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<TITLE>RE: [CARPA] benzathine needle jams</TITLE>
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<P ALIGN=LEFT><SPAN LANG="en-us"><FONT COLOR="#0000FF" FACE="Arial">Dear Alex</FONT></SPAN><SPAN LANG="en-us"></SPAN><SPAN LANG="en-us"></SPAN><SPAN LANG="en-us"><FONT COLOR="#0000FF" FACE="Arial">, please find a link to a protocol for</FONT></SPAN><SPAN LANG="en-us"></SPAN><SPAN LANG="en-us"></SPAN><SPAN LANG="en-us"><FONT COLOR="#0000FF" FACE="Arial"> the preparation of the</FONT></SPAN><SPAN LANG="en-us"></SPAN><SPAN LANG="en-us"></SPAN><SPAN LANG="en-us"><FONT COLOR="#0000FF" FACE="Arial"> benzathine</FONT></SPAN><SPAN LANG="en-us"></SPAN><SPAN LANG="en-us"></SPAN><SPAN LANG="en-us"><FONT COLOR="#0000FF" FACE="Arial"> injection</FONT></SPAN><SPAN LANG="en-us"></SPAN><SPAN LANG="en-us"></SPAN><SPAN LANG="en-us"><FONT COLOR="#0000FF" FACE="Arial"> issued by the Canadian Health Agency</FONT></SPAN><SPAN LANG="en-us"></SPAN><SPAN LANG="en-us"></SPAN><SPAN LANG="en-us"><FONT COLOR="#0000FF" FACE="Arial">. It explains why you are having</FONT></SPAN><SPAN LANG="en-us"></SPAN><SPAN LANG="en-us"></SPAN><SPAN LANG="en-us"> <FONT COLOR="#0000FF" FACE="Arial">problems</FONT></SPAN><SPAN LANG="en-us"></SPAN><SPAN LANG="en-us"></SPAN><SPAN LANG="en-us"><FONT COLOR="#0000FF" FACE="Arial"> with the injection</FONT></SPAN><SPAN LANG="en-us"></SPAN><SPAN LANG="en-us"></SPAN><SPAN LANG="en-us"><FONT COLOR="#0000FF" FACE="Arial"> and how to overcome this.</FONT></SPAN></P>
<P ALIGN=LEFT><SPAN LANG="en-us"></SPAN><A HREF="http://www.phac-aspc.gc.ca/std-mts/protocol_e.html"><SPAN LANG="en-us"></SPAN><SPAN LANG="en-us"></SPAN><SPAN LANG="en-us"><U><FONT COLOR="#0000FF" FACE="Arial">http://www.phac-aspc.gc.ca/std-mts/protocol_e.html</FONT></U></SPAN><SPAN LANG="en-us"></SPAN></A><SPAN LANG="en-us"></SPAN><SPAN LANG="en-us"></SPAN><SPAN LANG="en-us"></SPAN></P>
<P ALIGN=LEFT><SPAN LANG="en-us"><FONT COLOR="#0000FF" FACE="Arial">We received</FONT></SPAN><SPAN LANG="en-us"></SPAN><SPAN LANG="en-us"></SPAN><SPAN LANG="en-us"><FONT COLOR="#0000FF" FACE="Arial"> the following</FONT></SPAN><SPAN LANG="en-us"></SPAN><SPAN LANG="en-us"></SPAN><SPAN LANG="en-us"><FONT COLOR="#0000FF" FACE="Arial"> information from a doctor in NZ</FONT></SPAN><SPAN LANG="en-us"></SPAN><SPAN LANG="en-us"></SPAN><SPAN LANG="en-us"> <FONT COLOR="#0000FF" FACE="Arial">:</FONT></SPAN></P>
<P ALIGN=LEFT><SPAN LANG="en-us"><B><I><FONT COLOR="#0000FF" FACE="Arial">"</FONT></I></B></SPAN><SPAN LANG="en-us"><B><I></I></B></SPAN><SPAN LANG="en-us"><B><I></I></B></SPAN><SPAN LANG="en-us"><B><I><FONT COLOR="#0000FF" FACE="Arial">Crystalisation is prevented by heating the water for injection to<BR>
'body' temperature. Does this impare the antibiotic or alter the uptake<BR>
from the muscle?</FONT></I></B></SPAN><SPAN LANG="en-us"><B><I></I></B></SPAN><SPAN LANG="en-us"><B><I></I></B></SPAN><SPAN LANG="en-us"><B><I><FONT COLOR="#0000FF" FACE="Arial">"</FONT></I></B></SPAN></P>
<P ALIGN=LEFT><SPAN LANG="en-us"><FONT COLOR="#0000FF" FACE="Arial">This is the response received from the manufacturer of the drug:</FONT></SPAN></P>
<P ALIGN=LEFT><SPAN LANG="en-us"><B><I><FONT COLOR="#0000FF" FACE="Arial">" Did the user use needles of two different types: one larger to reconstitute the solution injecting the diluent into the vial of powder, one narrower for the injection once the vial has been rolled between the hands which also means heating the vial a little bit ? Please check that this reconstitution and injection procedure was followed properly.”<BR>
<BR>
“It is possible to heat the water for injection in order to make the benzathine benzylpenicillin disolution easier but the water shall not be heated over<BR>
+60°C (ie +140°F) which in fact would lead to the product degradation.<BR>
Moreover, the volume of w.f.i. must not be reduced; in fact if it was the case, the concentration would be too high and the injection far more too painful.”</FONT></I></B></SPAN><SPAN LANG="en-us"><B><I></I></B></SPAN><SPAN LANG="en-us"><B><I></I></B></SPAN><SPAN LANG="en-us"><B><I></I></B></SPAN></P>
<P ALIGN=LEFT><SPAN LANG="en-us"><FONT COLOR="#0000FF" FACE="Arial">Therefore it appears that the WFI can be heated to dissol</FONT></SPAN><SPAN LANG="en-us"></SPAN><SPAN LANG="en-us"></SPAN><SPAN LANG="en-us"><FONT COLOR="#0000FF" FACE="Arial">ve the powder.</FONT></SPAN></P>
<P ALIGN=LEFT><SPAN LANG="en-us"><FONT COLOR="#0000FF" FACE="Arial">With regard to the volume of the WFI, we have received feedback from doctors that they have successfully used 2mLs instead of 4mLs, however we leave this up to the discretion of the individual doctor.</FONT></SPAN><SPAN LANG="en-us"></SPAN><SPAN LANG="en-us"></SPAN><SPAN LANG="en-us"></SPAN></P>
<P ALIGN=LEFT><SPAN LANG="en-us"><FONT COLOR="#0000FF" FACE="Arial">Regards,</FONT></SPAN><SPAN LANG="en-us"></SPAN><SPAN LANG="en-us"></SPAN><SPAN LANG="en-us"><FONT COLOR="#0000FF" FACE="Arial"></FONT></SPAN><SPAN LANG="en-us"></SPAN><SPAN LANG="en-us"></SPAN><SPAN LANG="en-us"> </SPAN></P>
<P ALIGN=LEFT><SPAN LANG="en-au"></SPAN><A NAME=""><SPAN LANG="en-au"><FONT COLOR="#0000FF" FACE="Arial">Vanessa Thomas</FONT></SPAN></A></P>
<P ALIGN=LEFT><SPAN LANG="en-au"><FONT COLOR="#0000FF" FACE="Arial">Regulatory Affairs Manager</FONT></SPAN></P>
<P ALIGN=LEFT><SPAN LANG="en-au"><FONT COLOR="#0000FF" FACE="Arial">Aspen Pharmacare Australia Pty Ltd</FONT></SPAN></P>
<P ALIGN=LEFT><SPAN LANG="en-au"><FONT COLOR="#0000FF" FACE="Arial">34-36 Chandos Street</FONT></SPAN></P>
<P ALIGN=LEFT><SPAN LANG="en-au"><FONT COLOR="#0000FF" FACE="Arial">St Leonards 2065 NSW</FONT></SPAN></P>
<P ALIGN=LEFT><SPAN LANG="en-au"><FONT COLOR="#0000FF" FACE="Arial">ph: 61 2 8436 8300</FONT></SPAN></P>
<P ALIGN=LEFT><SPAN LANG="en-au"><FONT COLOR="#0000FF" FACE="Arial">fax: 61 2 99013540</FONT></SPAN><SPAN LANG="en-us"></SPAN><SPAN LANG="en-us"></SPAN><SPAN LANG="en-us"></SPAN><SPAN LANG="en-au"></SPAN></P>
<P ALIGN=LEFT><SPAN LANG="en-us"><FONT SIZE=2 FACE="Courier New">-----Original Message-----<BR>
From: carpa-bounces@ozdocit.org [<A HREF="mailto:carpa-bounces@ozdocit.org">mailto:carpa-bounces@ozdocit.org</A>] On Behalf Of Alex Hope<BR>
Sent: Friday, 12 January 2007 12:45 PM<BR>
To: carpa@ozdocit.org<BR>
Subject: [CARPA] benzathine needle jams</FONT></SPAN><SPAN LANG="en-us"></SPAN></P>
<P ALIGN=LEFT><SPAN LANG="en-us"><FONT SIZE=2 FACE="Courier New">G'day All,</FONT></SPAN></P>
<P ALIGN=LEFT><SPAN LANG="en-us"><FONT SIZE=2 FACE="Courier New">is it just us mob?</FONT></SPAN></P>
<P ALIGN=LEFT><SPAN LANG="en-us"><FONT SIZE=2 FACE="Courier New">We are having a lot of trouble with the Pan Benzathine product,</FONT></SPAN></P>
<P ALIGN=LEFT><SPAN LANG="en-us"><FONT SIZE=2 FACE="Courier New">no matter how well we mix it, and whether with water or lignocaine,</FONT></SPAN></P>
<P ALIGN=LEFT><SPAN LANG="en-us"><FONT SIZE=2 FACE="Courier New">and despite running it in and out of a syringe through a needle into the vial,</FONT></SPAN></P>
<P ALIGN=LEFT><SPAN LANG="en-us"><FONT SIZE=2 FACE="Courier New">when giving the actual injection the stuff jams part way through.</FONT></SPAN></P>
<P ALIGN=LEFT><SPAN LANG="en-us"><FONT SIZE=2 FACE="Courier New">sometimes you can retrieve it by jiggling the plunger, sometimes you can't. </FONT></SPAN></P>
<P ALIGN=LEFT><SPAN LANG="en-us"><FONT SIZE=2 FACE="Courier New">Then you pull the needle out, and try squirting it through and hey presto, the bloody thing is unblocked!</FONT></SPAN></P>
<P ALIGN=LEFT><SPAN LANG="en-us"><FONT SIZE=2 FACE="Courier New">But you won't always get a second or third go at the patient's backside!</FONT></SPAN></P>
<P ALIGN=LEFT><SPAN LANG="en-us"><FONT SIZE=2 FACE="Courier New">we are using 21G needles for giving, some say even with a 19G needle (in adults for RHD prophylaxis) it will jam up.</FONT></SPAN></P>
<P ALIGN=LEFT><SPAN LANG="en-us"><FONT SIZE=2 FACE="Courier New">Anyone else having the same trouble?</FONT></SPAN></P>
<P ALIGN=LEFT><SPAN LANG="en-us"><FONT SIZE=2 FACE="Courier New">Any clues as to how to get around it?Dr Alex Hope</FONT></SPAN></P>
<P ALIGN=LEFT><SPAN LANG="en-us"><FONT SIZE=2 FACE="Courier New">Community GP,</FONT></SPAN></P>
<P ALIGN=LEFT><SPAN LANG="en-us"><FONT SIZE=2 FACE="Courier New">Ltyentye Apurte Community Government Council Health Centre,</FONT></SPAN></P>
<P ALIGN=LEFT><SPAN LANG="en-us"><FONT SIZE=2 FACE="Courier New">CMB Santa Teresa,</FONT></SPAN></P>
<P ALIGN=LEFT><SPAN LANG="en-us"><FONT SIZE=2 FACE="Courier New">via Alice Springs,</FONT></SPAN></P>
<P ALIGN=LEFT><SPAN LANG="en-us"><FONT SIZE=2 FACE="Courier New">NT 0872.</FONT></SPAN></P>
<P ALIGN=LEFT><SPAN LANG="en-us"><FONT SIZE=2 FACE="Courier New">Ph 08 8956 0911</FONT></SPAN></P>
<P ALIGN=LEFT><SPAN LANG="en-us"><FONT SIZE=2 FACE="Courier New">Fax 08 8956 0910</FONT></SPAN></P>
<P ALIGN=LEFT><SPAN LANG="en-us"><FONT SIZE=2 FACE="Courier New">Mobile 0408 085 143</FONT></SPAN></P>
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