Prefilled glass syringes incompatible with certain needle-free connectors
Due to drug shortages of certain vials or prefilled syringes of emergency medications, including atropine and naloxone injections, some hospitals have been providing prefilled glass syringes instead. However, certain needle-free syringe connectors for I.V. lines called Luer-activated valve (LAV) connectors are incompatible with prefilled glass syringes. This was first reported by ISMP in April 2021 after reports of naloxone injection failures when attached to MicroClave needle-free syringe connectors (http://www.ismp.org/node/42880).
Recently, ISMP and the FDA have received multiple reports from clinicians who have been unable to inject medication into an I.V. line once the prefilled glass syringe has been connected to the needle-free system. Inserting the glass syringe tip can cause the pin in the MicroClave needle-free access system to break off in the syringe tip, preventing delivery of the medication. In some events, a piece of plastic was found lodged inside the syringe tip (nozzle), effectively blocking the flow of medication (see Pin from LAV connector and Clogged syringe tip).
On November 22, 2022, the FDA released an alert (http://www.ismp.org/ext/1046) regarding LAV internal pins breaking after practitioners attached prefilled glass syringes. This problem has involved glass syringes from Aurobindo Pharma, Dr. Reddy's Laboratories, and most recently, Accord Healthcare (atropine sulfate prefilled glass syringes). Incompatibility can delay therapy, particularly in emergent and urgent situations, and potentially result in serious harm. The FDA has requested LAV connector manufacturers to update the labeling on their products to warn practitioners that connectors with an internal pin may not be compatible with prefilled glass syringes. As of this writing, the FDA recommends:
* Inform staff that compatibility issues may occur when using prefilled glass syringes with LAV connectors with an internal pin.
* Review the instructions on LAV connectors used in your organization to determine if they have an internal pin and/or contact the manufacturer to confirm.
* Stock medications that come in plastic prefilled syringes or vials (when possible), or purchase connectors that do not use an internal pin.
* If your facility uses LAV connectors with an internal pin and medications packaged in prefilled glass syringes, establish and implement a plan to ensure the safe administration of these drugs.
QuVa Pharma two-sided labels for I.V. bags
Labels on I.V. bags by QuVa Pharma, a 503B outsourcing facility, will have significant improvements so clinicians can view product information from both sides of the bag (http://www.ismp.org/ext/1043). The oxytocin I.V. bag will be the first product with these new labels to be released in early 2023, with additional I.V. bags with these labels to follow later next year (see View of the new and improved oxytocin I.V. bag label).
The front of the I.V. bag label contains the required drug/dosing information, bar code, and important warnings, while the back of the label contains the drug name and concentration in a large font size so clinicians can see it when looking through the I.V. bag solution from the back. The new label will help differentiate oxytocin bags from hydrating solutions and magnesium infusions.