[CARPA] benzathine needle jams

[Vanessa Thomas]

Dear Alex, please find a link to a protocol for the preparation of the benzathine injection issued by the Canadian Health Agency. It explains why you are having problems with the injection and how to overcome this.
http://www.phac-aspc.gc.ca/std-mts/protocol_e.html

We received the following information from a doctor in NZ :
"Crystalisation is prevented by heating the water for injection to
'body' temperature. Does this impare the antibiotic or alter the uptake
from the muscle?"

This is the response received from the manufacturer of the drug:
" Did the user use needles of two different types: one larger to reconstitute the solution injecting the diluent into the vial of powder, one narrower for the injection once the vial has been rolled between the hands which also means heating the vial a little bit ? Please check that this reconstitution and injection procedure was followed properly."

"It is possible to heat the water for injection in order to make the benzathine benzylpenicillin disolution easier but the water shall not be heated over
+60°C (ie +140°F)  which in fact would lead to the product degradation.
Moreover, the volume of w.f.i. must not be reduced; in fact if it was the case, the concentration would be too high and the injection far more too painful."

Therefore it appears that the WFI can be heated to dissolve the powder.
With regard to the volume of the WFI, we have received feedback from doctors that they have successfully used 2mLs instead of 4mLs, however we leave this up to the discretion of the individual doctor.

Regards, 
Vanessa Thomas
Regulatory Affairs Manager
Aspen Pharmacare Australia Pty Ltd
34-36 Chandos Street
St Leonards 2065 NSW
ph: 61 2 8436 8300
fax: 61 2 99013540
-----Original Message-----
From: carpa-bounces at ozdocit.org [mailto:carpa-bounces at ozdocit.org] On Behalf Of Alex Hope
Sent: Friday, 12 January 2007 12:45 PM
To: carpa at ozdocit.org
Subject: [CARPA] benzathine needle jams

G'day All,

is it just us mob?

We are having a lot of trouble with the Pan Benzathine product,
no matter how well we mix it, and whether with water or lignocaine,
and despite running it in and out of a syringe through a needle into the vial,
when giving the actual injection the stuff jams part way through.
sometimes you can retrieve it by jiggling the plunger, sometimes you can't. 
Then you pull the needle out, and try squirting it through and hey presto, the bloody thing is unblocked!

But you won't always get a second or third go at the patient's backside!

we are using 21G needles for giving, some say even with a 19G needle (in adults for RHD prophylaxis) it will jam up.

Anyone else having the same trouble?

Any clues as to how to get around it?Dr Alex Hope

Community GP,
Ltyentye Apurte Community Government Council Health Centre,
CMB Santa Teresa,
via Alice Springs,
NT 0872.

Ph  08 8956 0911
Fax 08 8956 0910
Mobile 0408 085 143



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