Though a simple device, the syringe has become an integral part of most health care settings. The World Health Organization (WHO) estimates that health care organizations administer up to 16 billion injectables globally every year. The demand for higher quality, more cost-effective syringes is increasing.
Disposable syringes or single-use syringes are available in two types – three-piece syringes and two-piece syringes. Three-piece syringes, also known as conventional or rubber-tip plunger syringes, are the most common disposable syringes. As the name suggests, they have three parts, namely the barrel, plunger, and rubber gasket. The rubber gasket over the tip of the plunger provides a sealing action, thus creating a vacuum to draw medication or fluids into the barrel. A lubricant (silicone oil) is sprayed over the inner walls of the barrel to prevent the rubber from grasping the sides of the barrel while sliding.
Another type of disposable syringe is the two-piece syringe containing only a plunger and a barrel. This type of disposable syringe is designed such that the plunger glides smoothly over the barrel and maintains a vacuum without the rubber gasket. Hence this eliminates the need for a lubricant. Two-piece syringes are suitable for both standard injections and blood withdrawal. When compared to three-piece syringes, two-piece syringes have shown some distinct advantages.
Scientific studies suggest that syringe material and lubricants can affect the stability of pharmaceutical proteins. One study, in particular, showed a significant amount of protein aggregation and considerable protein loss in silicone oil lubricated syringes compared to unlubricated polymer syringes. This finding suggests that using a three-piece syringe may lead to improper dosing due to protein loss within the syringe, thereby reducing the effectiveness of the treatment given.
Surfactant (an injectable) administered in neonates with respiratory distress syndrome plays a vital role in the treatment of neonatal ARDS. When the surfactant is aspirated into a three-piece syringe (with silicone lubricant), the surfactant often becomes inactivated. In contrast, when a two-piece syringe made with a poly-ethylene piston is used, there is no risk of inactivation. Thus, three-piece syringes compromise the therapeutic effect of the medication, thereby increasing the chances of a negative patient outcome.
Two-piece syringes are often the syringe of choice in cancer therapy for several reasons. For instance, sodium chloride solution is commonly used for radioisotope studies. When a three-piece syringe is utilized for drawing up the sodium chloride solution, the radiochemical purity is reduced (when tested by high-performance liquid chromatography). In contrast, while using a two-part syringe, the radiochemical purity, when similarly tested, remains unaffected.
The silicone oil lubricant used in three-piece syringes may contaminate the medication during use, affecting its potency. For these reasons and more, two-piece syringes are often preferred over three-piece syringes in hospitals across the US.
Since the onset of the COVID-19 pandemic, procuring good-quality two-piece syringes has become challenging. Reduced availability is primarily linked to disrupted supply chains, scarcity of raw materials, and manufacturing problems. Hospitals and healthcare organizations would benefit from collaborating with external agencies experienced in overcoming these unique challenges.
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