July 19, 2010

Syringe Lore - how to make 'em last

Everyone who uses a tube needs to use syringes.  Some just use little ones for flusing and administering medications etc, and they are generally no problem at all.  Those who bolus feed though....well, that's a different matter.

The usual syringe used for bolus feeding is a 60ml catheter tip syringe, although some use a slip tip.  The main difference is that a slip tip has its tip off towards the side, rather than in the centre of the barrel, which can be handy on-the-go if you want to dissolve meds in the syringe itself.  Your average 60ml syringe holds more like 70 or 80 ml when filled right up, and is designed for a single use only.  This last point is important.  Being medical supplies in this throwaway age, they are made and packaged in a sterile state and are only meant to be used once.

As if that's going to happen.

Your average catheter tip types.

When I was a very small child I had recurring nightmares involving The Count from Sesame Street chasing me around my family doctor's surgery with a Very Large Needle.  Yet I've never been afraid of needles, weirdly.  Imagine the needle they'd use on a 60ml syringe!  And yes, he always caught me.

When I first had my tube placed, and the hospital dietitian came around to help with my first feeding, she pointed this out, and carefully explained that as this was a hospital, and they were presently responsible for my safety etc etc, they would be using a fresh syringe every time.  But as syringes can be costly, and I'll be feeding 5 times a day......"most people get a good week out of a syringe but I wouldn't recommend longer than that" she said.  She also said "you didn't hear that from me".

On my planet, syringes are not covered by insurance or subsidised by the state, and I use them a lot, so I'm understandably interested in useability and longevity.  Because of hygiene and CYA (Covering Your Ass) issues, you may not get good info about caring for syringes from your medical provider - which is odd, as most insurers in the USA only provide a fraction of the number you'd need for 'single use only'.

As we do here, we'll distill the wisdom of the group, and I've broken it down as much as possible into issues.

1) How long do they last?

Well, it depends on all sorts of things.  The type of syringe, the sort of feed or food, how they're washed and cared for, and so on.  If you're just doing gravity feeds (ie not using the plunger) then the answer is as long as they still wash up OK.  The weak point of the setup is the rubber tip on the plunger, we'll look at that next in...

2) The Case Of The Recalcitrant Plunger

No, not that sort.  But the principles are oddly similar.

So, yes, the main problem is that the plunger gets hard to push or pull.  This is nearly always because the texture of the plunger changes, and it also 'grows' slightly from the wet/dry/hot/cold cycle of washing.

Tip #1:  Don't wash it.  I wouldn't do this personally, but there are people who do and aren't dead from food poisoning so it's probably OK but what they do is just wipe the plunger with a paper towel.  this does in fact seem to make it last a whole lot longer.

Even without washing, the rubber (or synthetic rubbery stuff) that most syringe stoppers are made of will start to get sticky or large, but you still want to be able to eke out its life and not have to have arms like Popeye to do a feed, so...

Tip #2:  Lube it up.  The three main variations on this I've heard are cooking spray (like you use for baking pans etc), cooking oil/olive oil (Popeye wouldn't use Olive Oyl surely, oh, The Horror!) or the blend itself.  I use the blend because it's easier and my blends are always oily enought to do the job.  I've used olive oil, which was OK, but haven't tried cooking spray because frankly the whole concept of aerosolized synthetically amended cooking spray makes me feel all uncomfortable.  Just seems wrong, but that's my personal problem.  Everyone who uses it says it works great!  You simply do a quick spray/dip before the first plunge of the session, and away you go.  Should be good for 5 or 6 plunges before having to repeat.

Tip #3:  Wash cold, dry together.  I'll get to washing shortly, but it is true that if you just use cold water you avoid the whole heat-expansion issue, and many people swear by letting the plunger dry in the syringe barrel, not quite pushed in all the way.  Lots of those people give it a quick lube spray first.


Tip #4:  Use a silicon O-ring syringe.  Sometimes the BD and tubefeeding boards have really happy days where a thread makes everyone smile and say "wow!"  I remember a couple such days when this subject came up, and The Squirrel Store Syringes were discovered (click to see).  They are available elsewhere, yes, but this seems to be the best price in the US.  I'm waiting for them to get back to me about shipping overseas as I'd have to buy a box of 125 locally, which would be silly.  Why silly?  Because those people who use them are in some cases actually embarrassed to admit how old their everyday syringes are.  The silicon o-ring has none of the problems a rubber stopper does.  End of story.  I'll be getting some soon as my supply (I bought tons) of the old Monojects is running out.  Here's a picture, see the difference:





3) What else goes wrong?

a) Barrel discolouration, which isn't actually a problem unless you are freaked by a brownish tinge and can't stop yourself thinking of it as 'dirty'.  It isn't dirty, because you wash it properly, right?  It's just yummy (usually oily) food stuff migrating into the plastic and staining it.  I have seen no evidence to suggest that the reverse happens (plastic migrating into food) and along with many others have happily lived with a very brownish syringe with nothing bad happening.
b)  Disappearing numbers.  On the printed-on types of syringes (as opposed to the moulded/scored types) the numbers eventually wash off.  If you actually use the numbers, and have the printed type, many people have found a simple strip of sellotape over the numbers protects them, and weirdly enough seems dishwasher-safe too.  Problem solved.

4) Washing - the best way?

Look, I don't know that there's a right answer to this question.  I've certainly changed my procedure from the fairly paranoid days when I first got the tube.  I don't have a dishwasher (because I think they're silly for a two-person household on a planet with an energy and water scarcity problem) so I would thoroughly wash with super-hot water and detergent immediately after every feed.  Rubber stoppers didn't last long, I can tell you.  Now I just do a super-hot rinse each time, with a detergenty wash once a day.  If I'm out I don't even bother and rely on the flushing water to do a good enough job, but then I'll only use that syringe for 2 feeds or so before washing it properly at home.  Or, I use 'old' ones I've saved and treat them as disposables.
Many people just toss them in the dishwasher.  Others will mainly use cold water, and I can see the scientfic sense there as heat does coagulate proteins, so hot water may in fact be making it harder to clean.  As I said, there's no right way.  What I can say is that my syringes last longer now, and are no more stained, than when I was more full-on about their care.


5)  Well, what's the best way to use the syringes then?

Preloaded salvo method?
Plug in/pour/plunge/de-plug/close tube/unplunge/plug in and repeat method?
Or draw up rather than pour?

Everyone does it differently, and like everything, what works best for you is what works best for you.  I know a few dishwasher users who pre-load a whole feed into syringes - say 6 or so - and just plunge them one after another.  All in the dishwasher, quick lube spray when they come out, all done.  You need a lot of syringes going at once for this obviously.  I do the second method above, but depending on the blend and how I feel I'll dilute a bit and let gravity do the plunging - so much easier.  Some people don't pull the plunger out, but draw back the feed with it and reinsert.  I even know of someone who doesn't use syringes anymore!  They use squeezy sauce bottles, large enugh for a whole feed.  Insert directly into tube end/extension, squeeze, momentarily remove for the bottle to 'breathe in' again, and repeat until all done.  Genius, really.

As always, please let me know what I've missed, what I've got wrong, and all your useful bits and pieces.  May your syringes last as long as you want them to.
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14 comments:

  1. http://www.baxa.com/NursingProducts/OralAndEnteralSystems/

    these syringes from baxa are the same 0-ring style. I have used some of mine for over 2 years with no problems, finally throwing them out because the numbers wore off. I cycle through different washing methods, depending on the mood. They go through the dishwasher very well, never swelling. Currently I simply rinse them with hot water and lay out to dry, also works well.

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  2. I love your humor and "realness" thanks for sharing!
    Tennille

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  3. So glad to know we are not alone in the 'can we make this syringe last a little longer' quest. silicon O-ring syringe's are a new phenomenom to me, must see if we can source them here in NZ. Any brand names to share?
    Nic A

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  4. Good link up top there, thanks. I must admit I can't recall the brand names of the ones my Vet friend was looking at for me, but that's the ticket I reckon - your local Veterinary clinic. I'll post more as I discover more!

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  5. Brilliant post! I think you have covered almost every possible angle I have encountered in the last five and a half years of syringe use! The silicon o-rings are new to me. I have to get my hands on some! As for the washing bit, we dont have hot tap water. Therefore we do cold water rinse after each meal, and only wash with soap if there is visible scum as soap definatly cuts the syringe life. The secret is to rinse immediatly after use. If things start to dry up everything goes downhill quickly! : )

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  6. Will definitely try out some of those methods to see what lasts longer for me.

    Nic A, where in NZ are you? I'm in ChCh. I don't know anyone else in NZ doing BD for their children, not sure though if you or your loved one are tube fed, my son is. Would love to touch base. mjfrancis@xtra.co.nz

    Completely understand if you would rather not though :)

    Thanks Eric for your fab advice and humorous wisdom!!

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  7. Any comments on which are best of the one use ones. I am able to get them free each month as it is a covered expense here in New York City. I use one a day for 3 meals.
    Nancy

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  8. Well, you answered some questions no one else could. Thank you google, and thank you for writing this blog. It is very informative!

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  9. very informative you have beautifully covered the each aspect of syringe life, i also wash the plunger and the syringe immediately after every feed, squeezy sauce bottles is really genius.thanks uzma

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  10. Thanks for the care tips, I really appreciate it! I have an old cat who has to be syringe fed and I was really getting frustrated with the syringes. I'll just rinse them with cold water from now on. But a nice dose of olive oil has brought them back to life!

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    Replies
    1. Omg. Thank u for so much information. It was really helpful.

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  11. I have the 60 cc cath tip o ring in stock
    http://www.squirrelstore.com/product/00265

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  12. It's 2017. I just had jaw surgery and had been struggling with my feeding syringes until I found our article. Godsend is all I can say. Thank you fir this from the bottom of my heart.

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  13. Hello Sachmo, my name is Ignacio I am currently taking care on my mother who had throat cancer surgery. We are feeding her with Bolus syringes. Can you please share that article so we can learn more about bolus feeding.

    Thanks in advance

    ignacio

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