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Syringe dead space: difference between revisions

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94The vial-yield arithmetic follows from the wastage figure. Each dose consumes 0.20 mL delivered plus 0.070 mL retained, or 0.270 mL. From 2.00 mL, seven full doses can be drawn (7 × 0.270 = 1.89 mL), with 0.11 mL remaining — insufficient for an eighth. The nominal ten doses have become seven, a 30% reduction. With a fixed-needle insulin syringe at 0.005 mL, each dose consumes 0.205 mL and nine full doses can be drawn, with 0.155 mL remaining.{{r|ppdeadspace}}94The vial-yield arithmetic follows from the wastage figure. Each dose consumes 0.20 mL delivered plus 0.070 mL retained, or 0.270 mL. From 2.00 mL, seven full doses can be drawn (7 × 0.270 = 1.89 mL), with 0.11 mL remaining — insufficient for an eighth. The nominal ten doses have become seven, a 30% reduction. With a fixed-needle insulin syringe at 0.005 mL, each dose consumes 0.205 mL and nine full doses can be drawn, with 0.155 mL remaining.{{r|ppdeadspace}}
9595
+96| Device dead space | Volume consumed per 0.20 mL dose | Full doses from 2.00 mL | Loss against nominal |
+97|---|---|---|---|
+98| 0.005 mL | 0.205 mL | 9 | 10% |
+99| 0.020 mL | 0.220 mL | 9 | 10% |
+100| 0.070 mL | 0.270 mL | 7 | 30% |
+101| 0.100 mL | 0.300 mL | 6 | 40% |
+102
96=== Priming and air management ===103=== Priming and air management ===
97The mechanism by which the dose error arises is the presence of gas where liquid is assumed. Descriptions of injection technique in manufacturers' [[Prescribing information|prescribing information]] and in nursing references accordingly treat expulsion of air before the dose is measured as a defined step, and treat the graduation as valid only for a gas-free barrel and hub.{{r|who2015}}104The mechanism by which the dose error arises is the presence of gas where liquid is assumed. Descriptions of injection technique in manufacturers' [[Prescribing information|prescribing information]] and in nursing references accordingly treat expulsion of air before the dose is measured as a defined step, and treat the graduation as valid only for a gas-free barrel and hub.{{r|who2015}}
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104This is a separate error source from dead space and the two are additive. Insulin syringes carry the tighter requirements of ISO 8537 and are graduated in units rather than in millilitres, which introduces the conversion problem discussed at [[Insulin syringe unit conversion]].{{r|iso8537}}111This is a separate error source from dead space and the two are additive. Insulin syringes carry the tighter requirements of ISO 8537 and are graduated in units rather than in millilitres, which introduces the conversion problem discussed at [[Insulin syringe unit conversion]].{{r|iso8537}}
105112
+113== Low-dead-space devices ==
+114Interest in reducing dead space arose in two unrelated fields.
+115
+116In injecting-drug-use epidemiology, the retained volume determines how much blood a syringe carries between users. Modelling work has argued that widespread substitution of low-dead-space devices would materially reduce transmission of blood-borne viruses, on the basis that the residual blood volume — and therefore the inoculum — is reduced by more than an order of magnitude. The argument is a modelling argument supported by laboratory measurement of retained blood volume rather than by a trial of transmission outcomes, and it has been presented as such.{{r|zule2009,zule2013,bobashev2010}}
+117
+118In vaccination and pandemic preparedness, dead space determines how many doses can be drawn from a fixed vial, and therefore how far a constrained supply extends. Analyses during influenza-preparedness planning noted that substituting devices of a few microlitres of dead space for devices of 70–80 µL could increase the number of doses obtainable from a multi-dose presentation by a substantial fraction, and that the effect is proportionally larger the smaller the dose.{{r|strauss2006,who2015}}
+119
106== References ==120== References ==
107{{reflist}}121{{reflist}}
108<ref name="zule2009">Zule WA, Bobashev G. "High dead-space syringes and the risk of HIV and HCV infection among injecting drug users." ''Drug and Alcohol Dependence'' 100(3):204–213 (2009).</ref>122<ref name="zule2009">Zule WA, Bobashev G. "High dead-space syringes and the risk of HIV and HCV infection among injecting drug users." ''Drug and Alcohol Dependence'' 100(3):204–213 (2009).</ref>
109<ref name="zule2013">Zule WA, Cross HE, Stover J, Pretorius C. "Are major reductions in new HIV infections possible with people who inject drugs? The case for low dead-space syringes in highly affected countries." ''International Journal of Drug Policy'' 24(1):1–7 (2013).</ref>123<ref name="zule2013">Zule WA, Cross HE, Stover J, Pretorius C. "Are major reductions in new HIV infections possible with people who inject drugs? The case for low dead-space syringes in highly affected countries." ''International Journal of Drug Policy'' 24(1):1–7 (2013).</ref>
+124<ref name="bobashev2010">Bobashev GV, Zule WA. "Modeling the effect of high dead-space syringes on the human immunodeficiency virus (HIV) epidemic among injecting drug users." ''Addiction'' 105(8):1439–1447 (2010).</ref>
110<ref name="strauss2006">Strauss K, van Zundert A, Frid A, Costigliola V. "Pandemic influenza preparedness: the critical role of the syringe." ''Vaccine'' 24(24):4874–4882 (2006).</ref>125<ref name="strauss2006">Strauss K, van Zundert A, Frid A, Costigliola V. "Pandemic influenza preparedness: the critical role of the syringe." ''Vaccine'' 24(24):4874–4882 (2006).</ref>
111<ref name="who2015">World Health Organization. ''WHO Guideline on the Use of Safety-Engineered Syringes for Intramuscular, Intradermal and Subcutaneous Injections in Health Care Settings''. Geneva (2015).</ref>126<ref name="who2015">World Health Organization. ''WHO Guideline on the Use of Safety-Engineered Syringes for Intramuscular, Intradermal and Subcutaneous Injections in Health Care Settings''. Geneva (2015).</ref>
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122* [[Insulin syringe unit conversion]]137* [[Insulin syringe unit conversion]]
123* [[Reconstitution calculator]]138* [[Reconstitution calculator]]
+139* [[Multi-dose vial]]
124140
125{{DEFAULTSORT:Syringe dead space}}141{{DEFAULTSORT:Syringe dead space}}