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A medication’s effectiveness largely depends on its appropriate dosage and the route of administration. Dosage ensures that a sufficient drug concentration is maintained in the bloodstream to elicit the desired therapeutic effect without causing toxicity. The route of administration affects the drug's bioavailability, rate of absorption, and onset of action, which are crucial for achieving optimal therapeutic outcomes. Drug dosage calculations are critical to tailoring therapy to...
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Individualization in dosing regimens is the customization of medication doses for individual patients. Its necessity arises from the goal of maximizing therapeutic benefits while minimizing risks. This approach is pivotal because human responses to drugs can vary widely; what is effective for one person may be inadequate or excessive for another. Interpatient (intersubject) variability refers to differences in drug responses between individuals, while intrapatient (intrasubject) variability...
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Determining the optimal dose size and dosing frequency in pharmacotherapy is crucial for achieving therapeutic effectiveness while minimizing adverse effects. This article explores the methodologies employed in determining these parameters, focusing on their significance and interplay to tailor dosing regimens.Dose Size: Dose size refers to the amount of a drug administered in a single dose. It is determined based on the drug's pharmacodynamics and pharmacokinetics properties and...
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Pediatric patient dosages diverge from adults due to disparities in body surface area, total body water, and extracellular fluid per kilogram of body weight. The dosing regimen considers the variations in pharmacokinetics and pharmacology across distinct age groups, encompassing preterm newborns, infants, young children, older children, and adolescents. Calculation of pediatric patient doses is predicated on determining body surface area, which exhibits a superior correlation with the child's...
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Elderly individuals encompass a diverse population with varying degrees of age-related physiological changes. Defining the elderly presents challenges, as the geriatric population is often arbitrarily categorized as individuals older than 65. However, many individuals in this group lead active and healthy lives, with an increasing number surpassing 85 years and falling into the older elderly category. Physiological changes associated with aging impact performance capacity and homeostatic...
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Assessing dosing errors in legacy and low dose tip ENFit® syringes.

Suvajyoti Guha1, Wesley Niswander1, Alexander Herman1

  • 1Office of Science and Engineering Laboratories, Center for Devices and Radiological Health, Silver Spring, Maryland, USA.

Journal of Clinical Pharmacy and Therapeutics
|October 29, 2021
PubMed
Summary

New enteral syringes (LDT) have similar dosing errors to legacy syringes, but errors increase with medication in the connector or reuse. Strategies exist to minimize errors for both syringe types.

Keywords:
ENFit®low dose tipneonateoverdosingpaediatricslip tipsyringe

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Area of Science:

  • Medical Device Engineering
  • Patient Safety
  • Pharmaceutical Science

Background:

  • Standardized ENFit® connectors aim to prevent misconnections in enteral medical devices.
  • Concerns exist regarding potential dosing errors with low volume (≤2 ml) syringes utilizing these new connectors.
  • Novel low dose tip (LDT) syringes were developed to address these specific concerns.

Purpose of the Study:

  • To quantify unavoidable dosing errors associated with LDT syringes.
  • To compare dosing accuracy between LDT and legacy syringes.
  • To propose strategies for optimizing dose accuracy in enteral applications.

Main Methods:

  • Computer-aided design (SolidWorks®) was employed to calculate dosing errors.
  • Evaluated 0.5 ml and 1.0 ml LDT and legacy syringe connectors.
  • Investigated the influence of delivery orientation, spillage, and flushing on dosing error.

Main Results:

  • LDT syringes show a maximum ±5% dosing error (without medication in the moat) comparable to legacy syringes.
  • With medication present and syringe reuse for flushing, LDT errors range from 1-18% (1.0 ml) and 28-35% (0.5 ml).
  • Dosing errors increase with reduced syringe capacity and lower delivered volumes for both LDT and legacy types.

Conclusions:

  • LDT syringe dosing errors can be reduced by clearing the moat area and using new syringes for flushing.
  • Legacy syringe errors are minimized by upward connector orientation during disengagement and using new syringes for flushing.
  • Both LDT and legacy syringe dosing accuracy are compromised by smaller volumes and specific usage scenarios.