Low dead space syringe

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A low dead space syringe (LDSS) or low dead-volume syringe is a type of syringe with a design that seeks to limit dead space that exists between the syringe hub and needle.

Contents

Differences from high dead space syringes

Example a low and high dead space syringe and the average fluid remaining after complete depression of the plunger. Contrast in dead space between syringe designs.png
Example a low and high dead space syringe and the average fluid remaining after complete depression of the plunger.

The difference between high and low dead space syringes is determined by the average quantity of fluid that cannot be expelled from the device. Although no set standard for the designation of low dead space syringes and needles exists, it is the convention to designate any needle or syringe design that deviates from the standard needle and syringe design as low dead space if this new design yields a lower dead space. [1]

As opposed to low dead space syringes, high dead space syringes are conventional needle and syringe designs. The term "high dead space" refers to the fluid remaining within the needle and between the syringe hub and the plunger. This space can be as high as 84 micro liters in conventional syringes. [2] Conventional high dead space syringes have existed since the mass production of plastic syringes with removable needles in 1961. [3]

However, there are problems associated with the dead space in syringes: medication waste, [4] disease transmission, [2] and inaccurate dosing. [5] Specifically, there is some data to suggest that disease transmission for people who inject drugs and carry Hepatitis C virus can be reduced with the use of low dead space syringes. [6]

History of needle and syringe designs

The first hypodermic needle was first used by Dr. Alexander Wood and immediately efforts were made to improve the design. It was not until 1954, with the need for massive syringe distribution of Dr. Salk's polio vaccine, that the first disposable syringes were created. Initially, they were made of glass. In 1961 plastic disposable syringes became available. [7] The advent of the first low dead space syringe occurred with the creation of 1-ml syringes designed specifically for the administration of insulin. Then amongst the scare of HIV and rising concern of other communicable diseases to healthcare workers the creation of safety syringes occurred in 1988. As of the last few years new designs have emerged that work on a needle that is low dead space and fits onto and transforms high dead space syringes into low dead space syringes. One design achieves this by creating a plunger that inserts itself into the syringe neck to expel as much fluid as possible from the syringe body, thus reducing the amount of space available within the neck. [8]

Various designs of low dead space syringes

Standard high dead space needle and syringe with extended plunger Standard high waste needle with a low waste syringe.jpg
Standard high dead space needle and syringe with extended plunger
1-ml syringe, "insulin syringe" 1-ml insulin syringe.jpg
1-ml syringe, "insulin syringe"
Standard high dead space syringe with low dead space needle Low waste needle with standard syringe.jpg
Standard high dead space syringe with low dead space needle

Designs

Fixed needle design

The insulin syringe was the first syringe that is considered low dead space. It was initially created with low dead space for accurate measuring and mixing of fast and slow acting insulin, which had the added benefit of wasting as little of the expensive drug as possible. An attached short and small gauge needle was also designed into the syringe to prevent the needle from detaching during administration of insulin and to decrease pain from frequent injections. [8]

Detachable needle design

Low dead space can be achieved in detachable syringes and needles through designing either the syringe or needle components to have low dead space.

Currently, the design of the low dead space needle incorporates a plastic neck that fits within the neck of a standard syringe hub.

A low dead space syringe is accomplished by using a standard syringe body with an extended plunger that inserts into the neck of the syringe body to expel more fluid from the syringe.

WHO guidelines for people who inject drugs

According to WHO guidelines for people who inject drugs it is suggested that needle exchange programs provide low dead space syringes for distribution to people who inject drugs due to evidence that the provision of low dead space syringes leads to a reduction in the transmission of HIV, and hepatitis B and C. [9] [10]

Benefits of low dead space syringes

Criticism for distributing low dead space syringes

Criticism to proponents of low dead space syringes being distributed to needle exchange programs claim that real world pilot studies do not exist to support findings within labs. Some proponents point to America and its low prevalence of HIV and hepatitis among people who inject drugs and cite the reason for such low prevalence to low dead space syringes already being the standard preferred syringe in the United States and successful anti-needle sharing campaigns. Other critics argue that countries like Vietnam, where low dead space needles are distributed and available, have the highest rates of HIV among people who inject drugs. However, proponents claim that low dead space syringes are still difficult to get and many people who use low dead space syringes still use high dead space syringes and thus reduce the potential effect of using low dead space syringes. [12] [13]

Related Research Articles

Harm reduction

Harm reduction, or harm minimization, refers to a range of public health policies designed to lessen the negative social and/or physical consequences associated with various human behaviors, both legal and illegal. Harm reduction policies are used to manage behaviors such as recreational drug use and sexual activity in numerous settings that range from services through to geographical regions.

Syringe Medical injection device

A syringe is a simple reciprocating pump consisting of a plunger that fits tightly within a cylindrical tube called a barrel. The plunger can be linearly pulled and pushed along the inside of the tube, allowing the syringe to take in and expel liquid or gas through a discharge orifice at the front (open) end of the tube. The open end of the syringe may be fitted with a hypodermic needle, a nozzle or tubing to direct the flow into and out of the barrel. Syringes are frequently used in clinical medicine to administer injections, infuse intravenous therapy into the bloodstream, apply compounds such as glue or lubricant, and draw/measure liquids.

Needle and syringe programmes Method of providing drug users with uninfected equipment

A needle and syringe programme (NSP), also known as needle exchange program (NEP), is a social service that allows injecting drug users (IDUs) to obtain hypodermic needles and associated paraphernalia at little or no cost. It is based on the philosophy of harm reduction that attempts to reduce the risk factors for blood-borne diseases such as HIV/AIDS and hepatitis.

Hypodermic needle Device to inject substances into the circulatory system

A hypodermic needle, one of a category of medical tools which enter the skin, called sharps, is a very thin, hollow tube with one sharp tip. It is commonly used with a syringe, a hand-operated device with a plunger, to inject substances into the body or extract fluids from the body. Large-bore hypodermic intervention is especially useful in catastrophic blood loss or treating shock.

A blood-borne disease is a disease that can be spread through contamination by blood and other body fluids. Blood can contain pathogens of various types, chief among which are microorganisms, like bacteria and parasites, and non-living infectious agents such as viruses. Three bloodborne pathogens in particular, all viruses, are cited as of primary concern to health workers by the CDC-NIOSH: HIV, hepatitis B (HVB), & hepatitis C (HVC).

Subcutaneous injection

A subcutaneous injection is administered as a bolus into the subcutis, the layer of skin directly below the dermis and epidermis, collectively referred to as the cutis. Subcutaneous injections are highly effective in administering medications such as insulin, morphine, diacetylmorphine and goserelin. Subcutaneous administration may be abbreviated as SC, SQ, sub-cu, sub-Q, SubQ, or subcut.Subcut is the preferred abbreviation to reduce the risk of misunderstanding and potential errors.

Needle sharing is the practice of intravenous drug-users by which a needle or syringe is shared by multiple individuals to administer intravenous drugs such as heroin, steroids, and hormones. This is a primary vector for blood-borne diseases which can be transmitted through blood. People who inject drugs (PWID) are at an increased risk for Hepatitis C (HCV) and HIV due to needle sharing practices. From 1933 to 1943, malaria was spread between users in the New York City area by this method. Afterwards, the use of quinine as a cutting agent in drug mixes became more common. Harm reduction efforts including safe disposal of needles, supervised injection sites, and public education may help bring awareness on safer needle sharing practices.

Injection (medicine) Method of medication administration

An injection is the act of administering a liquid, especially a drug, into a person's body using a needle and a syringe. An injection is considered a form of administering drugs via the parenteral route, which refers to routes of administration which do not involve absorption in the digestive tract. This allows the medication to be absorbed more rapidly and avoid the first pass effect. There are many types of injection, which are generally named after the body tissue the injection is administered into. This includes common injections such as subcutaneous, intramuscular, and intravenous injections, as well as less common injections such as intraperitoneal, intraosseous, intracardiac, intraarticular, and intracavernous injections.

Jet injector Medical injecting syringe

A jet injector is a type of medical injecting syringe device used for a method of drug delivery known as jet injection, in which a narrow, high-pressure stream of liquid that penetrates the outermost layer of the skin to deliver medication to targeted underlying tissues of the epidermis or dermis, fat, or muscle.

Infusion pump

An infusion pump infuses fluids, medication or nutrients into a patient's circulatory system. It is generally used intravenously, although subcutaneous, arterial and epidural infusions are occasionally used.

Needlestick injury Accidental puncture of skin causing contamination

A needlestick injury is the penetration of the skin by a hypodermic needle or other sharp object that has been in contact with blood, tissue or other body fluids before the exposure. Even though the acute physiological effects of a needlestick injury are generally negligible, these injuries can lead to transmission of blood-borne diseases, placing those exposed at increased risk of infection from disease causing pathogens, such as the hepatitis B virus (HBV), hepatitis C virus (HCV), and human immunodeficiency virus (HIV). Among healthcare workers and laboratory personnel worldwide, more than 25 blood-borne virus infections have been reported to have been caused by needlestick injuries. In addition to needlestick injuries, transmission of these viruses can also occur as a result of contamination of the mucous membranes, such as those of the eyes, with blood or body fluids, but needlestick injuries make up more than 80% of all percutaneous exposure incidents in the United States. Various other occupations are also at increased risk of needlestick injury, including law enforcement, laborers, tattoo artists, food preparers, and agricultural workers.

Needle remover

A needle remover is a device used to physically remove a needle from a syringe. In developing countries, there is still a need for improvements in needle safety in hospital settings as most of the needle removal processes are done manually and under severe risk of hazard from needles puncturing skin risking infection. These countries cannot afford needles with individual safety devices attached, so needle-removers must be used to remove the needle from the syringe. This lowers possible pathogen spread by preventing the reuse of the syringes, reducing incidents of accidental needle-sticks, and facilitating syringe disposal.

Sharps waste

Sharps waste is a form of biomedical waste composed of used "sharps", which includes any device or object used to puncture or lacerate the skin. Sharps waste is classified as biohazardous waste and must be carefully handled. Common medical materials treated as sharps waste are hypodermic needles, disposable scalpels and blades, contaminated glass and certain plastics, and guidewires used in surgery.

Drug injection

Drug injection is a method of introducing a drug into the bloodstream via a hollow hypodermic needle and a, which is pierced through the skin into the body. Intravenous therapy, a form of drug injection, is universally practiced in modernized medical care. As of 2004, there were 13.2 million people worldwide who, of which 22% are from developed countries.

Medicine in Star Trek refers to the medical technologies, procedures and conditions as seen in the Star Trek fictional universe.

HIV/AIDS in Australia

The history of HIV/AIDS in Australia is distinctive, as Australian government bodies recognised and responded to the AIDS pandemic relatively swiftly, with the implementation of effective disease prevention and public health programs, such as needle and syringe programs (NSPs). As a result, despite significant numbers of at-risk group members contracting the virus in the early period following its discovery, the country achieved and has maintained a low rate of HIV infection in comparison to the rest of the world.

Vietnam faces a concentrated HIV epidemic.

HIV prevention refers to practices that aim to prevent the spread of the Human Immunodeficiency Virus (HIV). HIV prevention practices may be undertaken by individuals to protect their own health and the health of those in their community, or may be instituted by governments and community-based organizations as public health policies.

Low-threshold treatment programs are harm reduction-based health care centers targeted towards people who use substances. "Low-threshold" programs are programs that make minimal demands on the patient, offering services without attempting to control their intake of drugs, and providing counselling only if requested. Low-threshold programs may be contrasted with "high-threshold" programs, which require the user to accept a certain level of control and which demand that the patient accept counselling.

Injector pen Drug storage and delivery device

An injector pen is a device used for injecting medication under the skin. First introduced in the 1980s, injector pens are designed to make injectable medication easier and more convenient to use, thus increasing patient adherence. The primary difference between injector pens and traditional vial and syringe administration is the easier use of an injector pen by people with low dexterity, poor vision, or who need portability to administer medicine on time. Injector pens also decrease the fear or adversity towards self-injection of medications, which increases the likelihood that a person takes the medication.

References

  1. ↑ Modeling the effect of high dead‐space syringes on the human immunodeficiency virus (HIV) epidemic among injecting drug users Bobashev, Georgiy V.; Zule, William A. Addiction, 2010, Vol.105(8), pp.1439-1447, 2010
  2. 1 2 3 Modeling the effect of high dead‐space syringes on the human immunodeficiency virus (HIV) epidemic among injecting drug users. Addiction [0965-2140] Bobashev yr:2010 vol:105 iss:8 pg:1439 -1447
  3. ↑ "Why the Invention of the Syringe Was a Game Changer".
  4. 1 2 3 Strauss K, van Zundert A, Frid A, Costigliola V. "Pandemic influenza preparedness: the critical role of the syringe". Erembodegem-Dorp 86, European Medical Association
  5. 1 2 Inadvertent overdosing of neonates as a result of the dead space of the syringe hub and needle. Archives of Disease in Childhood: Fetal and Neonatal Edition [1359-2998] Bhambhani yr:2005 vol:90 iss:5 pg:F444 -5
  6. ↑ Trickey, A., May, M. T., Hope, V., Ward, Z., Desai, M., Heinsbroek, E., . . . Vickerman, P. (2018). Usage of low dead space syringes and association with hepatitis C prevalence amongst people who inject drugs in the UK. Drug and Alcohol Dependence, 192, 118-124. doi:http://dx.doi.org.libaccess.lib.mcmaster.ca/10.1016/j.drugalcdep.2018.07.041
  7. ↑ Howard-Jones, N. A Critical Study of the Origins and Early Development of Hypodermic Medication
  8. 1 2 "Archived copy" (PDF). Archived from the original (PDF) on 2015-05-08. Retrieved 2016-02-08.CS1 maint: discouraged parameter (link) CS1 maint: archived copy as title (link)
  9. ↑ http://apps.who.int/iris/bitstream/10665/77969/1/9789241504379_eng.pdf
  10. ↑ http://apps.who.int/iris/bitstream/10665/75357/1/9789241504041_eng.pdf
  11. ↑ Rannou, M. Lheureux, N. Prangere, T. Legrand, J. Huglo, D. (2012) Absorption of radiopharmaceuticals to plastic syringes: Measurement and consequences. European Journal of Nuclear Medicine and Molecular Imaging. (39)S528-S529.
  12. ↑ Low dead space syringes: Authors’ response Zule, William A.; Cross, Harry E.; Stover, John; Pretorius, Carel International Journal of Drug Policy, 2013, Vol.24(1), pp.21-22, 2013
  13. ↑ Could low dead-space syringes really reduce HIV transmission to low levels? International Journal of Drug Policy [0955-3959] Vickerman yr:2013 vol:24 iss:1 pg:8 -14
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