Small Volume Syringe Research Articles

ACCURACY AND PRECISION OF INTRAVITREAL INJECTIONS OF ANTI-VASCULAR ENDOTHELIAL GROWTH FACTOR AGENTS IN REAL LIFE: What Is Actually in the Syringe?

To evaluate the accuracy and precision of anti-vascular endothelial growth factor volume delivery by intravitreal injections in the clinical setup. Volume output was measured in 669 intravitreal injections administered to patients, calculated from the difference in syringe weight before and after expelling the drug. Three groups were included: prefilled bevacizumab 1.0 mL syringe (Group 1, n = 432), pre-filled ranibizumab in a small-volume syringe with low dead-space plunger design (Group 2, n = 125), and aflibercept drawn and injected using a 1.0-mL syringe (Group 3, n = 112). Accuracy was analyzed by mean absolute percentage error, and precision by coefficient of variation. Volume outputs in all 3 groups were significantly different from the target of 50 μL (P < 0.0001 for all), and mean absolute percentage error values were 12.25% ± 5.92% in Group 1, 13.60% ± 8.75% in Group 2, and 24.69% ± 14.84% in Group 3. No difference was found between groups 1 and 2, but both were significantly more accurate than Group 3 (P < 0.0001 for both). The current practices used for intravitreal injections are highly variable, with overdelivery of the anti-vascular endothelial growth factor drugs measured in most cases, but underdelivery in 16.3% of injections. Use of a prefilled syringe was associated with improved accuracy, and low dead-space plunger design may improve precision.

Safe vincristine use in Switzerland: Still a long way to go?

Different international organizations recommend safety measures for the use of vincristine to prevent wrong route administrations. A central recommendation is to use infusion bags instead of syringes to prevent confusion with intrathecal chemotherapy. This study aimed to investigate the implementation of safety measures for vincristine and intrathecal chemotherapies in Switzerland. We conducted a written survey among hospital pharmacies of all general care and pediatric hospitals in Switzerland (n = 102). A responsible person of each hospital pharmacy was invited by email to participate in the online survey in May 2018. Of 66 responding hospitals (response rate 65%), 27 have a hospital pharmacy preparing parenteral chemotherapy. All of these hospitals prepared vincristine in 2017, while 21 also prepared intrathecal chemotherapy. Of these 21, 16 hospitals prepared vincristine as syringes, with small volume syringes being the most widely distributed dosage form. A switch from syringes to infusion bags was discussed in seven hospitals, and discussions led to plans for switch in two. The most prevalent safety measures were labeling for vincristine and special delivery for intrathecal drugs. Of hospitals preparing both vincristine syringes and intrathecal chemotherapy, four reported to have no safety measures implemented neither for vincristine nor for intrathecal chemotherapy. International recommendations are not widely implemented in Swiss hospitals. Syringes are still in use and other safety measures are sparsely disseminated. Thus, Swiss vincristine patients are still at an increased risk for wrong route application. Recommendations have to be further disseminated and implementation could be enhanced.

Perfusion des médicaments vasoactifs à très faible débit : influence des modalités du relais et du volume des seringues (étude expérimentale)

ObjectiveThe flow rate of intravenous administration of vasoactive agents should be steady in order to prevent changes in hemodynamics. In the newborns, because the flow rate is often lower than 1mL/h, it is difficult to switch of the syringe. The aim of our study was to compare the variations of concentration of active substance delivered after a manual or an automatic switch off the syringe with three different volumes (10mL, 20mL and 50mL). Materials and methodsGlucose solution (10g/L) was used to simulate the administered substance. Saline was administered in “Y” simultaneously with the glucose solution through a catheter. The infused substance was collected at the tip of the catheter. The glucose concentration was measured at 15min-interval for 3hours. ResultsThe manual switch of the syringe was associated with a significant alteration of the flow rate, lasting more than 15min. In contrast, the automatic switch of syringes was associated with no change of the flow rate, especially with small-volume syringes (10mL). ConclusionIn newborns, in order to prevent the change in flow rate of drugs after a switch of syringes, our results suggest the use of syringe-pump with built-in automatic switch and small-volume syringes.

Accuracy and Reproducibility of Seven Brands of Small-Volume Syringes Used for Intraocular Drug Delivery

Little is known about the accuracy and precision of syringes used to deliver small-volume intravitreal injection of medication. The authors investigated the accuracy and reproducibility of seven brands of small-volume syringes used for intravitreal injection. This experimental laboratory investigation compared EXELint 1 cc TB, BD Luer-lok, BD 1 cc TB, Kendall Monoject TB, Nipro TB, Terumo 1 cc, and Terumo 0.5 cc syringes. A calibrated Pipetman served as a control. One hundred syringes of each brand delivered 0.05 mL and 0.10 mL distilled water onto a balance. One-sample t-test (P < .01) compared delivered and intended volumes. The Nipro TB was the most accurate syringe at 0.05 mL. All other brands over-delivered the target volume. At 0.10 mL, the BD Luer-lok and Nipro TB were the most accurate. BD Luer-lok over-delivered while Nipro TB under-delivered, but these deviations were not statistically significant. The Pipetman control was the most accurate and reproducible device at both volumes. Nipro TB was the most accurate syringe at both volumes. Terumo 0.5 cc gave the most reproducible results but lacked accuracy. These findings may affect treatment efficacy and explain variability in treatment responses. Industry-standardized delivery devices may increase the accuracy and reproducibility of medication delivery.

Assessing the accuracy of intracameral antibiotic preparation for use in cataract surgery

To evaluate 2 local dilution protocols to assess the accuracy and variability of intracameral antibiotic dosage in cataract surgery. Tennent Institute of Ophthalmology, Glasgow, United Kingdom. Ten ophthalmic operating room nurses from 2 local hospitals participated. Oven-dried analytical grade potassium chloride (KCl) was used as a surrogate for cefuroxime. Solutions intended for intracameral use (1.0 mg in 0.1 mL) were prepared according to the 2 protocols. Twenty samples were obtained for each protocol. Ten analytical chemists also performed both dilutions. Concentrations of KCl in each 0.1 mL sample were analyzed by flame photometry. Thirty samples were obtained for each protocol. The median dose after dilution was 1.17 mg (range 0.62 to 1.77 mg) for protocol 1 and 2.05 mg (range 0.52 to 7.25 mg) for protocol 2. The median was significantly higher for protocol 2 (P < .001). There was also greater variability with protocol 2. This study shows that the mathematical accuracy of a dilution protocol does not ensure dosage accuracy in the clinical scenario. Inadequate mixing in a 1.0 mL syringe was probably responsible for the inaccuracy of protocol 2, indicating that small-volume syringes should not be used for mixing. However, protocol 1 had an acceptable range of variability. Replication of this study could evaluate other protocols and address concerns regarding the accuracy of intracameral antibiotic preparations.

Guidelines for use of the MS26 daily rate syringe driver in the community.

Many patients cared for in the community have complex care and treatment needs and syringe drivers are commonly used to administer a range of drugs to patients at home. However, serious problems have been associated with this route of administration. In Scotland between 1989 and 1994 there were 23 incidents including 4 fatalities associated with the use of small volume syringe pumps reported to the Common Services Agency supplies division (Scottish Office Home and Health Department (SOHHD), 1995). The four fatalities were attributed to over-infusion (SOHHD, 1995). In those fatal inadvertent incidents no fault was found with the infusion device, suggesting that an inadvertent error had been made by attendants in setting up or in using the device, or that some form of tampering had taken place. The Department of Health issued a hazard warning in 1994 (DoH, 1994) about confusion between the two Sims Graseby syringe drivers the MS16A and the MS26. This article outlines guidance on the use of the Sims Graseby MS26 in the community. Community nurses have a vital role to play in management of syringe drivers, and it is through increased awareness of correct procedures that incidents and fatalities will be avoided.

Flow rate variability from selected syringe and mobile infusion pumps.

Alterations in response to pharmacological agents have been attributed to flow rate variation produced by intravenous infusion devices during drug delivery. A wide range of variation has been shown to occur with large-volume infusion devices. The intent of this investigation was to examine flow variation resulting from the use of selected small-volume syringe and mobile infusion devices and determine whether these devices have greater flow continuity than large-volume infusion pumps. Each syringe and mobile infusion device delivered iv fluid at three flow rates (1, 5, and 10 ml/h). The effusate was collected in a tared beaker and serial weights were measured every ten seconds using a computerized, gravimetric technique. Accuracy, continuity, and pattern of flow were determined for each of the syringe and mobile infusion devices. All of the devices produced accurate flow, within +/- 10 percent of the desired 5 and 10 ml/h rates. However, the actual iv flow rate ranged from 53 to 93 percent for the 1 ml/h rate. Continuity and pattern of flow resulting from each device were diverse. When compared with large-volume, microrate infusion devices, no significant differences could be observed. Therefore, no clear advantage to delivering drug solutions on a continuous basis can be expected from the use of small-volume devices. Specific infusion devices may be preferable for certain clinical applications; flow continuity data may be valuable when selecting an infusion device.