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Devices · Syringes & needles

A ten-fold dose error caught before injection

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CB
c.boatengTL212 Feb 2025#1

A ten-fold dose error caught before injection — setting out what I have, and where I think it stops being reliable.

Trying to work out what would count as evidence on ten-fold dose error caught, before collecting any. This is the part I usually skip and it is the part that makes the rest useful.

If two explanations predict the same observation, observing it does not help. So: what observation would separate them?

20 likes 17mo
CN
cohort_notesTL2Member18 Feb 2025#2

Graduation spacing is worth checking before you buy rather than after. Some 1 mL barrels are marked every two units and some every one, and that changes what doses you can read.

3 likes 17mo
ZA
z.adeyemiTL222 Feb 2025#3

I changed my mind about ten-fold dose error caught after someone here asked me for the source and I could not produce one. That is worth saying out loud because it is the ordinary way it happens.

0 likes 17mo
R
RidgewayTL3Regular26 Feb 2025#4
cohort_notes, post #2: Graduation spacing is worth checking before you buy rather than after. Some 1 mL barrels are marked every two units and some every one, and that changes what doses you can read. Go to post

Post #3 answers the question as asked. The question underneath it is different.

Two claims get bundled together under ten-fold dose error caught and they need separating. The descriptive one — this is what was observed — is usually well supported. The causal one — this is why — usually is not.

Almost every disagreement in threads like this one dissolves once you say which of the two you are making.

31 likes in reply to #2 17mo
AK
an.kirchnerTL22 Mar 2025#5

A detachable luer needle plus hub can retain enough volume to matter. Whether it matters to you depends on your dose, and the arithmetic is worth doing once.

15 likes 17mo
EF
erratum_fileTL3Regular5 Mar 2025#6

Aspirating before injection: for subcutaneous injection, aspirating (pulling back on the plunger to check for blood) is not necessary and is sometimes discouraged because it is associated with more discomfort. Subcutaneous injection without aspiration is standard practice.

6 likes 17mo
HJ
h.jansenTL28 Mar 2025#7

Coming back to post #3, because the follow-up matters more than the original answer.

The most useful thing anyone has posted about ten-fold dose error caught in this category was a table of what had been measured and by whom. That is what I would want again.

1 like 17mo
G
GEldridgeTL3Regular11 Mar 2025#8
Ridgeway, post #4: Post #3 answers the question as asked. The question underneath it is different. Two claims get bundled together under ten-fold dose error caught and they need separating. The descriptive one — this is what was observed — is usually well supported. The causal one — this is why — usually is not. Almost every disagreement in threads like… Go to post

That is clearer than the version I had in my head. Thank you.

0 likes in reply to #4 17mo
VK
v.kjaerTL214 Mar 2025#9
an.kirchner, post #5: A detachable luer needle plus hub can retain enough volume to matter. Whether it matters to you depends on your dose, and the arithmetic is worth doing once. Go to post

Silicone coating on the barrel affects how smoothly the plunger moves and how a very slow injection feels. It is one reason two syringes at the same specification are not identical to use.

3 likes in reply to #5 16mo
DB
d.bramleyTL3Regular17 Mar 2025#10

Adding the measurement that post #7 says would settle it.

Where the ten-fold dose error caught reasoning breaks down for me is the step from the group result to the individual case. That step is almost never argued for.

0 likes 16mo
CL
c.lundgrenTL220 Mar 2025#11

Insulin syringe graduations: U-100 syringes are marked in units where 100 units = 1 mL. Always confirm your syringe is U-100. Confusion between insulin units and milligrams is the most common syringe error.

Speaking for myself and not for anyone else who has posted here.

21 likes 16mo
NN
n.nybergTL223 Mar 2025#12
cohort_notes, post #2: Graduation spacing is worth checking before you buy rather than after. Some 1 mL barrels are marked every two units and some every one, and that changes what doses you can read. Go to post

Nothing to add, except that this is the answer I would give if asked.

0 likes in reply to #2 16mo
ZL
z.laurentTL226 Mar 2025#13

A definition problem is doing most of the work in this ten-fold dose error caught discussion. Once the term is pinned down I suspect the disagreement mostly goes away and what is left is small.

0 likes 16mo
HE
h.eriksenTL228 Mar 2025#14

Post #10 put the caveat in the right place and I want to underline it.

Needle length: typical lengths for subcutaneous injection are 4-6 mm (short), 8 mm (standard), or 10-12 mm (longer). Longer needles are needed for deeper tissue or if you have abdominal adiposity.

5 likes 16mo
CG
c.grimaldiTL231 Mar 2025#15
n.nyberg, post #12: Nothing to add, except that this is the answer I would give if asked. Go to post

Post #13 answers the question as asked. The question underneath it is different.

Sharps containers are a legal requirement for disposal in several jurisdictions and a sensible precaution everywhere. A rigid sealed container is the minimum.

28 likes in reply to #12 16mo
DO
dr_okonkwoTL4 Moderator2 Apr 2025#16
cohort_notes, post #2: Graduation spacing is worth checking before you buy rather than after. Some 1 mL barrels are marked every two units and some every one, and that changes what doses you can read. Go to post

Drawing air into the vial before withdrawing liquid equalises the pressure and makes the draw easier. It is not required and it is why some people find a full vial harder to draw from than a half-empty one.

A weak preference rather than a position.

0 likes in reply to #2 16mo
TP
t.pereiraTL25 Apr 2025#17

The number people quote for ten-fold dose error caught is a central estimate presented without its interval, and the interval is wide enough that the estimate is nearly uninformative on its own.

2 likes 16mo
FV
f.villalobosTL27 Apr 2025#18

Reading this ten-fold dose error caught thread as someone who came in with a fixed view: the third and seventh replies moved me and the confident ones did not.

9 likes 16mo
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LundqvistTL2Member10 Apr 2025 · edited#19
z.adeyemi, post #3: I changed my mind about ten-fold dose error caught after someone here asked me for the source and I could not produce one. That is worth saying out loud because it is the ordinary way it happens. Go to post

Marking my place. If it changes for me I will come back and say so.

10 likes in reply to #3 16mo
FL
f.laurentTL212 Apr 2025#20

Post #18 describes the usual case. This is about the unusual one.

U-100 means the barrel is graduated for a solution containing one hundred units of insulin per millilitre. For anything that is not insulin, the units are simply hundredths of a millilitre.

22 likes 15mo
D
DOdendaalTL3Regular15 Apr 2025#21
c.grimaldi, post #15: Post #13 answers the question as asked. The question underneath it is different. Sharps containers are a legal requirement for disposal in several jurisdictions and a sensible precaution everywhere. A rigid sealed container is the minimum. Go to post

Everything in post #20 holds. The case it does not cover is the one I have.

A note on scope: what I am saying about ten-fold dose error caught applies to the case in the first post and I would not extend it further without checking.

30 likes in reply to #15 15mo
BT
b.teixeiraTL217 Apr 2025#22

Useful. I had the fact and not the reason, which turns out to be the important half.

15 likes 15mo
ED
e.dalgleishTL3Regular20 Apr 2025 · edited#23

Reading units correctly: look at the marking from the side, not from above or below. The bottom of the plunger tip is the reading. Parallax error (wrong angle) is a source of dosing error.

The part I am sure of is shorter than the part I have written.

3 likes 15mo
RI
r.ilungaTL222 Apr 2025#24

Ten-fold dose error caught would be much easier to settle if anyone reported the denominator. Almost nobody reports the denominator.

0 likes 15mo
SG
s.grahameTL2Member24 Apr 2025#25

Buying a box of the wrong barrel size is the most common regret described in this subcategory, and the reason is nearly always that the dose was decided after the syringes.

The literature is thinner on this than the confidence in the thread implies.

22 likes 15mo
ER
e.roosTL227 Apr 2025#26

Post #23 answers the question as asked. The question underneath it is different.

Syringe barrel size: common sizes are 0.3 mL, 0.5 mL, and 1.0 mL. Smaller barrels are more legible for small doses. Larger barrels hold larger volumes. Choose based on your dose.

10 likes 15mo
BS
buffer_sheetTL3Regular29 Apr 2025 · edited#27

Distinguishing three things in the ten-fold dose error caught discussion that keep getting used interchangeably: the observation, the proposed mechanism, and the recommendation that gets attached to both.

1 like 15mo
AK
a.kravchenkoTL21 May 2025#28
e.roos, post #26: Post #23 answers the question as asked. The question underneath it is different. Syringe barrel size: common sizes are 0.3 mL, 0.5 mL, and 1.0 mL. Smaller barrels are more legible for small doses. Larger barrels hold larger volumes. Choose based on your dose. Go to post

An update on my earlier ten-fold dose error caught post: the pattern held for another six weeks and then stopped, which I did not predict and cannot explain.

0 likes in reply to #26 15mo
GH
g.haalandTL3Regular3 May 2025#29
c.grimaldi, post #15: Post #13 answers the question as asked. The question underneath it is different. Sharps containers are a legal requirement for disposal in several jurisdictions and a sensible precaution everywhere. A rigid sealed container is the minimum. Go to post

Needle gauge: smaller numbers (30G) are finer and less painful. Larger numbers (25G) are courser. For subcutaneous injection, 27-30G is typical. Finer needles take longer to draw up but hurt less.

Nothing above should be read as advice about what anyone else should do.

16 likes in reply to #15 15mo
ID
il.dumitruTL26 May 2025#30
v.kjaer, post #9: Silicone coating on the barrel affects how smoothly the plunger moves and how a very slow injection feels. It is one reason two syringes at the same specification are not identical to use. Go to post

What would change my mind on ten-fold dose error caught is a second dataset collected by someone with no stake in the first. Until then I hold it loosely and I would rather say so than pretend to more.

6 likes in reply to #9 15mo