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ForumsCompounding & FormulationNeedle gauge and dead space — need advice

Needle gauge and dead space — need advice

sarah_TO Wed, Jun 26, 2024 at 2:36 AM 14 replies 2,007 viewsPage 1 of 3
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sarah_TO
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Jun 26, 2024 at 2:36 AM#1

A reference post rather than a discussion. Corrections are the point; I would rather this be right than mine. It is about the dosing arithmetic, and it is deliberately narrow — everything I am not confident about is marked as such.

What is actually established

Dead space is the answer to the missing dose. A fixed-needle insulin syringe holds a few microlitres in the hub and needle after the plunger bottoms out, and on small draws that is a measurable percentage of every dose. Across ten draws it adds up to most of an eleventh, which is exactly the "nine draws from a ten-dose vial" complaint. Luer-lock syringes are worse; low-dead-space fixed-needle designs are better.

The condition it depends on

The arithmetic is right and one caveat matters: a U-40 syringe changes the markings, not the volumes. If someone hands you U-40 and you read it as U-100 you will be 2.5 times out, and that error has a direction — it is always an overdose.

The practical version

The three numbers to write on the vial: total mg, total ml, and mg per ml. Everything else is division. And the sanity check is that dose volume times number of doses should be less than the volume you put in, because dead space takes the difference.

What I am not sure about

The question I want answered is how much material I am losing to dead space, and whether that explains why a 10mg vial gives me nine usable draws rather than ten. I have searched first, so if this is covered somewhere point me at it and I will read it.

— sarah_TO · corrections welcome and will be edited into this post with credit
48 1andrew_nyc, Dr.EndoEP, GraceAZ_72 and 45 others
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MikeFit_NJ
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Jun 26, 2024 at 2:48 AM#2
sarah_TO said:
Dead space is the answer to the missing dose.

sarah_TO has the substance of this right. The condition it depends on is worth stating. Do it in two steps and it stops being confusing. First concentration: 10mg into 2ml is 5mg/ml. Then volume: a 0.5mg dose is 0.5 ÷ 5 = 0.1ml. Then units, and this is where people go wrong — a U-100 syringe is graduated in hundredths of a millilitre, so 0.1ml is 10 units. The word "units" has nothing to do with milligrams; it is a volume marking that exists because insulin happens to come at 100 units per ml.

I would rather be corrected than agreed with, if it comes to it.

49 2marcus_mpls, DeniseRN_TPA, SandraNC_45 and 46 others
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LibrarianMeg
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Jun 26, 2024 at 3:00 AM#3
sarah_TO said:
Dead space is the answer to the missing dose.

I am going to disagree with reconstituting low as a general rule. More diluent, more punctures, more in-use days at room temperature, and the stability trade-off is real. Precision is not the only variable being optimised.

Correct me if the detail matters more than I have assumed.

Last edited: Jun 26, 2024 at 5:00 AM
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DebRD_ATL
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Jun 26, 2024 at 3:12 AM#4

Short answer first, then the reasoning. Concentration choice is a precision decision, not a preference. Reconstitute high and every dose is a tiny volume where one unit of syringe error is a large fraction of the dose. Reconstitute low and you get more graduations per dose, so the same hand tremor costs proportionally less. Against that, more diluent means more benzyl alcohol and a shorter comfortable in-use window.

Last edited: Jun 26, 2024 at 7:12 AM
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GenomicsKate
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Jun 26, 2024 at 4:14 AM#5
MikeFit_NJ said:
Do it in two steps and it stops being confusing.

Same experience, arrived at from the opposite direction. I had assumed I was the exception until I read this.

Last edited: Jun 26, 2024 at 9:14 AM
2 5claudia_zurich, nancy_portland
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