Golan Shani, Pena John, Moore Jeffrey, Tandalam Sangeetha, Lelli Gary
Weill Cornell Medical College, Cornell University, New York.
New York-Presbyterian Weill Cornell, New York.
Facial Plast Surg. 2020 Aug;36(4):484-486. doi: 10.1055/s-0040-1713793. Epub 2020 Jul 20.
Clostridium botulinum toxin (BT) must be administered intramuscularly with a syringe, but dead space in the syringe-needle complex may cause product waste and result in cost implications for the patient and provider. Syringe dead space is the volume of residual fluid that remains within the syringe after the plunger is fully depressed during medication injection. We calculated the average volume of remaining product in a syringe-needle complex and cost loss implication of this volume of BT. This is a single-center, analytical study using saline and four different sized needles for analytics of waste product and cost-effectiveness. Syringes of 1 mL with attached 18, 21, 30, and 32-gauge (G) needles, respectively, were compared. The syringe-needle complex was weighed before drawing 0.05 mL of saline. The fluid was then discarded with the appropriate syringe and then weighed again. This procedure was repeated for the four needle types and the average difference in weight of the syringe-needle complex before and after saline waste was measured. The volume was converted to units of BT used in clinical practice and the cost of waste product evaluated. The mean difference in needle-syringe complex weight before and after intervention was 0.068, 0.056, 0.04, and 0.026 g for the 18, 21, 30, and 32G needles, respectively. We found a statistically significant difference comparing the 18G with the 30 and 32G (0.02 and 0.0007, respectively) and comparing the 21G with the 30 and 32G (0.0042 and 0.00002, respectively). When we extrapolated the data to BT units (4U/0.1 mL), we found that theoretically 2.72, 2.24, 1.6, and 1.04 units of BT are left in the syringe-needle complex for the 18, 21, 30, and 32G syringes, respectively. At a cost of $6.01/U of onabotulinum toxin A, we then calculated a provider loss of a gross average (mean) revenue of $96 and 62.4 per 10 syringes used with 30 and 32G needles. Needle size used for drawing up and administering BT has an effect on the amount of waste product and subsequently on cost-effectiveness.
肉毒杆菌毒素（BT）必须用注射器进行肌肉注射，但注射器 - 针头组合中的死腔可能会导致产品浪费，并给患者和医疗服务提供者带来成本问题。注射器死腔是指在药物注射过程中柱塞完全下压后仍留在注射器内的残留液体体积。我们计算了注射器 - 针头组合中剩余产品的平均体积以及该体积的BT所造成的成本损失。这是一项单中心分析研究，使用生理盐水和四种不同尺寸的针头来分析废品和成本效益。分别比较了连接18、21、30和32号（G）针头的1毫升注射器。在抽取0.05毫升生理盐水之前，对注射器 - 针头组合进行称重。然后用相应的注射器丢弃液体，再次称重。对四种针头类型重复此过程，并测量生理盐水浪费前后注射器 - 针头组合重量的平均差异。将体积转换为临床实践中使用的BT单位，并评估废品成本。对于18、21、30和32G针头，干预前后针头 - 注射器组合重量的平均差异分别为0.068、0.056、0.04和0.026克。我们发现，将18G与30G和32G进行比较（分别为0.02和0.0007）以及将21G与30G和32G进行比较（分别为0.0042和0.00002）时，存在统计学上的显著差异。当我们将数据外推到BT单位（4U/0.1毫升）时，我们发现理论上对于18、21、30和32G注射器，注射器 - 针头组合中分别剩余2.72、2.24、1.6和1.04单位的BT。以A型肉毒杆菌毒素每单位6.01美元的成本计算，我们随后计算出，每使用10个30G和32G针头的注射器，医疗服务提供者平均总收入损失分别为96美元和62.4美元。用于抽取和注射BT的针头尺寸会对废品量产生影响，进而影响成本效益。
