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The requirements of a drug infusion device for use in theatre are discussed. A modification of the Graseby MS16A syringe pump and an interface circuit permitting its remote control by microcomputer are described. The pump is controlled via a standard computer interface (RS232) which makes it a unique and powerful research tool. Aspects of safety are considered.
A simple procedure is described for synthesis of oligonucleotides by phosphate chemistry. Chains can be constructed rapidly with minimal equipment (a syringe and reagent bottles). The method is illustrated by synthesis of d-TGCAGGTT. Pertinent supporting data on the effect of variations in the detritylation, condensation, oxidation, capping and cleavage steps in the synthetic approach and in isolation procedures are also presented.
IMPLICATIONS: Remifentanil and propofol mixtures may be prepared extemporaneously. This study demonstrated that such mixtures are stable for 0 to 36 h, depending on relative concentrations of the drugs and the storage container used. The most stable mixtures were stored in syringes and used large concentrations of the two drugs.
The evaluation of hemodialysis ultrafiltrate is essential for the assessment of uremic toxins, dialyzer net performance, protein catabolic rate, and safety and environmental protection. Total dialysate collection (TDC), however, is technically far from the daily procedure used. In the present study, use of a continuous syringe extraction method (CSEM) as a substitute for TDC was tested to determine its comparative effectiveness. Measurements of urea nitrogen, creatinine, phosphate, beta2-microglobulin, and albumin were simultaneously obtained by both TDC and CSEM in 20 dialysis sessions. CSEM showed an extremely significant correlation with TDC for these values. The correlation coefficients were >0.97 for these indicators and the value of Fisher's r to z were all <0.001. Taken together, these data indicate that CSEM is an effective substitute for TDC. With use of CSEM, the evaluation of spent dialysate could become as a daily procedure.
The first large-scale syringe and needle exchange (SANE) programs were established in The Netherlands and in the United Kingdom (UK) about 8 years ago. Since then, SANE programs have been established in Australia, Sweden, Canada, and the United States. To date, the most useful data concerning the impact of these programs have come from studies in the UK and from New Haven, San Francisco, Tacoma, and New York City in the US. Successful SANE programs require careful planning; those in charge should be familiar with the accomplishments, problems, and goals of established programs. Advance publicity and involvement of community activists, the local police precinct, and ward or district politicians are imperative for overcoming misunderstandings and prejudices and fostering a team approach. Pilot projects must be adequately funded. Other requirements include accessible facilities, convenient hours of operation (including evening hours), provision of mobile units if at all possible, and provision for sanitary disposal of discarded injection equipment in the neighborhood around the SANE programs. Programs also should have a strong evaluation component, preferably staffed by an independent university-affiliated research center. Periodic site visits are necessary to ensure that services promised in the protocol are actually delivered not only initially, but also over time. Problems with security and drug dealing in and around the building where the SANE program is located are likely, and appropriate measures should be taken to counter them.
Providing single-use injection equipment to persons who inject illicit drugs would appear to be an effective method for reducing HIV transmission. However, interviews with manufacturers, syringe exchange program staff, and drug users revealed numerous difficulties with such a technologic solution. All designs for such equipment can be defeated and should probably be called difficult-to-reuse equipment. There are problems with consumer acceptance of difficult-to-reuse equipment and with safe disposal of large amounts of biohazardous waste. Despite these problems, it would be useful to conduct additional research, particularly on the potential for placing difficult-to-reuse equipment into shooting galleries.
Standard techniques of bone grafting for nonunion involve extensive dissection of the soft tissues surrounding the nonunion site to gain exposure and facilitate placement of the graft. Successful minimally invasive grafting has been described; however, it can involve difficulties in graft placement or require the use of advanced, expensive technical equipment. We describe a simple, inexpensive technique in which the distal end of a standard syringe is trimmed to provide a conduit for minimally invasive delivery of bone graft material. Three illustrative case reports are discussed in which this technique achieved successful union without operative morbidity.
Labelled adhesive tape for the identification of syringe contents with suitable dispensers which can be obtained in the United Kingdom is described. The equipment can be obtained from the 3M Company at the following address: 3M United Kingdom Ltd., Converted Products, Wigmore Street, London W1A 1ET.
An electronic syringe pump accidentally delivered a solution of buprenorphine at an accelerated rate. Following an extensive investigation by the manufacturers, this malfunction was attributed to a short circuit in the electronic control system by a particle of extraneous conductive material within the unit.
The stability of preservative-free morphine in plastic syringes over 36 hours in the range of concentrations commonly used in our hospital to provide continuous morphine infusions was investigated. The morphine concentration remained at 100% (SD 1.5 percent) of the control values over 36 hours and demonstrates that the concentration of morphine is not reduced with time in these circumstances.
Failure of battery-powered equipment during the interhospital transfer of patients is potentially life threatening. The time to failure of 60 fully-charged identical syringe pumps (20 from each batch purchased in 1992, 1994 and 1995) was measured. Older pumps were associated with less predictable charge capacity, with 40% of the 1992 pumps failing within 60 min. The premature failure of these pumps is most likely due to poor battery care. It is unsafe to assume that a fully-charged, battery-powered pump will continue to function throughout a long transfer. The routine carriage of spare pumps or a backup power supply is recommended.
This study examined the stability of concentrated sodium nitroprusside infusions during administration by a motorized syringe-pump system. Sodium nitroprusside and the free-cyanide degradation product were determined in infusion samples collected over periods of up to 24 h. Measures which were taken to protect the delivery system from light, ensured satisfactory stability of the infusion for at least 12 h from the time of preparation.
The shelf lives of doxorubicin, daunorubicin and epirubicin in infusion fluids were studied using high-performance liquid chromatographic (HPLC) methods. Doxorubicin and epirubicin were stable (loss in potency of less than 10%) for 24 and 20 days respectively, when dissolved in sodium chloride solution (0.9%; pH, 6.47) at 25 degrees C and stored in polyvinyl chloride (PVC) minibags, while daunorubicin was stable for at least 43 days. All three drugs were stable for at least 43 days in sodium chloride (0.9%; pH 6.47 and 5.20) and dextrose (5%; pH 4.36) at 4 and -20 degrees C. Repeated thawing and re-freezing of these solutions at ambient temperature did not cause degradation. All three drugs were stable for at least 43 days when reconstituted with Water-for-Injections BP and stored in polypropylene syringes at 4 degrees C.
The purpose of these investigations was to determine the stability and adsorption behaviour of succinylcholine chloride (SCC) when stored in plastic syringes. Drug degradation was monitored using the USP high-pressure liquid chromatography method. Solutions containing 20 mg/ml of SCC in 5% dextrose, and in normal saline, were studied at 5, 25 and 40 degrees C. The hydrolysis of SCC in i.v. fluids followed apparent zero-order kinetics. The manufacturer's recommended expiry period was found to be too conservative. If protected from light, storage at room temperature for up to 3 months can be safely recommended, without significant loss of chemical stability. However, microbiological quality assurance will need to be implemented and an appropriate shelf-life assigned on the basis of both microbiological and chemical stability data.
One hundred diabetics were investigated for the accuracy and reproducibility with which they delivered a mixture of insulins. In contrast with previous reports, 80 patients delivered their total dose with a bias less than 5% from the prescribed dose and 87 with a CV less than 5%. There was little deterioration with age. The proportions of short- and intermediate-acting insulin prescribed were also delivered with commendable skill. In a separate study, syringe dead space was shown to incur a potential financial loss through insulin wastage, as well as affecting the proportions of short- and intermediate-acting insulins delivered.
Eleven adolescent diabetics, aged 15.1 +/- 1.3 years (mean +/- 1SD) in poor glycaemic control (HbA1 12.0 +/- 1.5% at entry) were commenced on a four times daily insulin injection regimen using the Penject fountain-pen syringe with Initard (50:50 mixture of porcine soluble and isophane) insulin on a sliding scale. Diabetic control improved over a 3-month period, assessed by a reduction in both the mean preprandial blood glucose concentrations (10.9 +/- 3.3 mmol/l to 7.7 +/- 2.3 mmol/l) and mean glycosylated haemoglobin concentrations (12.0 +/- 1.5% to 9.5 +/- 0.9%). Further improvement was again seen in 5 patients who remained on four daily injections for an additional 3 months (mean HbA1: 9.6 +/- 0.9% to 8.4 +/- 1.0%), whereas diabetic control in 6 patients who returned to twice daily injections deteriorated (mean HbA1 rose from 9.5 +/- 1.0% to 10.6 +/- 1.6%). Multiple insulin injections using an injection pen are acceptable to adolescent diabetics and improve their control.
A 32-year-old insulin-dependent diabetic patient reported recurrent clouding of her short-acting insulin, caused by silicone oil contamination from re-used disposable syringes.
OBJECTIVE: To determine the accuracy of a syringe esophageal detector device (EDD) for detecting esophageal intubations in an out-of-hospital setting. METHODS: Prospective, observational study of adult (age > or = 18 years) patients intubated by paramedics from October 1993 through May 1994 in an urban emergency medical services (EMS) system. Paramedics were instructed to record the EDD reading after endotracheal tube placement. However, paramedics were instructed not to modify their tube locations based on the EDD reading. Tube placement was evaluated by a physician upon patient arrival at a local ED. RESULTS: Paramedics performed 374 intubations during the study period, and in 213, the EDD was used. Of these 213 patients, 45 were excluded from analysis (32-tube placement not confirmed, 11-paramedic uncertain of EDD reading, 2-too young). In the remaining 168 intubations, the EDD correctly identified 5 of 10 esophageal intubations (sensitivity 50%; 95% CI: 19%, 81%). The EDD correctly identified 156 of 158 tracheal intubations (specificity 99%; 95% CI: 96%, 100%). CONCLUSIONS: In this paramedic field study, the EDD demonstrated poor sensitivity for esophageal intubations. Further EMS studies of the EDD are needed to clarify the value of the device in out-of-hospital emergent clinical intubations.