title: Accuracy of enteral syringes with commonly prescribed paediatric liquid medicines.
abstract: Oral syringes are the preferred method for delivering paediatric enteral drugs; however, little is known about factors affecting accuracy, particularly at volumes <5 mL. We investigated volumetric accuracy for enteral syringes, using commercially available liquid drug formulations with various physicochemical properties at clinically relevant volumes.
  
  
  
  In vitro experiment.
  
  
  
  Ten drugs were tested using two syringe brands (Baxa, Medicina) across a range of formulation volumes (0.05-5 mL) and syringe sizes (1-5 mL). Syringe weights (empty and filled) were converted into volume, using known formulation densities. Ten replications were performed for each drug/syringe/volume combination.
  
  
  
  Delivered volume accuracy was expressed as a percentage of intended volume, with the desired range being within ±10%.
  
  
  
  Baxa demonstrated a slight positive bias (excess average volumes delivered) at the smallest volumes for each syringe size, while Medicina had poorer precision (greater variability, analysis of variance-interactions all p<0.005). From these results, we identified the limit for volume accuracy for each syringe size and brand. Of note, the 1 mL syringe for both brands was inaccurate for delivering volumes ≤0.1 mL. The physicochemical properties of pH (range 2.82-7.45), surface tension (30.2-86.7 mN/m) and viscosity (2-299 mPaS) did not influence error in a discernible pattern.
  
  
  
  Dosing was inaccurate when small volumes were used across all syringe sizes and brands. These reflect volumes used in clinical practice. Administration error could potentially be reduced by (1) clinicians using syringes appropriate to dosing volumes and (2) manufacturers revising formulation concentrations for drugs.
authors.affiliation: Evelina London Children's Hospital, Guy's & St Thomas NHS Foundation Trust, London, UK.
authors.forename: Sara
authors.initials: S
authors.lastname: Arenas-López
authors.affiliation: UCL School of Pharmacy, London, UK.
authors.forename: Karuna
authors.initials: K
authors.lastname: Gurung
authors.affiliation: Evelina London Children's Hospital, Guy's & St Thomas NHS Foundation Trust, London, UK.
authors.forename: Shane M
authors.identifier: 0000-0001-7774-8656
authors.initials: SM
authors.lastname: Tibby
authors.affiliation: Pharmacy Service, University of Granada, Granada, Spain.
authors.forename: Miguel Ángel
authors.initials: MÁ
authors.lastname: Calleja Hernández
authors.affiliation: UCL School of Pharmacy, London, UK.
authors.forename: Catherine
authors.initials: C
authors.lastname: Tuleu
mesh_terms: D000284:Administration, Oral; D000704:Analysis of Variance; D006801:Humans; D004364:Pharmaceutical Preparations / Q000008:administration & dosage*; D012680:Sensitivity and Specificity; D012996:Solutions; D013594:Syringes / Q000592:standards*
chemical_list: D004364:Pharmaceutical Preparations; D012996:Solutions
keywords: enteral syringe; medication error; oral formulation; paediatric medicine