Evaluation of a pre-filled diluent syringe (MixPro®) among patient/carer users and nurses
, , , and | May 31, 2018
About this article
Article Category: Clinical Research
Published Online: May 31, 2018
Page range: 12 - 23
DOI: https://doi.org/10.17225/jhp00106
Keywords
© 2018 Debra Pollard, Kate Khair, Cléa Percier, Yen Wong, Robyn Shoemark, published by Sciendo
This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
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Advantages and disadvantages of MixPro as perceived by nurses
| % SPONTANEOUS MENTIONS | TOTAL (N=39) | FAMILIAR WITH MixPro® (N=20) | UNFAMILIAR WITH MixPro® (N=19) |
|---|---|---|---|
| Advantages | |||
| Easy/intuitive/less steps/quick to use or to teach to use | 85 | 85 | 84 |
| More sterile/low risk of contamination (less handling/single vial/closed system/ cap on vial adaptor) | 33 | 25 | 42 |
| Needle-less system (lower risk of needle stick injury/safe/easy disposal/no need for sharps box) | 28 | 25 | 32 |
| Not bulky/small/fewer parts (easier to store/for travel) | 23 | 20 | 26 |
| Low risk of error (few parts/easy steps) | 15 | 20 | 11 |
| Powder easily dissolved/mixes easily | 10 | 15 | 5 |
| Ease of disposal (less waste/saves costs) | 8 | 5 | 11 |
| No need to change syringe for injection | 8 | 10 | 5 |
| Pre-filled syringe (can draw immediately) | 8 | 15* | – |
| Increased autonomy for patients (and reduces work in hospitals) | 5 | 5 | 5 |
| Smaller injection volume (no foam/with correct syringe size) | 5 | 5 | 5 |
| Syringe compatible with IV/PICC/butterfly | 5 | 10 | – |
| Vial adaptor grips well on to vial | 3 | – | 5 |
| Disadvantages | |||
| Components (such as vial, vial adaptor, plunger base) too small for nurses/ patients with large hands/arthritis/poor dexterity/poor vision | 15 | 20 | 11 |
| Plunger not attached (not intuitive where to put it/one extra step/may not attach properly/risk of contamination) | 15 | 15 | 16 |
| Difficult to remove plastic caps (syringe cap/vial adaptor cap) | 13 | – | 26** |
| Vial adaptors are cheap/flimsy/do not fit properly/spike risk of bending | 10 | 15 | 5 |
| Air bubbles are still a concern | 5 | 5 | 5 |
| Syringe is not suitable for large doses/multiple vials | 5 | 5 | 5 |
| Increased cost (syringes/solvents cheaper in big packages) | 5 | 5 | 5 |
| Unable to see clearly that powder is fully dissolved due to label | 5 | 5 | 5 |
| Syringe not compatible with central lines | 5 | 5 | 5 |
| Still risk of contamination (need to disinfect vial/may touch syringe tip) | 5 | 5 | 5 |
| Not suitable for those with Port-a-Cath – need sterile 10mL syringe | 3 | 5 | 0 |
| Still too many steps: pre-attached vial adaptors already exist | 3 | 5 | 0 |
| Vial adapter not attached | 3 | 0 | 5 |
| Risk of loss of vacuum seal so cannot draw out product | 3 | 5 | 0 |
| None/no disadvantages | 28 | 25 | 32 |
Sample demographics of patients and carers
| PARAMETER | TOTAL (N=45) | PATIENT (N=26) | CARED FOR (N=19) | US (N=9) | FRANCE (N=10) | GERMANY (N=8) | ITALY (N=10) | UK (N=8) |
|---|---|---|---|---|---|---|---|---|
| Mean age, years | 25 | 37* | 9 | 23 | 30 | 32 | 17 | 25 |
| Mean length of time on MixPro®, months | 14 | 15 | 12 | 15 | 13 | 10 | 7 | 26 |
| Type of haemophilia, % | ||||||||
| A (no inhibitors) | 16 | 23* | 5 | 33 | 40 | 0 | 0 | 0 |
| A (with inhibitors) | 73 | 62 | 89** | 56 | 50 | 88 | 100 | 75 |
| B (with inhibitors) | 11 | 15 | 5 | 11 | 10 | 13 | 0 | 25 |
| Treatment type, % | ||||||||
| On-demand | 42 | 50 | 32 | 11 | 90 | 38 | 20 | 50 |
| Prophylaxis | 58 | 50 | 68 | 89 | 10 | 63 | 80 | 50 |
| Infusion method, % | ||||||||
| PICC | 2 | 4 | 0 | 0 | 10 | 0 | 0 | 0 |
| Port-a-Cath | 31 | 15 | 53 | 44 | 0 | 63 | 20 | 38 |
| Peripheral vein with butterfly needle | 67 | 81* | 47 | 56 | 90 | 38 | 80 | 63 |
Advantages and disadvantages of MixPro as perceived by patients and carers
| % SPONTANEOUS MENTIONS | TOTAL (N=45) | PATIENTS (N=26) | CARERS (N=19) |
|---|---|---|---|
| Advantages | |||
| Ease of use (fewer steps/pre-filled syringe/quick to administer/fewer errors) | 96 | 96 | 95 |
| Hygienic/sterile – low risk of contamination/infection (advantageous for Port-a-Cath) | 47 | 38 | 58 |
| Ease of transport/portable/can take everywhere/on holidays (as small/compact packaging/no refrigeration needed/immediate treatment/can do more activities) | 33 | 35 | 32 |
| Reassuring/increased peace of mind | 13 | 4 | 26* |
| Able to self-administer (increased independence/autonomy) | 11 | 15 | 5 |
| Disadvantages | |||
| Vial too small to see/handle easily (cannot see if powder dissolved/all solution has been drawn up/afraid of breaking at first/especially if arthritis) | 16 | 15 | 16 |
| Preparation still required (several parts/two-part syringe/complicated at first) | 13 | 12 | 16 |
| No large syringe for high doses, such as 3000 units, >10mg, multiple vials | 9 | 15** | – |
| Not the easiest/quickest on market (Pfizer, all-in-one including needle, pen style) | 7 | 12** | – |
| More boxes/waste | 4 | 8 | – |
| Cumbersome/takes up more space during transport | 4 | 8 | – |
| Cost/have to pay extra due to high price | 4 | 4 | 5 |
| Requires assistance from caregiver | 4 | 4 | 5 |
| May touch edge when attaching plunger to syringe/difficult to tell if attached properly | 2 | – | 5 |
| Vial made of glass – worried about dropping and glass in solution | 2 | 4 | – |
| 1mL dose – risk of losing mixed-up solution if not careful | 2 | – | 5 |
| Mixed solution remains clear – have I remembered to mix the entire dose? | 2 | 4 | – |
| No disadvantages | 33 | 23 | 47* |
Sample demographics of nurses
| PARAMETER | TOTAL (N=39) | FAMILIAR WITH MixPro® (N=20) | UNFAMILIAR WITH MixPro® (N=19) | US (N=12) | FRANCE (N=7) | GERMANY (N=6) | ITALY (N=8) | UK (N=6) |
|---|---|---|---|---|---|---|---|---|
| Mean number of years involved in treatment/ management of patients with haemophilia | 11 | 12 | 9 | 11 | 13 | 10 | 10 | 10 |
| Patient caseloads in last 12 months, mean number of patients | ||||||||
| Haemophilia A (without inhibitors) | 51 | 77 Denotes statistically significant result at 90% level: familiar nurse data higher than unfamiliar nurse data | 24 | 68 | 89 | 15 | 21 | 50 |
| Haemophilia B (without inhibitors) | 20 | 33 Denotes statistically significant result at 90% level: familiar nurse data higher than unfamiliar nurse data | 7 | 31 | 35 | 3 | 9 | 14 |
| Haemophilia with inhibitors | 9 | 12 Denotes statistically significant result at 90% level: familiar nurse data higher than unfamiliar nurse data | 7 | 10 | 10 | 4 | 15 | 5 |
| Involvement in treatment decisions or routinely recommending factor products, % | ||||||||
| Yes | 58 | 71 | 44 Unfamiliar, n=16 | 67 | 0 | – Question not asked in Germany | 0 | 50 |
| No | 42 | 29 | 56 Unfamiliar, n=16 | 33 | 100 | – Question not asked in Germany | 100 | 50 |