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AUTO-DISABLE (AD) SYRINGES

auto disable syringe
Three types of syringes are supplied under the NIS for the purpose of vaccine administration:
a. 0.1ml AD syringes
b. 0.5 ml AD syringes and
c. 5 ml disposable syringes.
The auto – disable syringes are used for the administration of the appropriate vaccines and the disposable syringe is used for reconstitution of vaccines where needed.
The AEFI (adverse event following immunization) kit contains other types of syringes like, insulin type (with 0.01ml graduations and 26 G needle), 5 ml disposable syringes with 24 and 26 G needles.

Which NIS vaccines are given using these syringes?
The 0.1 ml AD syringe comes with the needle gauge of 26G and is used for intradermal injections:
• BCG and
• Fractional dose of IPV
The 0.5 ml AD syringe is used for the other injectable vaccines.

What is the recommended procedure for its safe disposal after use under the immunization program?
1 Cut the needle of the AD syringe immediately after administering the injection using the hub cutter. The cut needles will get collected in the puncture-proof container of the hub cutter
2 Store the broken vials in a separate white sturdy and puncture proof container
3 Segregate and store the plastic portion of the cut syringes and unbroken (but discarded) vials in the red bag or container. Both the containers should bear the biohazard symbol
4 Black bag is used for general waste like wrappers and needle caps.
5 Send the red, black bag and the hub cutter to PHC for disinfection and disposal by the designated person at the PHC and finally to a common Bio Medical Waste treatment facility (CBMWTF).

Mention the precautions to be taken while using the syringes for ensuring injection safety.
a. Wash or disinfect hands prior to preparing injection material
b. Always use AD syringes for each injection and a new disposable syringe to reconstitute each vial of BCG, measles/MR and JE
c. If the injection site is dirty, clean it with clean swab
d. Always pierce the rubber cap (septum) of the vial with a sterile needle
e. Do not touch the needle or rubber cap (septum) of a vial with your finger
f. Do not re-cap or bend needles
g. Cut the used syringe with the hub cutter immediately after use

Mention the steps for correct use of AD syringes.
1. Select the correct syringe for the vaccine to be administered i.e. 0.1ml for BCG and fractional dose of IPV and 0.5ml for all others
2. Check the packaging. Don’t use if the package is damaged, opened, or expired
3. Peel open or tear the package from the plunger side and remove the syringe by holding the barrel. Discard the packaging into a black plastic bag
4. Remove the needle cover/cap and discard it into the black plastic bag.
5. Do not move the plunger until you are ready to fill the syringe with the vaccine and do not inject air into the vial as this will lock the syringe.
6. Take the appropriate vaccine vial, invert the vial, and insert the needle into the vial through the septum. Insert the needle such that the tip is within the level of the vaccine. If inserted beyond that, you may draw an air bubble which is very difficult to expel. Do not touch the needle or the rubber cap (septum) of the vial
7. Pull the plunger back slowly to fill the syringe. The plunger will automatically stop when the necessary dose of the vaccine has been drawn (0.1 ml or 0.5 ml).
8. Do not draw air into the syringe. In case air accidentally enters the syringe, remove the needle from the vial. Holding the syringe upright, tap the barrel to bring the bubbles towards the tip of syringe. Then carefully push the plunger to the dose mark (0.5 or 0.1 ml) thus expelling the air bubble.
9. Clean the injection site (if dirty) with a clean swab.
10. Administer the vaccine as per the prescribed site, side and route.
11. Push the plunger completely to deliver the dose. Do not rub the injection site after vaccine is given
12. Do not re-cap the needle. Cut the hub of the syringe immediately after use with hub cutter
13. Then collect the plastic portion of the cut syringes in a red plastic bag.

Reference:
GOI. Immunization Handbook for Medical Officers. New Delhi: Department of Health and Family Welfare; 2016.