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At least 19 recordsLinked to original sources
PubMedDate not supplied

The effect on syringe performance of fluid storage and repeated use: implications for syringe pumps.

Syringe stiction has been reported to cause syringe pump malfunction, hence the effect on syringe performance of syringe use and the formulations used in the syringe were investigated. The force required for syringe plunger motion (at 2.5 mm min-1), when filled with soybean oil emulsion (SBOE) and with water, and the extraction of silicone oil from syringes by these fluids, were measured for Primo, Talus and Terumo 10 mL, and Terumo 50 mL syringes. The breakloose, average extrusion and maximum force required to maintain plunger motion increased after storage of SBOE for 7 days in all syringes tested (p < 0.05). The storage of water increased the breakloose force of all syringes, but only increased the maximum force of Talus syringes, and both the average extrusion and maximum forces of Terumo 10 mL syringes. The mechanism for this is most likely swelling of the elastomer of the piston due to sorption of fluid. The force was found to increase logarithmically with repeated syringe use. Electrothermal atomization atomic absorption spectroscopy was used to measure the silicone oil content of syringe extractions. Three extractions were performed: repeated flushing, vigorous washing, and storage for 7 days with occasional agitation. Up to 69.4% of the silicone oil present in the syringes was extracted with both water and SBOE when they were stored or washed. In contrast to water, SBOE also extracted the lubricant when the syringe was filled and flushed immediately. If syringes are refilled, stored filled before use, or used over a prolonged period, particularly with a SBOE formulation, syringe striction may occur during infusion with a syringe pump.

Drug Storage↗
PubMed2000

Syringe size and flow rate affect drug delivery from syringe pumps.

PURPOSE: To evaluate the effect of syringe size and infusion rate on drug delivery after vertical displacement of syringe pumps. METHODS: Four syringes (10 ml, 20 ml, 30 ml, 50 ml) were studied at three infusion speeds (2 ml x hr(-1), 1 ml x hr(-1) and 0.5 ml x hr(-1)). Fluid delivery was measured gravimetrically using an electronic balance. Aspiration volume (amount of fluid retracted into the syringe-infusion line assembly) and zero-drug delivery time (time between the lowering of the syringe pump and reattainment of the initial weight) were determined after lowering the syringe pump 130 cm or 50 cm. Then, infusion bolus was measured after elevating the pump to its initial position. Syringe compliance was calculated from the occlusion release bolus at an occlusion pressure of 300 mmHg. RESULTS: Zero-drug delivery time, aspiration volume and infusion bolus increased with syringe size (P < 0.0001). At 0.5 ml x hr(-1), a zero-drug delivery time of 29.7 +/- 0.6 min was recorded for the 50 ml syringe and 5.5 +/- 0.15 min for the 10 ml syringe. As infusion rates increased, zero-drug delivery times decreased following a 1/x ratio. Zero-drug delivery time highly correlated with calculated syringe compliance (Pearson's r = 0.97, P < 0.001), which was closely related to syringe plunger area (R2 = 0.93, P < 0.001). CONCLUSIONS: Vertical displacement of syringe pumps causes flow irregularities which correlate directly with syringe size and indirectly with infusion rate. Extreme vertical maneuvering of syringe pumps should be avoided. Infusion rates > or = 1 ml x hr(-1) and low-compliant, small syringes are recommended when highly concentrated drugs are administered.

Humans↗
PubMed1998

Access to sterile syringes in Maine: pharmacy practice after the 1993 repeal of the syringe prescription law.

In October 1993, the Maine legislature repealed the prescription law regulating the sale of syringes. The new law allowed but did not require licensed pharmacists to dispense syringes without a prescription to anyone 18 years of age or older. From November 1995 to January 1996, we conducted a telephone survey of 208 Maine pharmacists to evaluate the sale of syringes with and without a prescription and to assess pharmacists' willingness to sell syringes without a prescription. We found that 94% of pharmacists were willing, in all cases or at the discretion of the pharmacist, to sell syringes without a prescription. However, when asked specifically about willingness to sell syringes without a prescription to suspected injection drug users (IDUs) > or =18 years of age, 47% were willing, 40% were not willing, and 13% did not know or declined to answer. Pharmacists reported other requirements for the purchase of syringes without a prescription, such as the requirement for the customer to provide a reasonable justification for the purchase. In all, there were 31 (15%) pharmacists in the sample willing to sell syringes to without a prescription with no additional requirements for purchase to suspected IDUs as permitted by law. There were few negative incidents reported involving IDUs and the sale of syringes without a prescription since amendment of the law. Although sales of syringes without a prescription were reported, the numbers sold fell short of the estimated number of syringes required for IDUs in Maine to use a new syringe for every injection. Despite the change in the prescription law intended to increase access to syringes, the data suggest barriers such as drug paraphernalia laws and pharmacy policies may prevent IDUs from purchasing syringes and contribute to ongoing transmission of HIV. Amendment of the drug paraphernalia and syringe possession laws, clarification of the legitimate medical purpose of access to sterile syringes for IDUs, and offering pharmacists continuing education on the prevention of blood-borne disease appear to be necessary steps in the effort to decrease the transmission of HIV among IDUs in Maine.

Adult↗
PubMed2000

High street prices of syringes correlate with strict syringe possession laws.

The current epidemic of injection drug use in the United States and abroad has precipitated an increase in transmission of infectious diseases, including human immunodeficiency virus (HIV), hepatitis B, hepatitis C, and human T-lymphotrophic virus II (HTLV-II) in injection drug users (IDUs) who share syringes and other injection equipment. Sharing is often due to a lack of available sterile syringes, which is, in part, a result of laws and regulations controlling the purchase and possession of syringes. These laws, in turn, raise the price of questionably sterile black market syringes, inadvertently encouraging the reuse and sharing of syringes. To date, very little information has been gathered on the street price of syringes in different communities. We surveyed 42 needle exchange programs (NEPs) in the United States in July and August 1998 to determine the street prices of syringes. The relationship among local laws regulating syringe possession, the enforcement of those laws, and street syringe prices was examined. There was a strong correlation between the presence of syringe possession laws and higher street syringe price ($2.87 vs. $1.14, p< .01). In areas with syringe possession laws, cost was significantly higher when laws were perceived to be enforced strictly ($3.66 vs. $2.08, p<.01). Street prices for syringes are an easily quantifiable indirect measure of availability of sterile syringes and may reflect syringe sharing and reuse.

Communicable Disease Control↗
PubMed2002

Effects of increasing syringe availability on syringe-exchange use and HIV risk: Connecticut, 1990-2001.

Syringe-exchange programs (SEPs) in Connecticut operate with caps on the number of syringes exchanged per visit. We investigated the effects of legislation increasing the cap on drug injectors' access to clean syringes through the SEPs in New Haven and Hartford. The mixed design of this study included longitudinal and cross-sectional data from individuals and ecological data from program operations. Five parameters-syringe return rate, syringes per visit to the SEP, syringe reuse rate, syringe human immunodeficiency virus (HIV) prevalence, and syringe sharing-were monitored through syringe tracking and testing of SEP syringes and by interviewing injectors. Two increases in the cap-from 5 to 10 and then from 10 to 30-had little effect on the five parameters that measured injectors' access to clean syringes. In contrast, access to clean syringes increased when the New Haven SEP first began operations, when syringes first became available at pharmacies in Hartford, and when the agency running the Hartford SEP changed. Legislation providing piecemeal increases in the cap may not, by themselves, be sufficient to increase injectors' access to clean syringes and decrease the risk of human immunodeficiency virus transmission in this population.

Connecticut↗
PubMedDate not supplied

State syringe and drug possession laws potentially influencing safe syringe disposal by injection drug users.

OBJECTIVE: To review state laws and judicial decisions for potential barriers to proper syringe disposal by injection drug users (IDUs). DESIGN: Using standard legal research methods, this study reviewed drug paraphernalia, syringe prescription, drug possession, and syringe exchange laws and relevant case decisions in 59 jurisdictions. MAIN OUTCOME MEASURES: Drug paraphernalia, syringe prescription, and drug possession laws. RESULTS: Drug paraphernalia laws prohibit all possession of syringes by IDUs in 31 jurisdictions. Syringe prescription laws prohibit possession in 7 jurisdictions. In 53 jurisdictions, IDUs may be subject to prosecution for the possession of drug residue in used syringes. Only two states (HI, RI) have no legal barriers to safe syringe disposal by IDUs. Sixteen jurisdictions that have tried to expand syringe access for IDUs by authorizing SEPs or by deregulating pharmacy sale of syringes continue to have criminal law provisions that could pose barriers to proper disposal. CONCLUSION: IDUs are a significant source of syringes disposed of outside the health care system. Involving IDUs in safe community sharps disposal programs is an important public health goal, but may be frustrated by legal barriers. Although this study looked only at law on the books, and not law as actually applied, ethnographic and survey research indicates that criminal laws do influence the syringe possession behavior of IDUs. The findings of this study suggest that syringe and drug possession laws could deter IDUs from participating in safe syringe disposal programs.

Humans↗
PubMed2003

Warming of infusion syringes caused by electronic syringe pumps.

PURPOSE: To evaluate inadvertent warming of the infusion syringe in four different types of electronic syringe pumps. METHODS: Ambient temperature and syringe surface temperature were simultaneously measured by two electronic temperature probes in four different models of commercially available syringe pumps. Experiments were performed at an infusion rate of 1 ml h(-1) using both battery-operated and main power-operated pumps. Measurements were repeated four times with two pumps from each of the four syringe pump types at a room temperature of approximately 23 degrees C. Differences among the four syringe pump brands regarding ambient to syringe temperature gradient were compared using ANOVA. A P-value of less than 0.05 was considered statistically significant. RESULTS: Syringe warming differed significantly between the four syringe brands for both the battery-operated and main power-operated mode (ANOVA, P< 0.001 for both modes). Individual differences between syringe surface and ambient temperature ranged from 0.3 to 1.9 degrees C for battery operation and from 0.5 to 11.2 degrees C during main-power operation. CONCLUSION: Infusion solutions can be significantly warmed by syringe pumps. This has potential impact on bacterial growth and the stability of drug solutions and blood products infused, as well as on the susceptibility to hydrostatic pressure changes within the infusion syringe.

Hot Temperature↗
PubMed1998

Syringe use and reuse: effects of syringe exchange programs in four cities.

We determined the effect of syringe exchange programs (SEPs) on syringe reuse patterns. Five methods were employed to estimate injections per syringe made by exchange clients in four cities. In San Francisco, Chicago, and Baltimore, self-reported data on the number of injections per syringe were obtained. In New Haven, self-reported injection frequencies were combined with syringe tracking data to derive two methods for estimating the mean injections per syringe. The average number of injections per syringe declined by at least half after establishment of SEPs in New Haven, Baltimore, and Chicago, all cities where such an analysis could be made. There were significant increases in the percentages of exchangers reporting once-only use of their syringes in San Francisco, Baltimore, and Chicago, all cities where the data were amenable to this form of analysis. Self-report and syringe tracking estimates were in agreement that SEP participation was associated with decreases in syringe reuse by drug injectors. SEP participation was associated with increases in the once-only use of syringes. These findings add to earlier studies supporting the role of SEPs in reducing the transmission of syringe-borne infections such as HIV and hepatitis.

Baltimore↗
PubMed1995

Impact of increased legal access to needles and syringes on community pharmacies' needle and syringe sales--Connecticut, 1992-1993.

In May 1992, the Connecticut legislature passed new laws aimed at increasing injecting drug users' (IDUs) access to sterile needles and syringes (syringes); as of July 1992, pharmacists were permitted to sell and individuals were permitted to possess up to 10 syringes without medical prescriptions (nonprescription syringes). We evaluated the impact of the new laws by conducting (1) prospective surveillance of syringe sales and policies at selected community pharmacies (pharmacies) and (2) a telephone survey of pharmacy managers' reports of syringe sales and policies at a statewide stratified random sample of pharmacies. Our data provide direct evidence that most, but not all, Connecticut pharmacies sold nonprescription syringes when permitted to do so by the new laws. For example, using the telephone survey data, we estimate that during November, 1993, 83% [95% CI: 77-89%] of all Connecticut pharmacies sold nonprescription syringes and 56,000 [95% CI: 44,000-68,000] nonprescription syringes were sold, during November 1993. Our data provide indirect evidence that IDUs were purchasing nonprescription syringes at pharmacies. For example, in five Hartford pharmacies located in neighborhoods where injection drug use was prevalent, the total number of nonprescription syringes sold per month increased significantly from 460 in July 1992 to 2,482 in June 1993 (p = 0.0001). The data suggest that the new laws increased IDUs' access to sterile syringes in Connecticut.

Centers for Disease Control and Prevention, U.S.↗
PubMed1994

[Fluctuation of injection pressure of syringe pumps; the effect of syringe volumes and speed settings].

We measured fluctuation of injection pressure by several types of commercially available syringe pumps in order to investigate the effect of syringe volumes (Terumo syringe) and speed settings on the irregularity of injection speeds. We recorded the injection pressure continuously with various speed settings, except that one of the pumps injected irregularly at the settings of 2 and 1 ml.h-1. With 50 ml syringes, only two of the six pumps injected precisely at all the speed settings. With the other four types, a steep increase in pressure was recorded at the speed setting of 1 ml.h-1. However irregular infusion was never observed by using a syringe of a high resistant type (TOP syringe). With 30 ml syringes, injection pressures fluctuated in most of the six syringe pumps at a speed lower than 5 ml.h-1. In conclusion, changes in injection pressures depend on types of syringes, syringe volumes and speed settings. We urge not to use a 30 ml syringe to infuse vasoactive drugs with syringe pumps.

Infusion Pumps↗
PubMedDate not supplied

Pharmacy access to sterile syringes for injection drug users: attitudes of participants in a syringe exchange program.

OBJECTIVE: To examine attitudes of participants of a van-based syringe exchange program (SEP) toward the hypothetical prospect of pharmacy-based syringe access. DESIGN: One-time, cross-sectional survey. SETTING: Baltimore, Maryland. PARTICIPANTS: 206 injection drug users who participate in the Baltimore SEP. INTERVENTIONS: Face-to-face interviews. MAIN OUTCOME MEASURES: Location preferred for obtaining syringes, drug and syringe use, past experience with pharmacies, and willingness to pay. RESULTS: The sample was 67% men, 95% African American, and 95% unemployed; mean age was 39.8 years. A total of 19% of respondents had bought syringes at a pharmacy during the prior six months. Some 37% reported having been turned down when asking for syringes at a pharmacy, most commonly due to lack of identification to prove diabetic status (50%). If legal restrictions were lifted, 92% of respondents would obtain syringes from pharmacies, and would be willing to pay a mean price of $0.80 (median = $1.00) per syringe. Women were more likely than men to report the intention to switch from van-based SEP to pharmacy (57% versus 38%, p = .045). CONCLUSION: If current legal restrictions were lifted, pharmacies would be a viable syringe source appealing particularly to women, suggesting gender-specific access issues that should be addressed. The per-syringe price that study participants would be willing to pay exceeds typical retail prices, suggesting that pharmacists could charge enough per syringe to recoup operational costs.

Adult↗
PubMed1998

A sterile syringe for every drug user injection: how many injections take place annually, and how might pharmacists contribute to syringe distribution?

Our objectives were to estimate the annual number of injections by injection drug users (IDUs) in the United States of America, and to describe the potential role of pharmacists in providing IDUs with a sterile syringe for every injection. We estimated the number of annual injections by IDUs for the United States, selected U.S. states, and selected U.S. cities according to the following formula: number of injections per year = (number of IDUs) x (average number of injections per IDU per day) x 365. Data were obtained from published articles, personal communications with local experts, and selected national databases. We also reviewed published and unpublished studies of pharmacy kits, pharmacist attitudes, and pharmacist practices in the United States and abroad. Between 920 million and 1.7 billion injections by IDUs take place each year in the United States. We estimated 12 million injections per year in San Francisco and >80 million in New York City. A similar number of syringes would be needed to satisfy the goal of a sterile syringe for every injection. Pharmacy-based strategies, including the sale of kits for injection drug use, have provided sterile syringes to IDUs in Europe, Australia, and New Zealand. Modification of laws restricting syringe purchase and possession has led to marked increases in purchase of syringes from pharmacies and reductions in needle-sharing. In conclusion, large numbers of syringes would be required to provide a sterile syringe for every injection, but significant numbers of pharmacists seem to be willing to play a central role in syringe sale and distribution. Outreach programs should emphasize that using a sterile syringe for every injection is the optimal HIV prevention practice for IDUs who cannot or will not stop injecting. Pharmacy-based syringe sale or distribution has the potential to augment current efforts to prevent HIV infection in IDUs, their sex partners, and their children.

Australia↗
PubMed2002

New syringe acquisition and multi-person use of syringes among illegal drug users.

OBJECTIVES: This study reports on characteristics associated with "new" syringes by IDUs in Houston, Texas, where acquisition to sterile syringes is largely limited to pharmacy purchase. METHODS: Data were collected from street-recruited injection drug users in Houston, Texas. "New" syringe use was defined as always injecting with syringes that were obtained brand new from a pharmacy and that were always wrapped in plastic when they were purchased. Logistic regression was used to assess whether "new" syringe use affected the odds of injecting after other persons, and to assess individual characteristics associated with exclusive use of "new" syringes. RESULTS: Exclusive "new" needle use significantly decreased the odds that a respondent would report injecting after someone other than a sex partner, while methamphetamine consumption significantly increased the odds. None of the African-American injectors in the sample reported "new" syringe use. Social desirability and heroin consumption increased the odds that a respondent would report "new" syringe use. CONCLUSIONS: Results are consistent with previous studies showing that acquisition of new syringes reliably decreases multi-person use of syringes and may thus slow the spread of HIV.

Adult↗
PubMed2000

The effects of syringe plunger design on drug delivery during vertical displacement of syringe pumps.

Fluid delivery from four types of commercially available 50-ml syringes was measured using an electronic balance at an infusion rate of 1 ml.h(-1). Retrograde aspiration volume and zero-drug delivery time were recorded after lowering the syringe pump by 50 cm. Syringe compliance was calculated from the volume of bolus released after occlusion at 100 mmHg. Zero-drug delivery times differed significantly between syringes, ranging from [mean (SD)] 3.26 (0.40) min to 6.38 (0.56) min (F = 55.5, d.f. = 3/20, p < 0.0001). Syringe compliance correlated well with aspiration volume (Pearson r(2) = 0.92, p < 0.001) and zero-drug delivery time (r(2) = 0.90, p < 0.001). Syringe design affected the internal syringe compliance. All syringes were associated with potentially relevant zero-drug delivery times after moderate vertical displacement. To minimise this risk, vertical displacement of syringe pumps delivering highly vasoactive drugs should be avoided.

Compliance↗
PubMed1982

Effects of syringe material and needle size on the minimum plunger-displacement pressure of arterial blood gas syringes.

We determined the minimum systolic pressures required for blood to enter and begin to displace the plungers of four brands of 3-ml and 5-ml plastic and glass arterial blood gas syringes by combining samples of each syringe size with three sizes of short-beveled needles--25 gauge, 5/8"; 22-gauge, 1"; and 20-gauge, 1 1/2". We measured pressures by use of an arterial-vessel model that incorporated whole human blood and simulated the conditions of a percutaneous arterial puncture. We concluded that all the arterial blood gas syringes that we studied would self-fill in most clinical situations when they were combined with 20- or 22-gauge needles, but that 22-gauge needles with glass syringes were preferable for persons whose systolic pressures were less than 70 mm Hg, for persons in shock, and for persons undergoing CPR. Only glass 3-ml syringes should be used with 25-gauge needles, as two brands of plastic 3-ml syringes with 25-gauge needles required systolic pressures greater than 158 mm Hg and all brands of plastic and glass 5-ml syringes with 25-gauge needles required systolic pressures greater than 247 mm Hg. Because we found no clinical or statistical differences between 20- and 22-gauge needles, we do not recommend use of the larger 20-gauge needle. The syringe-needle combinations that we do recommend should negate the need for, and the potential trauma of, manual aspiration of the syringe plunger.

Blood Gas Analysis↗
PubMedDate not supplied

Impact of increased syringe access: preliminary findings on injection drug user syringe source, disposal, and pharmacy sales in Harlem, New York.

OBJECTIVE: To evaluate the New York State Expanded Syringe Access Demonstration Program (ESAP) through injection drug user (IDU) surveys, discarded needles and syringes studies, and pharmacy sales and experiences surveys. DESIGN: Pre-post comparison. SETTING: In Harlem, New York City, risk surveys among street-recruited IDUs, needle/syringe street counts on 27 systematically sampled city blocks, and Harlem pharmacist reports of sales and experiences. MAIN OUTCOME MEASURES: Number and types of IDU syringe sources, block mean counts of discarded needles and syringes, level of pharmacy nonprescription syringe sales (NPSS), and pharmacists' experiences. RESULTS: Comparing 209 pre-ESAP with 396 post-ESAP IDUs, pharmacies as a primary syringe source increased: 3.4% to 5.3% (P < .001, and ever pharmacy use increased: 4.9% to 12.5% (P < .001), respectively. Compared with pre-ESAP IDUs, post-ESAP IDUs tended to be younger and more often black. Harlem pharmacy participation in ESAP increased considerably from March 1, 2001, to March 1, 2002, 49% to 79%, respectively. Among three Harlem pharmacies, there was a modest increase in NPSS; pharmacists reported no problems, and no discarded needles and syringes were observed in pharmacy areas. In the three pharmacies, the proportion of syringe sales that were NPSS was 46% (110 to 240 NPSS/month), 3% (25 to 90 NPSS/month), and 0%. The mean ratios of needles/syringes to background trash have not increased in Harlem since ESAP began. CONCLUSION: To date, no evidence of harmful effects discarded needles/syringes, pharmacy altercations) resulting from ESAP were observed. While NPSS have increased in Harlem, pharmacy use among IDUs remains low. In Harlem, efforts are underway to increase ESAP awareness and reduce socioenvironmental barriers to ESAP.

Humans↗
PubMedDate not supplied

Pharmacy syringe sale practices during the first year of expanded syringe availability in New York City (2001-2002).

OBJECTIVE: [corrected] To assess the role that customer characteristics, including race, age, and gender and pharmacy characteristics, including type and location, play on actual syringe-selling practice by pharmacies registered to sell syringes under the New York State Expanded Syringe Access Demonstration Program (ESAP). DESIGN: 89 syringe-purchasing visits were made in randomly selected ESAP-registered pharmacies, stratified by chain and independent status. SETTING: Visits were conducted in 14 New York City neighborhoods. Three neighborhoods (two with high need for human immunodeficiency virus [HIV] prevention services and one with low need) were selected in each of New York City's five boroughs (except Staten Island, where only two neighborhoods were visited, as only one exists with high need for HIV prevention services). PARTICIPANTS: Visits were conducted by syringe-purchasing testers with different demographic characteristics, including age (< or = 25 and > 25), race/ethnicity (white, black, Latino), and gender (men, women). RESULTS: Testers were able to purchase syringes in 69% of visits. Tester race, age, and gender did not significantly affect sales of syringe-selling practices. Location of pharmacy was statistically significant, with only 33% of the registered pharmacies selling syringes in the Bronx, but 67% to 89% selling in other four boroughs. CONCLUSIONS: ESAP has been widely implemented among registered pharmacies in four of New York City's five boroughs. The program's effectiveness could be enhanced through pharmacy-based efforts focused broadly on the ESAP goal of preventing the transmission of HIV and other blood-borne infections among injection drug users.

HIV Infections↗
PubMed1999

Use of SoloShot autodestruct syringes compared with disposable syringes, in a national immunization campaign in Indonesia.

Autodestruct syringes can reduce the improper reuse of syringes, which present a significant risk in the transmission of bloodborne pathogens in developing countries, especially during immunization campaigns owing to the high number of injections given per session. SoloShot is an autodestruct syringe, distributed by UNICEF, which has been shown to be safer and easier to use than standard syringes. This study analyses the accuracy and dose-efficiency of SoloShot, compared with disposable syringes, during a national tetanus toxoid immunization campaign on the Indonesian island of Lombok. Observation and dose measurements revealed that SoloShot syringes delivered more precise and consistent doses and 15% more doses per vial than disposable syringes. Vaccine savings may partially be offset by the higher price of SoloShot. Vaccinators preferred SoloShot, describing it as easier to use, faster, and more accurate than the disposable syringe. The study indicates that SoloShot is highly appropriate for use in immunization campaigns by reducing vaccine wastage and improving injection safety.

Adult↗