from the refrigerator, has to be used or discarded after 14 days.
Preloaded syringes containing succinylcholine can maintain their
potency for 90 days.
3. They prevent mixing errors. Phenylephrine is packaged in concentra-
tions that are 100 times stronger than what's needed for a typical
dose. So to get it into a useable range, you need to do a double dilu-
tion. In other words, you draw up the contents, dilute it down to 10
ccs, and then squirt out 9 of those ccs. And then you draw up another
10 ccs. But there's a lot of production pressure in ORs, and doing dilu-
tion on the fly is risky. I can guarantee people occasionally fail to do
the double dilution. I can also guarantee that it's a mistake that's way
under-reported. Thankfully, pre-filled syringes that are already 100-
fold diluted, which are what we use in my hospital system, eliminate
the potential for that human error.
4. They reduce direct drug contamination. Accessing vials through a rubber
lid while mixing in an open room is inherently riskier than mixing
them under a hood in a clean room.
5. They reduce cross-contamination. Anesthesia providers often add drugs
like phenylephrine and epinephrine to bags of saline to use as a dis-
pensary over the course of the day, because it's so much easier that
way. But what happens if someone gets confused and violates that
supply bag with a syringe that was already used with another patient?
That's much less likely with pre-filled single-use syringes.
6. They maintain consistent quality standards for safety and potency. Assuming,
that is, you're using an FDA-approved 503B provider (see "Compounders
are Stepping Up, Achieving Impressive Safety" on page 34).
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