Compatibility of intravenous access connectors with pre-filled syringes, especially glass

Background

In May 2019, ANZCA issued Product Safety Alert- Adrenaline-Link 1:10,000 1mg/10mL Pre-filled syringe, warning that Link brand pre-filled glass syringes containing adrenaline may not be able to administer medication when used with an incompatible intravenous (IV) connector/bung or without an adaptor. This may delay a patient receiving potentially life-saving medication.

In August 2022, the college was made of aware of another incident of delayed emergency adrenaline administration arising from incompatibility of the Link pre-filled glass syringes with an IV connector. Staff were unaware that an adaptor was required.

Similar incidents involving various brands of glass pre-filled syringes have been reported internationally over several years. Glass pre-filled syringes are manufactured with different specifications than plastic because of the different properties of the material. This means they will not work correctly with all IV connectors on the market, unless the correct adaptor is used.

ANZCA notes that the cause of a blockage when using a pre-filled syringe or a giving set is not always known at the time it occurs. However, in the event of blockage, it can be helpful to change to a new IV connector, even if it is another of the same kind. This can be enough to resolve some blockages, even sometimes those caused by equipment incompatibility.

Recommendations

For prevention of similar incidents, ANZCA recommends implementation of the following by departments with relevant responsibilities:

• When stocking any pre-filled syringe product, especially those made of glass, ensure compatible connectors or adaptors are immediately available in the same location.
• Ideally only equipment confirmed to be compatible should be stocked – especially for emergency use.
• An audit of existing stock of pre-filled syringes and their connector requirements, especially those for emergency use, may be beneficial.
• Local clinical product advisors, pharmacy or supply departments can advise on the compatibility requirements of particular products.
  • For Link pre-filled glass syringes containing adrenaline, a leaflet in the product pack lists compatible connectors and adaptors. This list is also in the Link safety alert November 2017.
• The decision to stock a new product should include risk assessment of equipment compatibility issues and the need to train staff.

For immediate response during an incident, ANZCA recommends:

• In the event that medication cannot be administered from a pre-filled syringe or a giving set through an IV connector, consider changing to a new IV connector, even if it is another of the same kind.