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Accuracy of enteral syringes with commonly prescribed paediatric liquid medicines

Arenas-López, S; Gurung, K; Tibby, SM; Calleja Hernández, MÁ; Tuleu, C; (2017) Accuracy of enteral syringes with commonly prescribed paediatric liquid medicines. Archives of Disease in Childhood , 102 pp. 655-659. 10.1136/archdischild-2016-312492. Green open access

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Abstract

OBJECTIVE: Oral syringes are the preferred method for delivering paediatric enteral drugs; however, little is known about factors affecting accuracy, particularly at volumes <5 mL. We investigated volumetric accuracy for enteral syringes, using commercially available liquid drug formulations with various physicochemical properties at clinically relevant volumes. DESIGN: In vitro experiment. INTERVENTIONS: Ten drugs were tested using two syringe brands (Baxa, Medicina) across a range of formulation volumes (0.05-5 mL) and syringe sizes (1-5 mL). Syringe weights (empty and filled) were converted into volume, using known formulation densities. Ten replications were performed for each drug/syringe/volume combination. MAIN OUTCOME MEASURES: Delivered volume accuracy was expressed as a percentage of intended volume, with the desired range being within ±10%. RESULTS: Baxa demonstrated a slight positive bias (excess average volumes delivered) at the smallest volumes for each syringe size, while Medicina had poorer precision (greater variability, analysis of variance-interactions all p<0.005). From these results, we identified the limit for volume accuracy for each syringe size and brand. Of note, the 1 mL syringe for both brands was inaccurate for delivering volumes ≤0.1 mL. The physicochemical properties of pH (range 2.82-7.45), surface tension (30.2-86.7 mN/m) and viscosity (2-299 mPaS) did not influence error in a discernible pattern. CONCLUSIONS: Dosing was inaccurate when small volumes were used across all syringe sizes and brands. These reflect volumes used in clinical practice. Administration error could potentially be reduced by (1) clinicians using syringes appropriate to dosing volumes and (2) manufacturers revising formulation concentrations for drugs.

Type: Article
Title: Accuracy of enteral syringes with commonly prescribed paediatric liquid medicines
Location: England
Open access status: An open access version is available from UCL Discovery
DOI: 10.1136/archdischild-2016-312492
Publisher version: http://dx.doi.org/10.1136/archdischild-2016-312492
Language: English
Additional information: This version is the author accepted manuscript. For information on re-use, please refer to the publisher’s terms and conditions.
Keywords: Enteral syringe, medication error, oral formulation, paediatric medicine
UCL classification: UCL > Provost and Vice Provost Offices
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Life Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Life Sciences > UCL School of Pharmacy
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Life Sciences > UCL School of Pharmacy > Pharmaceutics
URI: http://discovery.ucl.ac.uk/id/eprint/1545527
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