Users Online: 866 Home Print this page Email this page Small font sizeDefault font sizeIncrease font size  
Home | About us | Editorial board | Search | Ahead of print | Current issue | Archives | Submit article | Instructions | Subscribe | Contacts | Login 


RSACP wishes to inform that it shall be discontinuing the dispatch of print copy of JOACP to it's Life members. The print copy of JOACP will be posted only to those life members who send us a written confirmation for continuation of print copy.
Kindly email your affirmation for print copies to dranjugrewal@gmail.com preferably by 30th June 2019.

 

 
Table of Contents
CORRESPONDENCE
Year : 2010  |  Volume : 26  |  Issue : 4  |  Page : 564-565

Particulate contamination in intravenous drugs: Coring from syringe plunger


Department 0f Anaesthesiology, PGIMS, Rohtak, India

Date of Web Publication3-Feb-2011

Correspondence Address:
S K Singhal
Department 0f Anaesthesiology, PGIMS, Rohtak
India
Login to access the Email id

Source of Support: None, Conflict of Interest: None


PMID: 21547200

Rights and PermissionsRights and Permissions

How to cite this article:
Singhal S K. Particulate contamination in intravenous drugs: Coring from syringe plunger. J Anaesthesiol Clin Pharmacol 2010;26:564-5

How to cite this URL:
Singhal S K. Particulate contamination in intravenous drugs: Coring from syringe plunger. J Anaesthesiol Clin Pharmacol [serial online] 2010 [cited 2020 May 27];26:564-5. Available from: http://www.joacp.org/text.asp?2010/26/4/564/74621

Dear Sir,

Particulate matter can be defined as "the mobile, undissolved substances unintentionally present in parenterals. [1] A wide variety of particulates have been reported in parenteral solutions, including asbestos fibers, rubber particles, chemical particles, cellulose fibres, fungi, starch, diatoms, and glass particles. [2] ("Particulates can enter these solutions in various manners. Many may enter the solutions during processing. There are not universally applicable guidelines, and thus assuming that problem may be of questionable significance. Colloidal particles of a plasticizer, di-2-ethylhexylphthalate (DEHP) have been identified as being present in solutions contained in polyvinylchloride (PVC) bags. Agitation of the bags increased the amount of DEHP delivered, while the addition of ethanol to the solution in the bags so significantly increased the amount of DEHP delivered that Corley,et al. recommended that a warning be included with solutions in PVC bags-" not to compound ethanol solutions in the bags". [3]

Recently we encountered a particulate contamination in freshly prepared thiopentone syringe. Three black particles were floating in the syringe and were grossly visible [Figure 1]. After filtering it on the cotton gauge [Figure 2] the particulate matter seemed to be of black rubber which we thought could have cored either from saline bottle seal or thiopentone vial. But when we examined the saline bottle and thiopentone vial, the colour of their seal was grey. Further looking into the cause it was observed that the particulate has sheared off from the syringe plunger. ([Figure 1] arrow showing the site). Ideally in a good quality syringe this problem should not occur but recycled goods are pumped into market by spurious manufactures which can cause such problem for which responsibility lies on the anaesthesiologist although ultimate sufferer is patient. As from literature syringe plunger can be a source of silicone contamination [4] and some time particulate contamination if it is sheared during transfer or aspiration of drug from other syringe with needle. [5]

There are many solutions offered to prevent complication from coring. In-line "final" filtration may be the ultimate answer. Davis, et al. report that in-line final filtration appears to be 100% effective in the removal of particulates. [6] There is still some question about the value of these filters under routine clinical conditions. The EmulSivTM filter (EF; Pall Biomedical Products Co., East Hill, NY, USA) is a filter specifically created for use with lipid emulsion based drugs like propofol. This 0.45 micron rated filter is purported to provide protection from accidental microbial contamination, particulate contamination and entrained air while maintaining the integrity of the emulsion. [7] For the prevention of glass particle contamination in peripheral intravenous admixtures, the use of pre-filled syringe drugs can be a useful method. [8]
Figure 1: Black particulate matter floating in thiopentone syringe and arrow depicting sheared plunger.

Click here to view
Figure 2: Particulates filtered on cotton gauge piece.

Click here to view


There is no consensus on the problems of and possible solutions to particulate contamination. It is a problem that the anaesthesiologist should be aware of, and exercise reasonable precautions to assure the particulate free drug delivery to patients.

 
   References Top

1.Lim Y S, Turco, S Davis N M. Particulate matter in small-volume parenterals as determined by two methods. Amer J Hos Pharm 1973; 30: 518-525.  Back to cited text no. 1
    
2.Garvan J M, Guinner B W. The harmful effects of particles in intravenous fluids. Med J Aust 1964; 2: 1-6.  Back to cited text no. 2
    
3.Corley J M, Needlham T E, Stumner E D, Mikeal R. Effects of various factors on the amount of plasticizer in intrav enous solutions packaged in flexible bags. Am J Hosp Pharm 1977; 34: 259-64.  Back to cited text no. 3
    
4.Sendo T, Otsubo K, Hisazumi A, et al. Particle contamination in contrast media induced by disposable syringes. J Pharm Sci 1995; 84: 1490-91.  Back to cited text no. 4
[PUBMED]    
5.Cohen H, Prieto N, Hunter CH. A foreign body in propofol syringe. Anesth Analg 2006; 103: 784  Back to cited text no. 5
    
6.Chamberland M E Lyons R W Brock S M Effects of in­line filtration of intravenous infiusions on the incidence of thrombophlebitis Am J Hosp Pharm 1977; 34: 1068-70.  Back to cited text no. 6
    
7.Hall Wendy C E , Jolly DT, Hrazdil J, Galbraith JC, Greacen M, Clanachan AS, The EmulSivTM filter removes microbial contamination from propofol but is not a substitute for aseptic technique. Can J Anesth 2003; 50: 541-46.  Back to cited text no. 7
    
8.Katsuhiro Yorioka, Shigeharu Oie, Masafumi Oomaki, Akihisa Imamura and Akira Kamiya, "Particulate and Microbial Contamination in In-Use Admixed Intravenous Infusions", Biol. Pharm. Bull 2006; 29: 2321-23.  Back to cited text no. 8
    


    Figures

  [Figure 1], [Figure 2]



 

Top
 
  Search
 
    Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
    Access Statistics
    Email Alert *
    Add to My List *
* Registration required (free)  

 
  In this article
    References
    Article Figures

 Article Access Statistics
    Viewed1748    
    Printed53    
    Emailed1    
    PDF Downloaded315    
    Comments [Add]    

Recommend this journal