My organization transitioned to use of ENFit syringes from NeoMed/Avanos in November '22. Since that time we have had an ongoing issue where significant air bubbles form in the morphine oral solution that we package into syringes for our neonate population.
We package morphine 240 mcg/0.6 mL in the 1 mL ENFit syringe using standard tip caps (not tamper evident caps). What we are seeing is that as syringes sit around in either our controlled substance vault or in Pyxis that air bubbles slowly start to accumulate and are the size of about 0.05 mL, which is about 8% of the dose in the syringe. Have others seen this and, more importantly, have you found ways to address/avoid this?
So far we have:
1) observed technicians making the syringes and they are indeed using the syringes and bottle cap adapters correctly and drawing up to 0.6 mL.
2) Confirmed no evidence of leaking outside of the syringe (no liquid or sticky residue).
3) Confirmed the tamper tape we apply is intact, arguing against diversion.
4) Tried different lots of syringes and caps with no success.
We continue to escalate to our NeoMed rep, but they say other sites are not reporting the same issue. The have opened a case for us but we are looking for ways to address more urgently.
Thanks for any information you may have. I've attached a representative picture of what we are experiencing.