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We are grateful to Dr Pryor and colleagues for highlighting this issue. We take any complaint seriously, and for products that are used in critical clinical situations we perform detailed investigation of the circumstances surrounding the incident.

For such root-cause investigations to be successful, it is vital we have an opportunity to examine the sample in question. Unfortunately, to date, the hospital has not responded to several requests to obtain the syringe for examination.

We do get a small but regular number of similar reports, representing < 0.001% of syringes supplied. With all syringes that we have been able to investigate to date, we have never found a blockage caused by a fault in the glass syringe. Customer feedback sometimes refers to syringe tips’ being ‘fused’ or blocked with glass; however, all cases examined have in fact been shown to be blocked through the presence of a foreign polymeric material. As the polymer is frequently colourless, it gives the impression of a glass blockage.

The polymeric material found is derived from certain types of needle-free connectors that are incompatible with standard glass syringes. All the reports we have received for blocked syringes have come from hospitals that, upon investigation, have been found to use the incompatible needle-free connectors either as standard issue, or in specific units.

In order to minimise the opportunity for errors caused by unintentional use of such needle free connectors, the MHRA has previously issued a Device Alert (MDA/2011/068) on this subject which clearly states that users should “ensure procedures are in place to determine the compatibility of needle free connectors in use with pre-filled syringes contained in emergency drug boxes”.

As additional support, in our role as a manufacturer, Martindale Pharma has distributed a connector compatibility poster that clearly identifies which connectors are compatible with the Aurum Range of prefilled syringes [1, 2].

  1. CA is an employee of Martindale Pharma. No other external funding or competing interests declared. Previously posted on the Anaesthesia Correspondence website: http://www.anaesthesiacorrespondence.com.