Accuracy and Reproducibility of Injections from Prefilled “Code Cart” Syringes Compared to Standard Polypropylene Syringes

Abstract

Specific Aims: To evaluate the accuracy and reproducibility of small-volume injections from prefilled syringes and different sizes of polypropylene syringes. Methods: Atropine and epinephrine prefilled syringes were used to measure volumes of 0.5 mL and 1 mL of drug solution. Different sized polypropylene syringes (1-mL, 3-mL, and 10-mL) were used to measure volumes of 0.4 mL and 1 mL drawn from prefilled syringes. The measured volumes were compared to expected delivery volume. For analysis, t-tests and folded F test were conducted for prefilled syringe data and the general linear model and Levene’s test were used for polypropylene syringe data. Results: Both prefilled syringes demonstrated high variability at the 0.5 mL volume. The coefficient of variance (CV) was 14.3% and 15.0% for atropine and epinephrine for the first delivery and 7.39% and 9.41% for the second delivery. The 10-mL polypropylene syringe overdelivered 0.4 mL doses by 17.1% and 10.6% for atropine and epinephrine, respectively. With the 1 mL volume, the accuracy was improved and the expected delivery range was 0.863 to 1.19 mL (19% error). Use of a 3-mL or 1-mL syringe expectantly resulted in improved accuracy and precision. Conclusions: Using a 10-mL syringe, either prefilled or polypropylene, to measure volumes of 1 mL or less did not result in reproducible delivery of doses at the ±10% error threshold. When preparing doses smaller than the 20% of the total volume of a pre-filled syringe, we recommend using the smallest available polypropylene syringe that will accommodate the volume needed.