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PubMed2004

Effects of syringe material and temperature and duration of storage on the stability of equine arterial blood gas variables.

OBJECTIVES: To evaluate the consistency of partial pressures (P) of arterial oxygen (aO(2)), arterial carbon dioxide (aCO(2)) and pH measurements in equine carotid arterial blood samples taken into syringes made from three different materials and stored at room temperature or placed in iced water for measurement at three different times. STUDY DESIGN: Prospective observational study over 19 days. ANIMALS: Four clinically normal Thoroughbred or Thoroughbred-cross horses (three geldings, one mare, mean age 6.25 years, range 5-7 years). METHODS: Identical blood samples were taken on two separate occasions from the carotid arteries of the four horses into syringes made of glass, plastic and polypropylene. PaO(2), PaCO(2) and pH determinations were performed on blood from each syringe type at 10, 60 and 120 minutes post-sampling with samples stored at room temperature (approximately 20 degrees C) or in iced water (approximately 0 degrees C). Data were analysed by anova and a split plot model fitting syringe within horse X pair and time within temperature within syringe. RESULTS: Syringe material, storage temperature and time before analysis all had significant effects on PaO(2) (p < 0.001). PaCO(2) was unaffected by syringe material or storage temperature. However, over 120 minutes, storage duration significantly (p = 0.002) affected values. Temperature of storage and duration prior to analysis both significantly affected pH values (p = 0.005 and p < 0.001, respectively), but syringe material did not. Several significant interactions between these variables were noted. CONCLUSIONS: Equine arterial blood gas determination has a different sensitivity to storage conditions compared to other veterinary species. CLINICAL RELEVANCE: For accurate equine arterial blood analysis, PaO(2) samples need to be analysed within 10 minutes or taken into glass syringes, stored on ice and analysed at 2 hours post-sampling. PaCO(2) and pH measurements can be performed on samples stored in glass, plastic or polypropylene syringes at room temperature for up to 1 hour post-sampling.

Animals↗
PubMed1994

Air embolus risk with glass versus plastic syringes: in vitro study and implications for neuroangiography.

PURPOSE: To assess syringe use among neuroangiographers and evaluate air emboli produced with glass and plastic syringes. MATERIALS AND METHODS: Questionnaires on syringes use were sent to 100 members of the American Society of Neuroradiology (ASNR). An in vitro system counted emboli during injections of contrast material and saline solution with either glass or plastic syringes. At Doppler sonography, an embolic signal was defined as the power of the reflected amplitude with auditory and visual confirmation. RESULTS: Of 62 respondents, 11.3% used glass syringes exclusively and 80.6% used plastic exclusively. Glass breakage was experienced by 72.5%, and 40% of them recalled an injury associated with such a breakage. No statistically significant difference was found between glass and plastic syringes for introduction of air emboli, though two outlying values represented larger numbers of emboli in the group with plastic syringes and contrast material. CONCLUSION: No reason for the continued use of glass syringes was found. No statistically greater risk of air emboli was shown with plastic syringes, and risk of breakage and injury is prevented. Caution is advised when injecting contrast material with plastic syringes because more air emboli may be introduced.

Cerebral Angiography↗
PubMedDate not supplied

Syringe source, use, and discard among injection-drug users in New Haven, Connecticut.

We examined syringe source, use, and discard practices of injection-drug users (IDUs) in New Haven, Connecticut, a city with both a legal syringe-exchange program (SEP) and non-prescription availability of syringes through pharmacies. The population demographics, syringe use, and discard practices of IDUs who obtained syringes from various sources were compared using structured interview data. Of the 373 IDUs recruited, 268 (72 percent) resided in the city of New Haven. Among the New Haven IDUs, 111 (41 percent) reported pharmacies, 36 (13 percent) reported the New Haven SEP, 90 (34 percent) reported both, and 27 (10 percent) reported neither as their usual source of syringes in the past six months. No significant differences (p value < 0.05) were observed among New Haven IDUs who relied on pharmacies versus the SEP. However, IDUs who relied on the SEP were significantly less likely to report they threw away used syringes, compared with pharmacy users. Both the pharmacies and the New Haven SEP are important sources of sterile syringes for IDUs in New Haven. The lower frequency of syringe discard by IDUs who obtained their syringes primarily through the SEP indicates another public health benefit of programs such as these.

Connecticut↗
PubMed2006

Effects of syringe material, sample storage time, and temperature on blood gases and oxygen saturation in arterialized human blood samples.

BACKGROUND: The practice of on-ice storage of arterial-blood samples in plastic syringes for delayed analysis continues, and the effects of storage time and temperature on the measurement of blood-oxygen-saturation values (S(aO2)) have not been adequately described. OBJECTIVE: To determine the effects of syringe material, storage time, and storage temperature on normal arterialized blood gas and S(aO2) values. METHODS: We used a temperature-controlled extracorporeal circuit to "arterialize" 500 mL of fresh, whole human blood at 37 degrees C, and we used certified calibration gases of 12% O2 and 5% CO2 to produce normal blood-gas values. From that arterialized blood we took 90 samples and randomly assigned them to 6 groups, until there were 15 samples in each group. The groups were (1) plastic syringe, analyzed immediately, (2) plastic syringe, stored 30 min at 0-4 degrees C, (3) plastic syringe, stored 30 min at 22 degrees C, (4) glass syringe, analyzed immediately, (5) glass syringe, stored 30 min at 0-4 degrees C, and (6) glass syringe, stored 30 min at 22 degrees C. RESULTS: Compared to the samples that were analyzed immediately, the P(O2) of the samples stored in plastic syringes for 30 min at 22 degrees C and at 0-4 degrees C was significantly higher, with a clinically important magnitude of 11.9-13.7 mm Hg. The P(CO2) of blood stored in glass for 30 min at 0-4 degrees C was significantly lower, although the magnitude of the difference (1.5 mm Hg) was not clinically important. There were no statistically significant differences in pH or oxygen saturation among the 6 groups. CONCLUSION: For accurate arterial-blood-gas results, samples drawn in plastic syringes should be analyzed immediately. If the analysis is going to be delayed, the samples should be drawn and stored in glass.

Analysis of Variance↗
PubMed1990

Cost and acceptability of three syringe-pump infusion systems.

The fiscal impact and acceptability of implementing a syringe-pump infusion system at a 900-bed university teaching hospital where the minibag system has been in use is reported. Researchers selected three models of syringe pumps for evaluation: the Bard Harvard Mini-Infuser 150XL, the Becton Dickinson 360 Infuser, and the Strato Stratofuse System. Each pump was evaluated for three weeks on a medical-surgical unit and a hematology-oncology unit. Drugs to be infused were chosen after a literature review to determine which drugs had been successfully infused via syringe pump; 22 formulary medications were selected. Syringes were prepared as singly packaged doses or as doses prepared in bulk and packaged frozen. Control of the syringe pumps and microbore tubing was assigned to the inpatient pharmacy staff. Nurses and pharmacy personnel were apprised of the study and taught how to use the syringe pumps. Time-and-motion studies were performed in the sterile products preparation area, and a cost analysis was done. Nurses preferred syringe pumps over the minibag system because the pumps reduced the nursing time needed to infuse a drug, administered less fluid, provided consistent infusion rates, had alarms, and were relatively easy to use. The time required to prepare syringes did not differ substantially among syringe-pump models. It was estimated that using any of the evaluated pumps in place of the minibag system would save $126,500 during the three-year period 1988-91, primarily because of differences in the cost of disposable items. The syringe-pump infusion system is an acceptable and cost-effective alternative to the minibag system.

Costs and Cost Analysis↗
PubMed1986

Variation in light transmission properties of amber oral syringes.

Four brands of amber oral syringes were tested for compliance with compendial standards for light-resistant packaging. United States Pharmacopoeia (USP) specifications state that light-resistant packaging must not transmit more than 10% of incident light with wavelengths of 290-450 nm. The amount of light transmitted by samples of the barrels of 200 amber plastic oral syringes from each of four manufacturers was determined by spectrophotometry. Samples of both the printed and unprinted sides of the barrel were tested (after removal of all ink). The thickness of each syringe-barrel sample was measured, and the apparent density was determined. All of the Becton-Dickinson syringes tested met the USP standard for light transmittance, and none of the syringes from Baxa or Solopak met the compendial standards. Of the Burron syringes tested, 70 syringes met the standard, 83 did not meet the standard, and 47 could not be classified. The samples of the printed side of the syringe barrel had light transmission properties similar to those of the unprinted side with the exception of the syringes from Baxa, which had substantially higher apparent densities at all wavelengths for the printed side. Only one manufacturer's oral syringes consistently met the USP standard for light-resistant packaging. Further testing is needed to determine the clinical importance of these findings.

Color↗
PubMed1994

Atropine and ephedrine adsorption to syringe plastic.

The purpose of this study was to compare daily changes in the concentration of atropine or ephedrine sulfate solutions that had been stored up to 4 days in plastic or glass syringes. Sets of three plastic and one glass syringe were used for each drug; the glass syringes acted as controls. Each set of syringes was labeled as day 0, 1, 2, 3, or 4. Syringes with medication were laid horizontally, had needles attached, and were stored in the dark at an ambient temperature. Each day, the assigned set of syringes was analyzed by high-performance liquid chromatography. Results showed that the change in the ephedrine sulfate concentration in the plastic syringes from day 0 to day 4 was less than 1.4%. Atropine sulfate decreased 52% over 4 days, with the largest single drop occurring during the first 24 hours. It can be concluded that the two brands of ephedrine sulfate stored up to 4 days at ambient temperature in the brand of syringe used do not significantly decrease in concentration. However, this was not the case with the brand of atropine sulfate studied. The practice of storing atropine sulfate in plastic syringes should be discouraged, because of the possibility of loss of potency due to medication adsorption to syringe plastic.

Adsorption↗
PubMed2000

Short tandem repeat methodology for genotypic identification of single-person versus multi-person use of syringes.

OBJECTIVE: To develop laboratory methods to differentiate between single- versus multi-person use of syringes by injection drug users. METHODS: Forensic short tandem repeat (STR) genetic analysis was undertaken to cross-validate a test panel of trace blood contents from syringes representing single- versus multi-person syringe use. Laboratory-simulated scenarios of needle sharing generated 34 syringe washes that were blinded for evaluation. Polymerase chain reaction was used to amplify the polymorphic STR locus D6S502 from blood trace contents in used syringes. Alleles were sized and quantified using a commercial gene sequencer. A statistical algorithm was developed to determine the number of alleles present in the amplified DNA fragments. Syringes with more than two expected alleles were considered to represent multi-person syringe use. Sensitivity, specificity and the kappa coefficient were calculated. RESULTS: Allelic matrix-based analysis of alleles from the single STR successfully characterized single-use (n = 12) and multiple-use (n = 22) syringes with 68% sensitivity and 100% specificity upon re-analysis. The extent of agreement over and above chance (kappa = 0.6; P < 0.0001) indicated good agreement for differentiating single- versus multi-person syringe use. CONCLUSIONS: These findings suggest that improved genotypic STR analysis of syringe material could be an adjunct to methods for validating self-reported needle sharing, conducting behavioral surveillance of needle-sharing behaviors, and evaluating interventions such as needle-exchange programs. Assays based on multiple STR loci will undoubtedly improve upon the promising results obtained from laboratory simulations of needle sharing.

Alleles↗
PubMed2004

A novel tetrahydrofolate-dependent O-demethylase gene is essential for growth of Sphingomonas paucimobilis SYK-6 with syringate.

Sphingomonas paucimobilis SYK-6 degrades syringate to 3-O-methylgallate (3MGA), which is finally converted to pyruvate and oxaloacetate via multiple pathways in which protocatechuate 4,5-dioxygenase, 3MGA dioxygenase, and gallate dioxygenase are involved. Here we isolated the syringate O-demethylase gene (desA), which complemented the growth deficiency on syringate of a Tn5 mutant of the SYK-6 derivative strain. The desA gene is located 929 bp downstream of ferA, encoding feruloyl-coenzyme A synthetase, and consists of a 1,386-bp open reading frame encoding a polypeptide with a molecular mass of 50,721 Da. The deduced amino acid sequence of desA showed 26% identity in a 325-amino-acid overlap with that of gcvT of Escherichia coli, which encodes the tetrahydrofolate (H(4)folate)-dependent aminomethyltransferase involved in glycine cleavage. The cell extract of E. coli carrying desA converted syringate to 3MGA only when H(4)folate was added to the reaction mixture. DesA catalyzes the transfer of the methyl moiety of syringate to H(4)folate, forming 5-methyl-H(4)folate. Vanillate and 3MGA were also used as substrates for DesA; however, the relative activities toward them were 3 and 0.4% of that toward syringate, respectively. Disruption of desA in SYK-6 resulted in a growth defect on syringate but did not affect growth on vanillate, indicating that desA is essential to syringate degradation. In a previous study the ligH gene, which complements the growth deficiency on vanillate and syringate of a chemical-induced mutant of SYK-6, DC-49, was isolated (S. Nishikawa, T. Sonoki, T. Kasahara, T. Obi, S. Kubota, S. Kawai, N. Morohoshi, and Y. Katayama, Appl. Environ. Microbiol. 64:836-842, 1998). Disruption of ligH resulted in the same phenotype as DC-49; its cell extract, however, was found to be able to convert vanillate and syringate in the presence of H(4)folate. The possible role of ligH is discussed.

Base Sequence↗
PubMed2004

A comparison between single and double-pump syringe changes of intravenous inotropic medications in children.

The purpose of this study was to examine the consistency of dosage delivery of inotropic medications when changing syringes in syringe pumps. Two nursing practices of syringe changes were compared: single-pump (SP) versus double-pump (DP). The SP syringe change involved using one and the same pump, and changing only the syringe. The DP syringe change involved using another pump. This other pump infuses simultaneously, for a period of time, at the same dose as the pump containing the syringe that is to be discarded. Data collection included the volume and concentration of fluid when the syringes were changed. Volume measurement, biochemical analysis and spectrophotometry were used to analyze the data. The findings suggest that the DP practice for syringe changes provides better consistency in the dosage delivery of inotropic medications. However, the SP practice can also be highly suitable when considering the overall benefits and risks of both practices of syringe changes. Implications for nursing are discussed.

Cardiotonic Agents↗
PubMed1997

Continued risky injection subsequent to syringe exchange use among injection drug users in New York City.

Although the vast majority of injection drug users (IDUs) attending syringe exchange programs in New York City have stopped risky injection (injecting with syringes used by someone else), there remains a subgroup of IDUs who continue to engage in high-risk injecting behaviors despite access to sterile syringes. Subjects were randomly recruited from five legally authorized syringe exchange programs in New York City between October 1992 and August 1994. Participants were asked about drug and sexual risk behavior 30 days prior to their first use of the syringe exchange as well as during the 30-day period prior to the interview while using the exchange. Of the 2,465 participants, 77.4% reported no risky injection during the 30 days prior to using syringes exchange. For this analysis we included only those who reported risky injection for the 30-day period prior to using syringe exchange (N = 556). We compared sociodemographics and behavioral characteristics of a group who continued risky injection while using the syringe exchange, "continuers," N = 158 (28.8%) with a group who reported risky injection prior to using the exchange and then ceased risky injection while using the exchange, "stoppers," N = 391(71.2%). Continuers were significantly more likely to report passing on dirty syringes to social network members and to inject cocaine at least daily. We present other predictors of continued risk and discuss the implications for interventions and make recommendations for syringe exchange programs.

Adult↗
PubMed1991

In vitro characteristics of volume-reduced platelet concentrate stored in syringes.

For convenience, small volumes of platelet concentrate (PC) intended for neonatal patients are often dispensed in syringes. The PC, however, may remain in the syringe for up to several hours before the actual transfusion. As there are few data on the effect of such syringe storage on PCs, the in vitro syringe storage properties of small volumes of 1- and 5-day-old units, and volume-reduced units of PC were evaluated. In four separate experiments, PCs were stored in syringes in volumes of 10, 15, or 30 mL for up to 6 hours at 20 to 24 degrees C without agitation. Platelets were evaluated for pH, platelet count, and a variety of biochemical and in vitro functional assays. Results showed that even with the equivalent of a full unit of platelets stored in the syringe for up to 6 hours, the pH did not fall below 6.0. Although there was an increase in lactate production and consumption of glucose, which paralleled the decline in pH, the changes were not greater than those seen in platelets stored up to 5 days in gas-permeable blood bags. Similar results were seen for PCs stored in syringes for 6 hours at 37 degrees C. All of the pH levels recorded at the end of 6 hours of syringe storage were above the minimum required level of pH 6.0. Data from in vitro platelet assays imply that at any time during their shelf life, PCs can be stored in gas-impermeable polypropylene syringes for up to 6 hours and can maintain acceptable storage characteristics; in vivo data are needed to confirm these observations.

Blood Glucose↗
PubMed2004

Syringe distribution to injection drug users for prevention of HIV infection: opinions and practices of health care providers in New York City.

The Expanded Syringe Access Demonstration Program (ESAP), which was intended to increase access to syringes for injection drug users (IDUs), went into effect in New York State on 1 January 2001. ESAP allowed prescription-authorized health care providers to register to distribute syringes without a prescription. In spring 2002, we conducted a random postal survey of 1100 providers in New York City to evaluate involvement in ESAP and willingness to furnish IDUs with syringes. Among 363 nurse practitioners, physicians, and physician assistants responding, 16.9% knew about ESAP, and 2.0% believed they were registered; 50.5% would consider distributing syringes to patients who were IDUs. Most of those unwilling to distribute syringes were concerned about legal and moral issues. More respondents agreed that providers should prescribe syringes than distribute syringes (41.1% vs. 22.7%; P<.0001). These results suggest that many providers are willing to furnish IDUs with syringes but are unaware of the current law.

HIV Infections↗
PubMed1998

Stability of somatropin stored in plastic syringes for 28 days.

The stability of somatropin stored in two types of plastic syringes was studied. Reconstituted somatropin at high (3.33-mg/mL) and low (1.0-mg/mL) concentrations was stored in polypropylene and propylene-ethylene copolymer syringes at 2-8 degrees C for 28 days. The contents of all syringes were analyzed immediately and at 7, 14, 21, and 28 days by high-performance liquid chromatography for purity, potency, and preservative (m-cresol) content; pH, physical appearance, clarity, and preservative effectiveness were analyzed at the same times. Glass vials of somatropin reconstituted with diluent served as controls. Somatropin did not show significant losses in purity or potency during the 28-day study. m-Cresol concentrations decreased in both types of plastic syrings, more so in the polypropylene syringes, but remained in excess of the minimum required to pass the USP test of preservative effectiveness. On average, the contents of the propylene-ethylene copolymer syringes had greater turbidity than the contents of the polypropylene syringes and, after 21 days, had an unacceptable level of turbidity. No visible particulates were present except at 28 days in high-concentration samples stored in propylene-ethylene copolymer syringes. Somatropin 3.33 and 1.0 mg/mL was stable in polypropylene syringes for up to 28 days and in propylene-ethylene copolymer syringes for up to 14 days when stored at 2-8 degrees C.

Cresols↗
PubMed1998

Stability of undiluted and diluted adenosine at three temperatures in syringes and bags.

The stability of adenosine in various diluents in polypropylene syringes and polyvinyl chloride (PVC) bags at three temperatures was studied. Portions of pooled undiluted adenosine infusion (3 mg/ mL) were stored in 60-mL capped syringes, 20 for each storage condition. Adenosine infusions were prepared by mixing adenosine with 5% dextrose injection, 0.9% sodium chloride injection, lactated Ringer's injection, or 5% dextrose and lactated Ringer's injection to produce a concentration of 0.75 mg/mL. Samples of each infusion were stored in 60-mL capped syringes and 50-mL bags, 20 syringes and 20 bags for each storage condition. Syringes and bags were stored in the dark at 25, 5, and -15 degrees C. At various sampling times, three syringes and three bags of each infusion were removed for visual inspection, pH measurement, and high-performance liquid chromatographic analysis. At 10 and 16 days, fungal growth at 25 degrees C was suspected in the infusions prepared with 5% dextrose injection. For all other samples, there was no evidence of precipitation or change in pH. The concentration of adenosine remained constant in all samples at all storage conditions. Adenosine 3 mg/mL was stable in polypropylene syringes for 7 days at 25 degrees C, 14 days at 5 degrees C, and 28 days at -15 degrees C; adenosine 0.75 mg/ mL in 0.9% sodium chloride injection and in 5% dextrose injection was stable in polypropylene syringes and PVC bags for 16 days at 25, 5, and -15 degrees C; and adenosine 0.75 mg/mL in lactated Ringer's injection and in 5% dextrose and lactated Ringer's injection was stable in syringes and bags for 14 days at 25, 5, and -15 degrees C.

Adenosine↗
PubMed2004

Potency and stability of frozen urokinase solutions in syringes.

PURPOSE: The stability and potency of frozen urokinase solutions in syringes were studied. METHODS: To determine the stability and potency of compounded urokinase dilutions after multiple freeze-thaw cycles, a total of 160 syringes containing five urokinase concentrations (2,500, 5,000, 7,500, 12,500, and 25,000 IU/mL) were prepared. For each of the five concentrations tested, two syringes per concentration were reserved for baseline testing. The remaining 150 syringes were frozen at -30 degrees C. After 7 days, half of the syringes (group 1) were thawed at room temperature, tested, and left at room temperature for 12 hours before refreezing. The other half of the syringes (group 2) were kept frozen for 30 days. Thirty days after initial compounding, all syringes were thawed, and the samples' urokinase potency, pH, and physical appearance were evaluated. Syringes were visually inspected for color, clarity, and precipitation. Descriptive statistics were computed for each concentration group and testing day. RESULTS: The compounded dilutions were stable under each experimental condition, with no physical deterioration or loss of in vitro potency after two freeze-thaw cycles. The reduced waste associated with the ability to refreeze unused urokinase could substantially lower the cost of procedures such as thrombolysis after intraventricular hemorrhage and catheter clearance by as much as 95%. CONCLUSION: Dilutions of urokinase 2,500-25,000 IU/mL were stable in single-use syringes after being frozen for 7 days, thawed, and refrozen for another 23 days.

Drug Compounding↗
PubMedDate not supplied

Field evaluation of a simplified unit-dose syringe for administration of measles vaccine.

Ezeject is a plungerless syringe prefilled with lyophilized measles vaccine. Ezeject syringes were compared with standard 3-cc syringes and 10-dose measles vaccine vials in the vaccination of 884 Guatemalan infants 8-23 months of age. Vaccination was performed by experienced vaccinators and by individuals without prior vaccination experience who received 2.5-3 hours of training. The overall seroconversion rate following administration was 96%, regardless of the type of syringe used or of the experience of the vaccinator. No significant adverse events were observed in children vaccinated with the new syringes. Although incomplete emptying was noted in 87% of the Ezeject syringes used, this had no effect on the serologic response to measles vaccine. Aspiration for detection of blood before injection of the vaccine was performed significantly (P less than .001) less frequently with Ezeject than with 3-cc syringes by both experienced and inexperienced personnel. Inexperienced vaccinators administered measles vaccine significantly faster (P less than .001) with Ezeject than with 3-cc syringes, but the times were similar for experienced vaccinators. Ezeject is an acceptable alternative to standard syringes for the administration of measles vaccine. Several design modifications that would improve the handling of the device and eliminate the possibility of its reuse have been suggested.

Antibodies, Viral↗
PubMed2004

A syringe prescription program to prevent infectious disease and improve health of injection drug users.

Injection drug users (IDUs) are at increased risk for many health problems, including acquisition of human immunodeficiency virus (HIV) and hepatitis B and C. These risks are compounded by barriers in obtaining legal, sterile syringes and in accessing necessary medical care. In 1999, we established the first-ever syringe prescription program in Providence, Rhode Island, to provide legal access to sterile syringes, reduce HIV risk behaviors, and encourage entry into medical care. Physicians provided free medical care, counseling, disease testing, vaccination, community referrals, and prescriptions for sterile syringes for patients who were not ready to stop injecting. We recruited 327 actively injecting people. Enrolled participants had limited stable contact with the health care system at baseline; 45% were homeless, 59% were uninsured, and 63% did not have a primary care physician. Many reported high-risk injection behaviors such as sharing syringes (43% in the last 30 days), reusing syringes (median of eight times), and obtaining syringes from unreliable sources (80%). This program demonstrates the feasibility, acceptability, and unique features of syringe prescription for IDUs. The fact that drug use is acknowledged allows an open and frank discussion of risk behaviors and other issues often not disclosed to physicians. The syringe prescription program in Providence represents a promising and innovative approach to disease prevention and treatment for IDUs.

Adult↗