scleral resistance between standard disposable 27 gauge (G) needle versus the Macugen prefilled syringe needle. METHODS: Observational study at one eye center. One injecting physician performed 46 intravitreous injections using standard Becton Dickinson 27 G needles and 71 intravitreous injections using Macugen needles during January to May 2005. The procedure in two patients was videotaped and analyzed frame by frame. Microphotographs of used needles were analyzed. RESULTS: There were no complications during the injection procedure in either group. Microphotographic analysis after injection revealed 3 and 5 facets on standard 27 G needle and Macugen needles, respectively. The bevel forming the tip of the 27 G needle was steeper and longer than that of the Macugen needle. The inside diameter in the standard 27 G needle was 220 microm versus 210 microm in the Macugen needle. CONCLUSION: There are differences in needle design between commonly used disposable 27 G needles and 27 G Macugen needles which result in higher resistance to penetration with Macugen needle. Careful needle design is an important concern in manufacturing prefilled syringes with needles attached to them.

Animals↗
PubMed1993

An interview study of participants in the Tacoma, Washington, syringe exchange.

Although European and Australian studies of syringe exchange programs have reported safer injection among participants and no increase in drug use, the generalizability of these findings to the US is uncertain. We report on the operations and potential effectiveness of the longest-operating syringe exchange in the US and compare our results to studies of exchange programs outside the US. The sample of 204 study subjects reported no change in the frequency of injection, from 155 to 152 injections per month, and a decline in the frequency of unsafe injections, from 56 to 30 times per month, while participating in the program. In all studies, participants report reduction in unsafe injections, and no increase in illicit drug use. However, the comparison also suggests that a high proportion of Tacoma exchangers have higher initial rates of drug injection, unsafe injection and homelessness, all of which were associated with unsafe injection while using the exchange. These indicate a need for additional services but that the Tacoma program is no less effective than European and Australian programs.

Acquired Immunodeficiency Syndrome↗
PubMed1987

Chemical stability of thiopental sodium injection in disposable plastic syringes.

The chemical stability of thiopental sodium injection (2.5%) when stored at 25 degrees and 5 degrees in disposable plastic syringes of two manufacturers (Monoject and Becton Dickenson and Co.) has been studied using the USP-NF method. The injection appeared to be stable for five days at 25 degrees and 45 days at 5 degrees with a loss in potency of less than 7%. The thiopental sodium did not adsorb on the syringes. The pH values and the physical appearance did not change. An additional peak was obtained in the chromatogram from both the freshly prepared and the assay solution probably due to an impurity in the powder.

Disposable Equipment↗
PubMed1995

Stability of vancomycin in plastic syringes measured by high-performance liquid chromatography.

The shelf-life of vancomycin in infusion fluids was studied using high-performance liquid chromatographic (HPLC) methods. Vancomycin was stable (loss in potency less than 10%) for 47 days and 29 days, respectively, when dissolved in water-for-injections BP at 25 degrees C and stored in plastic syringes (Becton Dickinson Plastipak (three-piece) and B. Braun Medical Injekt (two-piece)). In sodium chloride solution (0.9%; pH 5.4) it was stable for 62 and 34 days, while in dextrose solution (5%; pH 4.2) it was stable for 55 and 33 days, respectively, at the same temperature. At 4 degrees C vancomycin was stable in all three infusion fluids and both types of syringe for at least 84 days.

Chromatography, High Pressure Liquid↗
PubMed1981

Diazepam adsorption to infusion sets and plastic syringes.

The adsorption of diazepam to infusion sets and plastic syringes was studied. Infusion solutions consisting of diazepam injection (Valium) in glucose 5.5%, or diazepam emulsion in a lipid emulsion (Intralipid 10%) were infused through two different infusion sets (Transcodan L-74 and Cutter IL). It was found that, when an infusion solution with a low diazepam concentration (0.04 mg/ml) was infused slowly (4 ml/h), the diazepam adsorption was more than 80%. At a higher diazepam concentration (0.1 mg/ml) and increased infusion rate (20ml/h) the adsorption decreased. Diazepam injection in glucose 5.5% was adsorbed to a higher degree (40-75%) than diazepam emulsion in glucose 5.5% (15-35%). When diazepam emulsion was diluted with the lipid emulsion, no diazepam adsorption to the infusion set occurred at this concentration and infusion rate. No significant difference between the two infusion sets could be found. The miscibility of diazepam emulsion with glucose 5.5%, glucose 10%, or sodium chloride 0.9% was examined. Diazepam emulsion proved to be miscible with glucose 5.5% and glucose 10%, but sodium chloride should not be used to dilute diazepam emulsion. The effect on the diazepam concentration of storing diazepam injection and diazepam emulsion in plastic syringes for up to 4h was also studied. It was found that the diazepam concentration remained unchanged during this time.

Adsorption↗
PubMed1976

The clinical effectiveness of a disposable aspirating syringe.

In 18 per cent of mandibular block injections and 2 per cent of maxillary infiltrations blood appeared in the carpule aspiration. In 500 mandibular block injections when an aspirating syringe was used in 250, only 0.7 per cent patients suffered toxic side effects compared with 5 per cent when a conventional non-aspirating syringe was used.

Anesthesia, Dental↗
PubMed1982

Particulate contamination of sterile syringes and needles.

Commercially available sterile needles and syringes have been examined for particulate contamination using the Hiac light blockage technique. The number of particles delivered was small compared with the total number permitted for large volume parenterals. Where syringes are used in particle counting techniques, the contribution of particles should be taken into account.

Drug Contamination↗
PubMed1986

Slow viscous flow in a syringe.

The slow viscous flow in a syringe is modeled by the quasi-steady axisymmetric Stokes equation with a point sink for the needle hole. The governing equations are approximated using nonstandard finite difference formulas optimized for the boundary conditions, and solved numerically using a SOR technique. Streamlines and pressure profiles are computed for a variety of syringe configurations.

Biomedical Engineering↗
PubMed2002

Experimental investigation of dose calibrator response for 125I brachytherapy solutions contained in 5 mL plastic syringes and 2 mL conical glass v-vials as a function of filling mass.

The effect of measurement geometry on the determination of the activity of solutions containing 125I for use in brachytherapy applications has been investigated for 5 mL plastic syringes and 2 mL conical glass dose vials as a function of filling mass. New dial settings for the syringes over a filling mass range of 1 to 3 g have been determined to be 497+/-8 and 469+/-8 (expanded, k = 2, uncertainties) for the NIST Capintec CRC- 12 and Capintec CRC-35R, respectively, with any effect due to the filling mass lying within the uncertainty in the activity calibration. A filling mass effect was observed in the dose vials, causing a 10.5% reduction in the chamber response from a 2 g filling mass to 1 g. Dial settings at 2 g were experimentally found to be 143+/-2 and 135+/-2 (expanded uncertainties) for the NIST Capintec CRC-12 and Capintec CRC-35R, respectively. The appropriate dial settings for the same vials with a 1 g filling mass were found to be 120+/-2 and 114+/-2 for CRC-12 and CRC-35R, respectively. Differences of up to +/-45% in the activity determination were observed between values obtained with the manufacturer's recommended setting and the settings obtained experimentally for each specific geometry. Calibration factors were also determined for a Vinten 671 Radionuclide Calibrator, giving values of 0.226+/-0.009 pA x MBq(-1) and 0.231+/-0.004 pA x MBq(-1) (expanded uncertainties), respectively, for the 1 and 2 g dispensings. This study demonstrates that experimentally determined calibration factors for the exact measurement geometry are necessary when measuring radionuclides in configurations other than the manufacturer's standard geometry, especially when nuclides that emit low-energy radiations are involved.

Brachytherapy↗
PubMed1983

Disposable or non-disposable syringes and needles for diabetics? Strathclyde Diabetic Group.

In a survey undertaken in the west of Scotland 801 adult diabetics taking insulin were questioned about their use of disposable or non-disposable needles and syringes, the life of such equipment, infected injection sites, and future preferences. Six hundred and eight preferred to use disposable equipment even if it meant reusing it; of the 413 who already bought disposable needles, 211 reused them, and of the 234 who bought disposable syringes, 153 reused them. Comparison of total annual costs showed that disposable equipment used only once was more expensive than non-disposable equipment. Reuse of disposable equipment for a few days, however, considerably reduced annual costs when compared with non-disposable equipment. Fewer infected injection sites were recorded in patients reusing disposable equipment without sterilisation than in patients sterilising non-disposable equipment according to government recommendations.

Adult↗
PubMed1995

Bacterial succession within a biofilm in water supply lines of dental air-water syringes.

Biofilms have been implicated as reservoirs for bacterial contamination of water delivered by dental air-water syringes. A 6-month study was done of bacterial colonization and biofilm formation in plastic water supply lines connected to dental air-water syringes. Changes in biofilm flora were observed by both scanning electron microscopy and bacteriologic culture. By day 7, many rod- and spiral-shaped bacteria had colonized the ridged surface of the luminal wall of the tubing, as revealed by scanning electron microscopy. By day 30, individual microcolonies were embedded in extracellular polymeric material. By day 120, these microcolonies had begun to coalesce, and by day 180 the biofilm had developed into a multilayered, heterogeneous mixture of microcolonies. The mean aerobic plate counts of colony-forming units of planktonic and biofilm populations were, in log10 values, 5.9 +/- 0.54/mL and 4.2 +/- 0.82/cm2, respectively. Early colonizers were predominantly Pseudomonas spp., but included Pasteurella, Moraxella, Ochrobactrum, and Aeromonas spp. Flavobacterium and Acinetobacter spp. were observed later. Many of these organisms are opportunistic pathogens. These results demonstrate the longitudinal dynamics of biofilm formation.

Biofilms↗
PubMed1987

Blood clot formation in angiographic syringes containing nonionic contrast media.

Spontaneous thrombus formation may occur if blood is allowed to mix with a nonionic contrast medium in the injection syringe or angiographic catheter. This is probably due to the absence of significant inhibition of the normal blood coagulation mechanism by currently used nonionic contrast media. Careful angiographic techniques will prevent blood from mixing with the contrast medium before injection. The use of a three-way stopcock and connecting tube between catheter and syringe is suggested. Contrast material should be flushed from the catheter immediately after injection. Systemic anticoagulation is not justified as a means of preventing thrombus formation. The potential prophylactic use of heparin added to the contrast medium during angiography or premedication with aspirin, and the attendant risks of these techniques, are discussed.

Angiography↗
PubMed1988

Compatibility of clindamycin phosphate with aztreonam in polypropylene syringes and with cefoperazone sodium, cefonicid sodium, and cefuroxime sodium in partial-fill glass bottles.

The stability and compatibility of clindamycin phosphate admixed with four beta-lactams, an experimental monobactam (aztreonam), and three cephalosporins (cefoperazone sodium, cefonicid sodium, and cefuroxime sodium), were studied. Aztreonam alone and the combination of clindamycin phosphate-aztreonam were prepared in duplicate polypropylene syringes. Each cephalosporin antibiotic as well as the three clindamycin phosphate-cephalosporin combinations were admixed in duplicate 100 ml partial-fill glass bottles containing either dextrose 5% in water or NaCl 0.9%. All solutions were examined, antibiotic concentrations were determined, and pH was measured at the time of admixture and 1, 4, 8, 12, 24, and 48 hours later. The solutions were maintained at room temperature under fluorescent lighting for the length of the study. Antibiotic concentrations were determined by drug-specific high performance liquid chromatographic assays. Significant instability or incompatibility was defined as a decrease in concentration of greater than ten percent relative to the initial concentration measured at the time of admixture. All antibiotics were stable for 48 hours. In the combination studies, clindamycin was stable for 48 hours, both in partial-fill glass bottles and syringes. Aztreonam, cefoperazone, cefonicid, and cefuroxime were also stable for 48 hours.

Aztreonam↗
PubMedDate not supplied

Stability of intravenous famotidine stored in polyvinyl chloride syringes.

The stability of intravenous famotidine in dextrose 5% injection (D5W), NaCl 0.9% injection (NS), and sterile water for injection stored in polyvinyl chloride (PVC) syringes at 4 degrees C for 14 days was studied. The concentration of famotidine samples was determined at time 0, 7 days, and 14 days by reverse-phase high-performance liquid chromatography. Samples were inspected for visual changes and tested for changes in pH. Results of the HPLC analysis indicated that the famotidine samples remained within 94-100 percent and 99-103 percent of the time 0 concentrations at 7 and 14 days, respectively. Repeated measures analysis of variance demonstrated a significant time effect on famotidine concentration as concentrations changed over time (p less than 0.01). This change was small in magnitude, however, and concentrations decreased at 7 days and increased at 14 days. Famotidine is stable at a concentration of 2 mg/mL in D5W, NS, and sterile water for injection stored in PVC syringes at 4 degrees C for 14 days.

Chromatography, High Pressure Liquid↗
PubMed1993

Stability of famotidine in polyvinyl chloride minibags and polypropylene syringes and compatibility of famotidine with selected drugs.

OBJECTIVE: (1) to determine the stability of famotidine 200 micrograms/mL in admixtures with dextrose 5% injection (D5W) and NaCl 0.9% injection (NS) in polyvinyl chloride (PVC) minibags and polypropylene syringes, at room temperature (22 degrees C), protected and unprotected from light for 15 days; and (2) to evaluate the visual compatibility of famotidine with 34 selected drugs for four hours at room temperature. DESIGN: Concentration of famotidine samples was determined on day 0 and again on days 3, 6, 9, 12, and 15 by a stability-indicating HPLC. Inspection for visual and pH changes was also performed at these time intervals. RESULTS: More than 95 percent of the day 0 famotidine concentration remained in all samples over the 15-day study period. During this period, all samples remained clear and colorless and no change in absorbance at 450 and 540 nm was observed. The pH of the samples also remained unchanged. Famotidine 2000 micrograms/mL was found to be compatible with 33 selected drugs; only furosemide was found to be incompatible. A white precipitate was observed when an equal volume of famotidine 2000 micrograms/mL in NS was mixed with furosemide 3000 micrograms/mL in D5W. The concentration of famotidine in the supernatant gradually decreased during the 4-hour study period. At 0.5, 1.0, 2.0, and 4.0 hours after mixture of famotidine with furosemide, famotidine concentrations were 97.5, 23.6, 21.7, and 17.2 percent of the initial famotidine concentration, respectively. CONCLUSIONS: Our results show that famotidine 200 micrograms/mL was stable in admixture with D5W and NS in PVC minibags and polypropylene syringes when these solutions were stored at room temperature, protected and unprotected from light for 15 days. Famotidine 2000 micrograms/mL in NS was compatible with 33 of the drugs, and was incompatible with furosemide.

Analysis of Variance↗