EBME Forums Forums Maintenance Technical Assistance Syringe types

I have concerns about the different types of syringes used on the various syringe drivers within a Hospital. As you may be aware all the syringe drivers with the exception of the ms16A and ms26A series, are capable of detecting the size of syringe in use but not the make of syringe( e.g Omnifix). The models we have in use will recognise the size of the syringe correctly and then prompt the user to confirm the make of syringe before continuing on to start the infusion. This unfortunately is not very clear on some syringe drivers or for their users. What therefore can and has been happening is that the user confirms the wrong make of syringe to the one actually in the syringe barrel and the pump goes on to infuse as requested. However, although the outside diameter of most syringes is very similar, the variation is within the internal diameter. This as you can see leads to the actual infused volume varying higher or lower than what the correct make of syringe would have infused. This of course could have serious implications should an incident ever occur.
Does any one have information on the % of error that can be introduced with the various syringes.

Woodie
The % variation can be quite marked and is dependant on the diameter variations between the different makes of syringe as you have stated. However, obtaining the specifications for each syringe manufactured can prove impossible.
Why doesn't your hospital standardise on one make of syringe? This will eliminate your problem.

Problem is that you can standardise on a syringe type but the users can select and then confirm a different type of syringe is being used on a pump (e.g. ALARIS Asena) and continue to use it - this can lead to under or over-infusion despite a standard syringe being used, i.e. operator error is the problem. What is required is both standard syringes only being available and these being the only ones capable of being selected on the syringe pump. The facility to default to a very limited range of standardised syringes is a useful feature that can be used to prevent the scenario described I suppose.

The other problems you might get is occlusion pressure. Not only when enter the type of syringe, the software selects the correct speed and pumping pressure of that type of syringe. This is not so much of a problem if you are using the transducer for occlusion monitoring.

We did some test using BD Plastipak and Thermo syringes. Using a Graseby 3100 syringe pump. Keeping the pump set at BD Plastipak we ran the two types of syringe overnight on the IDA. The errors we got were around the 22% mark.

Accuracy of Pump: 5%
Biotek IDA-4+: 1%

We try to get the trust to use one type of syringe, but had no luck there.

A.M

We are having similar problems anaesthetists using anaesthesia pumps and not allowing us to deselect "problem syringes" that are obviously being selected in error, in use, with the likelihood that this is causing them to underinfuse propofol under certain circumstances.

As you say, the pumps cannot always determine that the incorrect syringe is fitted. The argument is that they don't know what syringes stores may send on any given day - not a particularly valid one in my opinion. I'm just waiting for a genuine incident to crop up concerning patient awareness under anaesthesia.

This, coupled with the fact that these same staff are complaining about how long it takes for use to investigate these potentially operator-induced problems (in my opinion) leads to frustration for all concerned. I wish people would stop seeing the work we do as an obstacle rather than being of value in establishing engineering controls to mitigate risk.

Don't think I'll be wasting my time working in this environment much longer if this attitude to the work we do persists.

Hi Richard,

I'll think you will find you can lock out certain syringe types on the Alaris Asena, thus eradicating operator error.

If you have a problem with different makes of syringe being available in your Trust and all the potential risks that this could cause; then why not refer it to your Risk Management Team to look at.

Yes John and it's a fact I've been using the ASENA PK editor for quite a while now and I have years of experience of working with ALARIS syringe drivers of all types so I'm pretty familiar with them. I have been doing PK configurations for a while.

Unfortunately (fortunately?) it's a senior anaesthetist that needs to "sign off" the configurations for release (I think this should be the case) hence the request is to retain syringe types I personally would not wish to retain.

Even if you lock the Asenas to one syringe type, say BD-Plastipak, you can still fit 5 - 30 ml Braun Omnifix syringes which the pump will allow you to run as BD's and give, as we discovered in the department, a 15% over-infusion.

With trusts always trying to save money by looking for cheaper consumables, I feel that the potential risks of over/under infusions are increasing rapidly. Effective user training with regards correct consumables for correct pumps must be the way forward.

Yes I agree - operators are the potential source of problems in this case.