Syringe

A typical plastic medical syringe, fitted with a detachable stainless steel needle

According to the World Health Organisation, about 90% of the medical syringes are used to administer drugs, 5% for vaccinations and 5% for other uses such as blood transfusions.^[1]

A syringe is a simple pump consisting of a plunger that fits tightly in a tube. The plunger can be pulled and pushed along inside a cylindrical tube (called a barrel), allowing the syringe to take in and expel a liquid or gas through an orifice at the open end of the tube. The open end of the syringe may be fitted with a hypodermic needle, a nozzle, or tubing to help direct the flow into and out of the barrel. Syringes are often used to administer injections, insert intravenous drugs into the bloodstream, apply compounds such as glue or lubricant, and measure liquids.

The word "syringe" is derived from the Greek σύριγξ (syrinx, meaning "tube") via back-formation of a new singular from its Greek-type plural "syringes" (σύριγγες).

Medical syringes

The threads of the Luer lock tip of this 12mL disposable syringe keep it securely connected to a tube or other apparatus.

An old glass syringe.

Sectors in the syringe and needle market include disposable and safety syringes, injection pens, needleless injectors, insulin pumps, and specialty needles.^[2] Hypodermic syringes are used with hypodermic needles to inject liquid or gases into body tissues, or to remove from the body. Injecting of air into a blood vessel is hazardous, as it may cause an air embolism; preventing embolisms by removing air from the syringe is one of the reasons for the familiar image of holding a hypodermic syringe pointing upward, tapping it, and expelling a small amount of liquid before an injection into the bloodstream.

The barrel of a syringe is made of plastic or glass, usually has graduated marks indicating the volume of fluid in the syringe, and is nearly always transparent. Glass syringes may be sterilized in an autoclave. However, most modern medical syringes are plastic with a rubber piston, because this type seals much better between the piston and the barrel and because they are cheap enough to dispose of after being used only once, reducing the risk of spreading blood-borne diseases. Reuse of needles and syringes has caused spread of diseases, especially HIV and hepatitis, among intravenous drug users. Syringes are, however, commonly reused by diabetics, and this is safe if the syringe is only used by one person.^[3] In medical settings, single-use needles and syringes effectively reduce the risk of cross-contamination.^[4]

Medical syringes are sometimes used without a needle for orally administering liquid medicines to young children or animals, or milk to small young animals, because the dose can be measured accurately and it is easier to squirt the medicine into the subject's mouth instead of coaxing the subject to drink out of a measuring spoon.

Tip designs

Syringes come with a number of designs for the area in which the blade locks to the syringe body. Perhaps the most well known of these is the Luer lock, which simply twists the two together.

Bodies featuring a small, plain connection are known as slip tips and are useful for when the syringe is being connected to something not featuring a screw lock mechanism.

Similar to this is the catheter tip, which is essentially a slip tip but longer and tapered, making it good for pushing into things where there the plastic taper can form a tight seal. These can also be used for rinsing out wounds or large abscesses in veterinary use.

There is also an eccentric tip, where the nozzle at the end of the syringe is not in the centre of the syringe but at the side. This causes the blade attached to the syringe to lie almost in line with the walls of the syringe itself and they are used when the blade needs to get very close to parallel with the skin (when injecting into a surface vein or artery for example).

Standard U-100 insulin syringes

Insulin syringes are marked in insulin "units".

Syringes for insulin users are designed for standard U-100 insulin. The dilution of insulin is such that 1 mL of insulin fluid has 100 standard "units" of insulin.^[5] Since insulin vials are typically 10 mL, each vial has 1000 units.

Insulin syringes are made specifically for self injections and have friendly features:

• shorter needles,^[6] as insulin injections are subcutaneous (under the skin) rather than intramuscular,
• finer gauge needles,^[6] for less pain, and
• markings in insulin units to simplify drawing a measured dose of insulin.^[7]
• low dead space to reduce complications caused by improper drawing order of different insulin strengths.^[8]

Multishot needle syringes

There are needle syringes designed to reload from a built-in tank (container) after each injection, so they can make several or many injections on a filling. These are not used much in human medicine because of the risk of cross-infection via the needle. An exception is the personal insulin autoinjector used by diabetic patients.

Venom extraction syringes

Venom extraction syringes are different from standard syringes, because they usually do not puncture the wound. The most common types have a plastic nozzle which is placed over the affected area, and then the syringe piston is pulled back, creating a vacuum that allegedly sucks out the venom. Attempts to treat snakebites in this way are specifically advised against, as they are ineffective and can cause additional injury.^[20]

Syringes of this type are sometimes used for extracting human botfly larvae from the skin.^[21]

Oral

An oral syringe is a measuring instrument used to accurately measure doses of liquid medicine which are expressed in millilitres (mL). They do not have threaded tips, because no needle or other device needs to be screwed onto them. The contents are simply squirted or sucked from the syringe directly into the mouth of the person or animal.

Oral syringes are available in various sizes, from 1-10 mL and larger. The sizes most commonly used are 1 mL, 2.5 mL and 5 mL.^[22]

Dental syringes

A dental syringe is a used by dentists for the injection of an anesthetic. It consists of a breech-loading syringe fitted with a sealed cartridge containing anesthetic solution.

The ancillary tool (generally part of a dental engine) used to supply water, compressed air or mist (formed by combination of water and compressed air) to the oral cavity for the purpose of irrigation (cleaning debris away from the area the dentist is working on), is also referred to as a dental syringe or a dental irrigation nozzle. A 3-way syringe / nozzle has separate internal channels supplying air, water or a mist created by combining the pressurized air with the waterflow. The syringe tip can be separated from the main body and replaced when necessary.

Governmental control of syringes

In some jurisdictions, the sale or possession of hypodermic syringes may be controlled or prohibited without a prescription,^[23] due to its potential use with illegal intravenous drugs.^[24]

Non-medical uses

The syringe has many non-medical applications.

Laboratory applications

Laboratory grease, commonly used to lubricate ground glass joints and stopcocks, is sometimes loaded in syringes for easy application

Some chemical compounds, such as thermal paste and various glues e.g.epoxy, are sold in prepackaged syringes.

Medical-grade disposable hypodermic syringes are often used in research laboratories for convenience and low cost. Another application is to use the needle tip to add liquids to very confined spaces, such as washing out some scientific apparatus. They are often used for measuring and transferring solvents and reagents where a high precision is not required. Alternatively, microliter syringes can be used to measure and dose chemicals very precisely by using a small diameter capillary as the syringe barrel.

The polyethylene construction of these disposable syringes usually makes them rather chemically resistant. There is, however, a risk of the contents of the syringes leaching plasticizers from the syringe material. Non-disposable glass syringes may be preferred where this is a problem. Glass syringes may also be preferred where a very high degree of precision is important (i.e. quantitative chemical analysis), because their engineering tolerances are lower and the plungers move more smoothly. In these applications, the transfer of pathogens is usually not an issue.

Used with a long needle or cannula, syringes are also useful for transferring fluids through rubber septa when atmospheric oxygen or moisture are being excluded. Examples include the transfer of air-sensitive or pyrophoric reagents such as phenylmagnesium bromide and n-butyllithium respectively. Glass syringes are also used to inject small samples for gas chromatography (1 μl) and mass spectrometry (10 μl). Syringe drivers may be used with the syringe as well.

Cooking

Some culinary uses of syringes are injecting liquids (such as gravy) into other foods, or for the manufacture of some candies.

Syringes may also be used when cooking meat to enhance flavor and texture by injecting juices inside the meat, and in baking to inject filling inside a pastry.

Others

Syringes are used to refill ink cartridges with ink in fountain pens.

Common workshop applications include injecting glue into tight spots to repair joints where disassembly is impractical or impossible; and injecting lubricants onto working surfaces without spilling.

Sometimes a large hypodermic syringe is used without a needle for very small baby mammals to suckle from in artificial rearing.

Historically, large pumps that use reciprocating motion to pump water were referred to as syringes. Pumps of this type were used as early firefighting equipment.

There are fountain syringes where the liquid is in a bag or can and goes to the nozzle via a pipe. In earlier times, clyster syringes were used for that purpose.

Loose snus is often applied using modified syringes. The nozzle is removed so the opening is the width of the chamber. The snus can be packed tightly into the chamber and plunged into the upper lip. Syringes, called portioners, are also manufactured for this particular purpose.

Syringes that are able to administer medication can be used to act as cap guns, where the projectile is not usually a cap but can be paper or aluminium pellets.

Historical timeline

De medicina

• The first piston syringes were used in Roman times. During the 1st century AD Aulus Cornelius Celsus mentions the use of them to treat medical complications in his De Medicina.
• 9th century AD: The Iraqi/Egyptian surgeon Ammar ibn 'Ali al-Mawsili' created a syringe in the 9th century using a hollow glass tube, and suction to remove cataracts from patients' eyes, a practice that remained in use until at least the 13th century.
• c. 1650: Blaise Pascal invented a syringe (not necessarily hypodermic) as an application of what is now called Pascal's law.
• 1844: Irish physician Francis Rynd invented the hollow needle and used it to make the first recorded subcutaneous injections, specifically a sedative to treat neuralgia.
• 1853: Charles Pravaz and Alexander Wood developed a medical hypodermic syringe with a needle fine enough to pierce the skin.
  • Alexander Wood experimented with injected morphine to treat neuralgia. He and his wife became addicted to it. His wife was the first woman to die of an injected drug overdose,^[25] although Richard Davenport-Hines says, 'It is a myth: she outlived him, and survived until 1894.'^[26]
• 1899: Letitia Mumford Geer of New York was granted a patent for "In a hand-syringe the combination of a cylinder, a piston and an operating-rod which is bent upon itself to form a smooth and rigid arm terminating in a handle, which, in its extreme positions, is located within reach of the fingers of the hand which holds the cylinder, thus permitting one hand to hold and operate the syringe..." ^[27]
• 1946: Chance Brothers in Smethwick, Birmingham, England produced the first all-glass syringe with interchangeable barrel and plunger, thereby allowing mass-sterilisation of components without the need for matching them.
• 1949: Australian inventor Charles Rothauser created the world's first plastic, disposable hypodermic syringe at his Adelaide factory.
• 1951: Rothauser produced the first injection-moulded syringes made of polypropylene, a plastic that can be heat-sterilised. Millions were made for Australian and export markets.
• 1956: New Zealand pharmacist and inventor Colin Murdoch was granted New Zealand and Australian patents for a disposable plastic syringe.

See also

• A fire syringe has two meanings: as a fire piston, a fire starting device; and a squirt, one of the first firefighting devices in history used to squirt water onto the burning fuel which was in the form of a large syringe.^[28]
• Autoinjector, a device to ease injection, e.g. by the patient or other untrained personnel.
• Hippy Sippy
• Hypodermic needle
• Jet injector, injects without a needle, by squirting the injection fluid so fast that it makes a hole in the skin.
• Luer Taper, a standardized fitting system used for making leak-free connections between syringe tips and needles.
• Needle exchange programme, is a social policy based on the philosophy of harm reduction where injecting drug users (IDUs) can obtain hypodermic needles and associated injection equipment at little or no cost.
• Trypanophobia, a fairly common extreme fear of hypodermic syringes
• Syrette, similar to a syringe except that it has a closed flexible tube (like that used for toothpaste) instead of a rigid tube and piston.
• Syringing the ear to remove excess ear wax.
• Syrinx, the nymph from classical mythology after which syringes were supposedly named.
• Safety Syringe, with features to prevent accidental needlesticks and reuse
• Vaginal syringe

References

Further reading

• Hans-Jürgen Bässler und Frank Lehmann : Containment Technology: Progress in the Pharmaceutical and Food Processing Industry. Springer, Berlin 2013, ISBN 978-3642392917

External links

Wikimedia Commons has media related to Syringe.

Look up syringe in Wiktionary, the free dictionary.

• Inventors of the hypodermic syringe
• Hypodermic syringe patents
• Medical syringe patents

Routes of administration, Dosage forms
Oral	Digestive tract (enteral) Solids Pill Tablet Capsule Pastille Time release technology Osmotic delivery system (OROS) Liquids Decoction Elixir Electuary Emulsion Extended-release syrup Effervescent powder or tablet Herbal tea Hydrogel Molecular encapsulation Powder Softgel Solution Suspension Syrup Syrup Concentrate for dilution and/or addition of carbonated water Tincture Buccal (sublabial), sublingual Solids Orally disintegrating tablet (ODT) Film Lollipop Sublingual drops Lozenges Effervescent buccal tablet Chewing gum Liquids Mouthwash Toothpaste Ointment Oral spray Respiratory tract Solids Smoking device Dry-powder inhaler (DPI) Liquids Anaesthetic vaporizer Vaporizer Nebulizer Metered-dose inhaler (MDI) Gas Oxygen mask and Nasal cannula Oxygen concentrator Anaesthetic machine Relative analgesia machine
Ophthalmic, otologic, nasal	Nasal spray Ear drops Eye drops Ointment Hydrogel Nanosphere suspension Insufflation Mucoadhesive microdisc (microsphere tablet)
Urogenital	Ointment Pessary (vaginal suppository) Vaginal ring Vaginal douche Intrauterine device (IUD) Extra-amniotic infusion Intravesical infusion
Rectal (enteral)	Ointment Suppository Enema Solution Hydrogel Murphy drip Nutrient enema
Dermal	Ointment Topical cream Topical gel Liniment Paste Film DMSO drug solution Electrophoretic dermal delivery system Hydrogel Liposomes Transfersome vesicles Cream Lotion Lip balm Medicated shampoo Dermal patch Transdermal patch Contact (rubbed into break in the skin) Transdermal spray Jet injector
Injection, infusion (into tissue, blood)	Skin Intradermal Subcutaneous Transdermal implant Organs Intracavernous Intravitreal Intra-articular injection Transscleral Central nervous system Intracerebral Intrathecal Epidural Circulatory, musculoskeletal Intravenous Intracardiac Intramuscular Intraosseous Intraperitoneal Nanocell injection Patient-Controlled Analgesia pump PIC line
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