Design, Evaluation, and Dissemination of a Plastic Syringe Clip to Improve Dosing Accuracy of Liquid Medications

Abstract

Pediatricians in Africa requested a tool to improve caregiver dosing of liquid antiretroviral medication. We developed, evaluated and disseminated a clip to control the amount of medication drawn into an oral syringe. In a laboratory, a user tested clips of different lengths, corresponding to different volumes, by drawing water into a syringe with a clip. In Texas and Malawi, 149 adults attempted to measure Pepto-Bismol™ using a syringe with a clip, a syringe without a clip, and a dosing cup, in a randomly assigned order. In the laboratory, the volume of liquid, ranging from 1 to 4.5 mL, drawn into the syringe was always within at least 5 μL of the intended dose. In Texas, 84% of doses were accurate within ±10%, vs. 63% using the syringe alone, and 21% with the dosing cup. In Malawi, 98% of doses were accurate to within ±10%, vs. 90% using the syringe alone, and 27% with the dosing cup. For target accuracy values within ±45% (±21%), a significantly higher fraction of Houston (Kamangira) participants delivered an accurate dose using the syringe with the clip than with the syringe alone (p < 0.05). The clip enables a greater proportion of users to accurately measure liquid medication.

Devices for oral and respiratory paediatric medicines: What do healthcare professionals think?

“…Caregivers may find it difficult to identify the correct dose, and marking or colour-coding the required dose on the device may alleviate this issue (Frush et al, 2004). Other strategies such as controlling the amount of medication that can be drawn up into an oral syringe have been applied (Spiegel et al, 2013). However, there are disadvantages to such approaches, for example, the dose required might change due to the growth of the child, or the marking may be removed during the cleaning of the device.…”

Drug safety: The concept, inception and its importance in patients’ health

“…For example, plastic syringes are excellent choices for administering syrups to children. They are better than measuring caps as they are easier to handle and can provide precise and accurate dosing (Madlon-Kay and Mosch, 2000, Sobhani et al, 2008, Ryu and Lee, 2012, Spiegel et al, 2013). If a medication is only available in the form of tablets or capsules, it is preferable to consult a pharmacist about the proper way to use the drug and how it should be administered to children.…”

Putting medical devices in context: a systematic review of evidence on design targeting low-resource settings

“…Feedback from the users came later, after having been through a series of prototyping cycles and a company was hired to further redesign the prototype to improve its functionality and reduce costs of manufacturing. Spiegel et al (2013) provide a similar example with the design of a dosing clip. In this case, a team of students received feedback from users in different countries after the device was designed.…”

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