Conventional Syringe Research Articles

A systematic review of measures for reducing injection pain during adult immunization

ObjectiveTo evaluate the effectiveness of different pain-relieving interventions to reduce pain from immunization in adults. Data sourcesMEDLINE (1950 to October Week 3 2008) PsycINFO (1967 to December Week 1 2008), CINAHL (1982 to October Week 4 2008), EMBASE (1980 to 2008 Week 43) and the Cochrane Central Register of Controlled Trials (3rd Quarter 2008). Review methodsDatabases were searched for trials of pharmacological, behavioural, physical or operator-dependant techniques to reduce pain from immunization in adults. The primary outcome was pain as assessed by visual analogue scale or other numeric rating scale. ResultsSix studies representing 853 participants were identified. One study evaluating pharmacological interventions (lidocaine–prilocaine) found them to be effective in reducing pain from immunization. Similarly, two studies evaluating physical pain relieving techniques, either skin cooling interventions (Fluori-Methane®) or tactile stimulation (manual pressure at the site of injection) found them to reduce pain. One study of jet injectors found them to be more painful than conventional needle and syringe. Neither freezing needles nor warming vaccines was found to be effective in reducing pain. No studies investigated psychological interventions or oral analgesics (acetaminophen and ibuprofen). ConclusionThere was limited evidence to support the use of lidocaine–prilocaine, Fluori-Methane® and manual pressure for reducing immunization pain in adults. There was limited evidence of more pain with jet injectors compared to needle and syringe. Due to limited data, we recommend further investigation of methods to reduce immunization pain in adults, primarily psychological and physical techniques.

Recombinant follitropin alfa/lutropin alfa in fertility treatment

Recombinant human follicle stimulating hormone (rFSH) and luteinizing hormone (LH), also known as follitropin alpha and lutropin alpha, are manufactured by genetic engineering techniques which ensure high quality and batch to batch consistency. Follitropin alpha can be used for controlled ovarian hyperstimulation in assisted reproduction, ovulation induction for WHO group I and II anovulatory infertility and in men with hypogonadotrophic hypogonadism (HH) or idiopathic oligo-asthenospermia. Current evidence suggests superiority of urinary human menopausal gonadotropin (HMG) over follitropin alpha in controlled ovarian hyperstimulation for IVF in terms of live birth rate per couple. Addition of lutropin to follitropin alpha in an unselected IVF population does not appear to confer any benefit; however, it may have a role in ovulation induction in women with hypothalamic hypogonadism. Urinary HMG preparations (especially currently available highly purified preparations) are more cost effective than rFSH in terms of cost per ongoing pregnancy. However, women using rFSH injection pen devices have higher levels of satisfaction as compared to those using urinary HMG by means of conventional syringes.

Automated Ultrafiltration Device for Efficient Collection of Environmental Nanoparticles from Aqueous Suspensions

Environmental nanoparticles exist in the hydrosphere, pedosphere, biosphere, and atmosphere. Their biogeochemical and ecological impacts are some of the fastest growing areas of research today. However, efficient separation of environmental nanoparticles remains difficult. The objective of this study was to develop an automated ultrafiltration device (AUD) for efficient collection of environmental nanoparticles. The AUD utilizes an automated hydraulic ram to facilitate collection of nanoparticles using the ultrafiltration membrane with pore size in the range of 1 to 100 nm. Zeolite A was used as a model nanoparticle sample to demonstrate the efficiency of the AUD. The size distribution and mean particle sizes determined by zeta‐sizer analysis on the collected nanoparticles and their transmission electron micrographs indicated the adequacy of the AUD developed in this study in collecting nanoparticles (1–100 nm). Because of its ability to reduce the time needed for sample collection, coupled with the quantity of nanoparticles collected, the AUD was far more efficient than the conventional syringe method for collecting nanoparticles. The AUD has the characteristics of automation, easy operation, and high efficiency in the separation of nanoparticles and would, thus, facilitate future research and developments in environmental nanoscience and nanotechnology and their impacts on the ecosystem.

A Comparison of the Handling and Accuracy of Syringe and Vial Versus Prefilled Insulin Pen (FlexPen)

To determine the preferable method for self-injecting insulin, we compared the handling, safety, and dose accuracy of a conventional disposable syringe and vial with FlexPen (Novo Nordisk A/S, Bagsvaerd, Denmark), a prefilled pen. Insulin therapy-naive healthcare professionals (HCPs) (n = 30), unfamiliar with insulin delivery, injected 10 U of insulin into a sponge pad using either a syringe and vial or the FlexPen, both with 30-gauge 8-mm needles, on day 1. The following day, they used the alternative method. They evaluated the handling of the two methods on device-specific questionnaires and compared overall preference on a third questionnaire. To evaluate dose accuracy, 30 insulin therapy-experienced HCPs and 20 insulin therapy-naive HCPs were asked to deliver 10 U of insulin using each method, and the amount discharged was weighed. FlexPen was rated easier to use and overall more preferable than the syringe and vial by insulin therapy-naive HCPs (P < 0.001). The pen device was more accurate than the syringe and vial when used by experienced HCPs (mean +/- SD dose delivered, 9.91 +/- 0.11 U vs. 9.82 +/- 0.25 U, respectively; P < 0.001) and by insulin therapy-naive HCPs (9.91 +/- 0.12 U vs. 9.74 +/- 0.85 U; P < 0.001). Insulin therapy-naive HCPs found FlexPen easier to handle and preferable to use compared to a conventional syringe and vial. Both insulin therapy-experienced and -naive HCPs were able to deliver insulin significantly more accurately with the FlexPen than with a syringe and vial (P < 0.001).

Initial evaluation of a new safety needle system at a clinical setting in Taiwan

Needle‐protective devices have been investigated for decades for preventing health‐care workers from infecting blood‐borne pathogens. This initial evaluation of a new safety needle system in a disposable conventional syringe (new safety syringe) in a clinical setting was to see how nurses view its safety, usability and compatibility. A convenient sample of 205 nurses was involved and completed a user evaluation questionnaire. The results showed 163 nurses (88.1%) would use the safety syringes if the hospital provided safety syringes. Over 50% agreed that the new device was able to maintain the sterile principles and was easy to operate. Less than 25% disagreed that the new device ‘does not spend more work time’ and ‘does not affect the standard procedure while changing needle’. Positive attitude towards the new device associated with higher ‘job position’ and more ‘work experience’. Further evaluation of reducing incidence of needle‐stick injuries is required.

A Clinical Assessment on the Efficacy of the Anterior and Middle Superior Alveolar Nerve Block Technique During Extraction of Maxillary Teeth

Aims: A clinical evaluation on a recently introduced technique of anesthesia for maxillary teeth namelythe Anterior and Middle Superior alveolar nerve block compared with the conventional infiltrationtechnique for extraction of upper anterior and premolar teeth. Materials and methods: In the first partof the study, testing of pulpal anesthesia were performed after administering this technique for teethfrom upper central incisor to upper second premolar. The sample chosen for the second part of thestudy included 60 subjects of different ages and genders. The patients were divided randomly into twogroups: control group to whom the conventional supraperiosteal injection technique was administeredand the trial group to whom the anterior and middle superior alveolar nerve block technique was administered.In both groups, extraction was carried out. Results: The result of this study indicated thesuccess of achieving pulpal anesthesia after AMSA injection for teeth from the upper canine to the uppersecond premolar with no significant difference noticed between AMSA and control group in regardingto pain score levels after extraction of these teeth. Conclusions: This new technique could beused as a good alternative and or supplementary to the infiltration technique for anesthetizing maxillaryanterior and premolar teeth using a conventional dental syringe.

Assessment of Patient-Reported Outcomes of Insulin Pen Devices Versus Conventional Vial and Syringe

Patient-reported outcomes (PROs) associated with insulin therapy are potentially important determinants of adherence to diabetes management programs. This article reviews published evidence of PROs over the past 3 decades in patients with type 1 diabetes (T1D) and/or type 2 diabetes (T2D) who used vial and syringe for insulin delivery compared to those who used insulin pens. Based on predetermined selection criteria, articles were identified through a search of primary sources published from January 1980 to February 2008. Two independent reviewers determined study eligibility and performed a detailed evaluation of the articles that met the selection criteria. Of the 124 articles screened, 41 met selection criteria. Approximately 75% of the selected articles were published between 1990 and 2008, and a majority (78%) of the research studies was conducted outside the United States. Most (>75%) of the studies evaluated male and female patients with T1D and/or T2D and mean ages around 45 years. Studies used varied comparative study designs with follow-up periods ranging from 2 weeks to 5 years. The PROs assessed in these articles included preference, acceptability, treatment satisfaction, ease of use, convenience, injection pain, handling, and dosing. Most articles (n = 36) showed more favorable PROs for insulin pen users compared to vial and syringe users. These findings have potential clinical and policy implications for patients, diabetes care providers, and/or payers to make evidence-based decisions regarding ways to facilitate initiation and management of insulin therapy.

Local Anesthetic Syringe Ergonomics and Student Preferences

With a diverse population of dentists, dental hygienists, and dental assistants, there is a wide range of sizes and shapes of individuals. Ergonomic considerations have resulted in the design of many adjustable delivery systems, chairs, and pieces of equipment. Companies have marketed instrumentation specifically for people with small hands, yet little research has been done regarding the advertising claims. The objective of this study was to compare the perceptions of dental and dental hygiene students after they used a conventional syringe and a petite syringe that has been marketed as advantageous for individuals with smaller hands. The two syringes were compared for aspiration, injection, and sense of control. A total of 181 students were invited to serve as subjects in the study, and ninety participated. The study involved two phases. During phase I, students used conventional and petite syringes to give a simulated inferior alveolar nerve block injection. In phase II, students gave a simulated palatal injection using both sizes of syringes. After performing the simulations, the students responded to a questionnaire. The students reported that the petite syringe gave them control, and 62.2 percent of them preferred it to the conventional syringe. There were differences in preferences between female and male students and also differences in preferences based on students' glove sizes. The female students preferred the petite syringe when aspiration was required. Overall, the students who wore small and extra small gloves had a preference for the petite syringe and felt it provided a sense of control, a key component when learning to provide injections.

Syringe Size

We hypothesized that the size of syringe influenced needle control in physician-performed procedures. Operators were tested for their ability to control a 1-, 3-, 5-, 10-, and 20-mL syringe and equivalent sizes of the new safety device, the reciprocating procedure device (RPD), using the quantitative needle-based displacement method. Three hundred twenty clinical syringe procedures were then randomized to either a 3- or 10-mL conventional syringe or to a 3- or 10-mL RPD. Patient pain was measured with the Visual Analog Pain Scale (VAPS). Increasing syringe size was associated with the undesirable characteristic of unintended forward penetration (loss of control of the needle in the forward direction) (r(2) = 0.97, slope = 2.14, 95% CI: 1.54-2.76, P < 0.002), and unintended retraction (loss of control of the needle in the reverse direction) (r(2) = 0.97, slope 2.15, 95% CI: 1.54-2.76, P < 0.002). In addition, 2-handed operation of a syringe resulted in greater control than 1-handed operation of a syringe (P < 0.001). When 1-handed operation was required, the RPD control syringe reduced unintended penetration by 52.3% (P >or= 0.001), unintended retraction by 56.8% (P >or= 0.001), and patient pain by 54.7% (P >or= 0.001) at each device size. For greater safety and control when operating the conventional syringe, smaller syringe sizes and 2 hands instead of 1 hand should be used whenever possible. If 1-handed operation of a syringe is necessary, a safety technology like the RPD control syringe should be used.

Pulsed lavage reduces the incidence of radiolucent lines under the tibial tray of Oxford unicompartmental knee arthroplasty

The aim of the study was to determine whether the incidence of radiolucencies can be reduced using pulsed lavage before cementing the tibia in unicompartmental knee arthroplasty (UKA). We prospectively studied a consecutive series of 112 cemented Oxford UKA in 100 patients in two centres. In group A (n = 56) pulsed lavage and in group B (n = 56) conventional syringe lavage was used to clean the cancellous bone. The same standardised cementing technique was applied in all cases. At a minimum follow-up of one year patients were evaluated clinically and screened radiographs were obtained. The cement bone interface under the tibial plateau was divided into four zones and evaluated for the presence of radiolucent lines. All radiographs were evaluated (n = 112), and radiolucencies in all four zones were found in two cases in group A (4%) and in 12 cases in group B (22%) (p = 0.0149). Cement penetration showed a median of 2.6 mm (group A) and 1.5 mm (group B) (p < 0.0001). We recommend the routine use of pulsed lavage in Oxford UKA to reduce the incidence of radiolucency and to improve long-term fixation.

Reducing blood transfusion requirements in preterm infants by a new device: a pilot study

To test a new device designed to salvage red blood cells (RBCs) from blood samples drawn from preterm infants, with the intent of decreasing blood loss and lowering the requirements for RBC transfusions. A case-controlled pilot study was conducted in two Israeli neonatal intensive care units in large municipal hospitals. Twenty low-birthweight preterm infants were randomly and equally divided into the ErythroSave group or a control group. All blood tests in the study group (except for complete blood count and coagulation parameters) were obtained during the first week of life by the new device in the study group and by ordinary syringes in the control group. The main outcome measure was the total number of units of blood needed. The average volume of blood obtained for laboratory analyses from each infant was 27 mL in the ErythroSave group and 24 mL in controls (not significant). The average volume of transfused packed cells was 6.4 mL for the ErythroSave group and 21.3 mL for the controls (p = 0.008). The use of ErythroSave for sampling blood significantly reduced blood transfusion requirements in premature infants compared to sampling by conventional syringes.

Integration of Patient Safety Technologies Into Sclerotherapy for Varicose Veins

The American College of Surgeons, the Joint Commission, the Needlestick Safety and Prevention Act, and the Occupational Safety and Health Administration all direct surgical departments, including vascular surgeons who supply sclerotherapy services, to develop formal mechanisms to improve the safety of the patient and health care worker (HCW), including integration of new safety technologies. The purpose of the present study was to identify and evaluate new safety technologies for outpatient sclerotherapy for chronic venous disease. Using national resources for patient safety and literature review, the following safety technologies were identified: (1) a safety needle to reduce inadvertent needlesticks to workers, and (2) the reciprocating procedure device (RPD) to reduce iatrogenic injuries to patients. Both devices were evaluated in the clinic, and physician responses were determined. Although the safety sheath of the needle was somewhat bulky and could interfere with the ultrasound transducer, sclerotherapy could be performed with it. The RPD safety device required instruction to show how the RPD functioned ("push-push" to aspirate-inject with the RPD rather than the usual "push-pull" with the conventional syringe), but the RPD permitted better needle control and more precise injections. The RPD was well accepted by physicians who found it to be convenient, safer, and less painful. Subsequently, the involved services successfully integrated these safety technologies into their routine clinical practices. As recommended by the Joint Commission, safety technologies can be successfully evaluated and introduced into the clinic to improve patient and HCW safety during physician-performed syringe and needle procedures, including sclerotherapy.

Summary of: Pain perception during inferior alveolar injection administered with the Wand or conventional syringe

Objective This study compared a computerised device (the Wand) with a conventional syringe in terms of the pain of needle insertion and injection during inferior alveolar nerve (IAN) block injection. Methods and materials The subjects were 40 patients between the ages of 18 and 30 years requiring local anaesthesia for dental restoration in the mandible. Before anaesthetic administration, the patients' anxiety levels were determined. Contralateral IAN injections were administrated at two separate appointments with random use of either the Wand or a conventional syringe. Following the injection, the patients used both the pain rating score (PRS) and a visual analogue scale (VAS) to assess the intensity of pain. Results When pain was measured after the injection, the Wand was found to be less painful than the syringe for the pain of both needle insertion and injection (p <0.05). Conclusion The Wand technique resulted in significantly lower pain scores during the IAN block injections. Most of the patients preferred the IAN injection with the Wand for future dental injections.

Pain perception during inferior alveolar injection administered with the Wand or conventional syringe

This study compared a computerised device (the Wand) with a conventional syringe in terms of the pain of needle insertion and injection during inferior alveolar nerve (IAN) block injection. The subjects were 40 patients between the ages of 18 and 30 years requiring local anaesthesia for dental restoration in the mandible. Before anaesthetic administration, the patients' anxiety levels were determined. Contralateral IAN injections were administrated at two separate appointments with random use of either the Wand or a conventional syringe. Following the injection, the patients used both the pain rating score (PRS) and a visual analogue scale (VAS) to assess the intensity of pain. When pain was measured after the injection, the Wand was found to be less painful than the syringe for the pain of both needle insertion and injection (p <0.05). The Wand technique resulted in significantly lower pain scores during the IAN block injections. Most of the patients preferred the IAN injection with the Wand for future dental injections.

Alternative Anesthetic Technique for Maxillary Periodontal Surgery

Maxillary periodontal surgery typically requires multiple injections and may inadvertently affect facial structures such as the upper lip, lateral aspect of the nose, and lower eyelid. To minimize these sequelae and reduce the number of total injections, a relatively new injection technique has been proposed for maxillary procedures. The anterior middle superior alveolar (AMSA) injection is reported to effectively anesthetize maxillary teeth and associated gingival tissues extending from the buccal root of the first molar mesially to the central incisor with a single injection while avoiding undesirable side effects. The purpose of this article is to provide background information on the AMSA injection and demonstrate its use in a variety of maxillary periodontal surgeries. Anesthesia was provided for five separate maxillary periodontal surgeries with unilateral or bilateral AMSA injections. Injections were administered via conventional syringe with a 27-gauge needle. Confirmation of anesthesia was subjectively tested with buccal mucosal sticks and palatal transgingival probing. The AMSA injection provided promising results for a variety of maxillary periodontal surgical procedures. Benefits of the AMSA injection included outstanding palatal hemostatic control, avoidance of undesirable collateral anesthesia, and a reduced number of cumulative injections. Drawbacks of the AMSA injection included occasionally inadequate buccal hemostatic control and short-lived anesthesia of the maxillary central incisors. The AMSA injection is a novel anesthetic technique that may prove useful for certain maxillary periodontal surgeries.

Synthesis of various stimuli‐responsive gradient copolymers by living cationic polymerization and their thermally or solvent induced association behavior

AbstractStimuli‐responsive gradient copolymers, composed of various monomers, were synthesized by living cationic polymerization in the presence of base. The monomers included thermosensitive 2‐ethoxyethyl vinyl ether (EOVE) and 2‐methoxyethyl vinyl ether (MOVE), hydrophobic isobutyl vinyl ether (IBVE) and 2‐phenoxyethyl vinyl ether (PhOVE), crystalline octadecyl vinyl ether (ODVE), and hydrophilic 2‐hydroxyethyl vinyl ether (HOVE). The synthesis of gradient copolymers was conducted using a semibatch reaction method. Living cationic polymerization of the first monomer was initiated using a conventional syringe technique, followed by an immediate and continuous addition of a second monomer using a syringe pump at regulated feed rates. This simple method permitted precise control of the sequence distribution of gradient copolymers, even for a pair of monomers with very different relative monomer reactivities. The stimuli‐responsive gradient, block and random copolymers exhibited different self‐association behavior. © 2008 Wiley Periodicals, Inc. J Polym Sci Part A: Polym Chem 46: 6444–6454, 2008

Thermosensitive gradient copolymers by living cationic polymerization: Semibatch precision synthesis and stepwise dehydration‐induced micellization and physical gelation

AbstractThermosensitive forced gradient copolymers with various sequence distributions were synthesized by living cationic polymerization in the presence of an added base. The synthesis was conducted using a semibatch reaction method, which is unfavorable for ionic polymerization, especially when a simple apparatus is employed. Polymerization of 2‐ethoxyethyl vinyl ether (EOVE) was initiated using a conventional syringe technique. Immediately after initiation, 2‐methoxyethyl vinyl ether (MOVE) was continuously added using a syringe pump at regulated feed rates, which allowed control of the sequence distribution. The resulting gradient copolymers of EOVE and MOVE underwent thermally induced association in water, forming micelles with a hydrophobic core derived from EOVE‐rich segments. Interestingly, the size of the micelles obtained from gradient copolymers decreased monotonously with increasing solution temperature, while the micelles of the corresponding block copolymers were unchanged in size. This self‐association behavior can be controlled by designing the gradient pattern of the instantaneous composition. © 2008 Wiley Periodicals, Inc. J Polym Sci Part A: Polym Chem 46: 6151–6164, 2008

Patient satisfaction and costs associated with insulin administered by pen device or syringe during hospitalization

Patient satisfaction, safety and efficacy outcomes, and cost savings with insulin pens versus conventional insulin delivery via vials and syringes in hospitalized patients with diabetes were compared. Patients were recruited from two general medical-surgical units from July 2005 to May 2006. Patients completed a survey regarding satisfaction with the method in which insulin was administered before discharge. Patients completed a telephone survey approximately four weeks after discharge to determine home insulin use. Cost savings were determined using the average wholesale price of insulin vials and syringes, pens, and pen needles. A total of 94 patients were randomized to receive insulin administered via pen devices (n = 49) or using conventional vials and syringes (n = 45). Significantly more subjects in the pen group prepared or self-injected at least one dose of insulin during hospitalization, wanted to continue taking insulin at home using the method used during hospitalization, and would recommend their method of insulin administration used during hospitalization to other patients with diabetes compared with the vial and syringe group (p < 0.05). A cost saving of $36 per patient was projected if only insulin pens were dispensed during the entire hospital stay compared to insulin vials and syringes (p < 0.05). Increased patient satisfaction and continuation of the method of insulin administration used in the hospital at home were reported by patients who received insulin pens compared with patients who received conventional vials and syringes during hospitalization. A substantial cost saving was projected for patients in the insulin pen group if insulin pens had been dispensed during their entire hospital stay.

Comparison of follitropin- administered by a pen device with conventional syringe in an ART programme a retrospective study

This study compares the efficacy and patient tolerance of follitropin-beta (recagon) administered using a pen device with conventional syringe in infertile couples undergoing in vitro fertilization/intracytoplasmic sperm injection treatment. Data for 481 patients were retrieved retrospectively for the analysis. Conventional syringe group constituted 204 patients with 217 cycles and 265 patients with 294 cycles in the pen-device group. Down-regulation was achieved with GnRH agonist. Comparison of follitropin-beta administered with pen and syringe showed the following data, respectively. A total dose of 1909.38/2100.65 IU (P < 0.001), duration of stimulation, 9.70/10.47 days (P < 0.05), oestradiol levels on the day of human chorionic gonadotropin, 1488.34/1067.63 pg/ml, number of follicles reaching >16-mm size, 9.75/7.34 (P < 0.05), number of oocytes retrieved, 13.84/9.55 (P < 0.001) and number of embryos available for freezing, 4.56/1.30 (P < 0.05), the above data were observed in pen/conventional syringe groups, respectively. The live birth rates per cycle were 28.85% and 30.95% in the conventional syringe/pen-device groups, respectively. Patient tolerance with respect to pain at injection site was better with the pen device (P < 0.025). The data show that follitropin-beta administered with pen device is well tolerated and more efficacious with respect to ovarian stimulation outcome compared with the conventional syringe.

Integration of safety technologies into rheumatology and orthopedics practices: A randomized, controlled trial

To identify and integrate new safety technologies into outpatient musculoskeletal procedures and measure the effect on outcome, including pain. Using national resources for patient safety and literature review, the following safety technologies were identified: a safety needle to reduce inadvertent needlesticks to heath care workers, and the reciprocating procedure device (RPD) to improve patient safety and reduce pain. Five hundred sixty-six musculoskeletal procedures involving syringes and needles were randomized to either an RPD group or a conventional syringe group, and pain, quality, safety, and physician acceptance were measured. During 566 procedures, no accidental needlesticks occurred with safety needles. Use of the RPD resulted in a 35.4% reduction (95% confidence interval [95% CI] 24-46%) in patient-assessed pain (mean +/- SD scores on a visual analog pain scale [VAPS] 3.12 +/- 2.23 for the RPD and 4.83 +/- 3.22 for the conventional syringe; P < 0.001) and a 49.5% reduction (95% CI 34-64%) in patient-assessed significant pain (VAPS score > or =5) (P < 0.001). Physician acceptance of the RPD combined with a safety needle was excellent. As mandated by the Joint Commission and the Occupational Safety and Health Administration, safety technologies and the use of pain scales can be successfully integrated into rheumatologic and orthopedic procedures. The combination of a safety needle to reduce needlestick injuries to health care workers and the RPD to improve safety and outcome of patients is effective and well accepted by physicians.