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Devices · Syringes & needles · continued

A ten-fold dose error caught before injection — one year on posts 31–60

This is a continuation of a long topic, addressed by post number rather than by page. Start at post 1.

MR
m.radichTL21 Aug 2025#31
pe.onwuka, post #6: Worth separating ten-fold dose error caught as a question about the compound from ten-fold dose error caught as a question about the documentation. They get answered by different people and only one of them is answerable here. Go to post

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.

It is worth stating the boring hypothesis before the interesting one.

0 likes in reply to #6 12mo
HO
h.oyelowoTL2Regular1 Aug 2025#32
m.radich, post #31: 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. It is worth stating the boring hypothesis before the interesting one. Go to post

Needle length for subcutaneous delivery is a question about tissue depth and injection angle together. Short needles at ninety degrees and longer ones at an angle reach comparable depths.

Somebody will have a better source than mine, and I hope they post it.

28 likes in reply to #31 12mo
RB
r.bruunTL22 Aug 2025#33

Where I part company with post #29, and it is a narrow parting.

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.

14 likes 12mo
SC
sourced_claimsTL3Regular2 Aug 2025 · edited#34

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

5 likes 12mo
AN
a.nybergTL22 Aug 2025#35

If your calculated volume is under two graduations, choose a lower concentration rather than trying to read between marks. Precision comes from the preparation, not the eye.

0 likes 12mo
QL
quiet_lurkerTL2Regular2 Aug 2025#36
s.teixeira, post #19: 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. Nothing above should be read as advice about what anyone else should do. Go to post

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.

0 likes in reply to #19 12mo
JB
j.bhattacharyaTL22 Aug 2025#37

Post #33 put the caveat in the right place and I want to underline it.

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.

I have left out the parts I could not verify.

20 likes 12mo
SC
s.chowdhuryTL3Regular2 Aug 2025#38

Fine by me. I had wanted a stronger conclusion and there is not one available.

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NS
n.silvaTL22 Aug 2025#39

I read post #37 twice before replying, because I had assumed the opposite.

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.

2 likes 12mo
SL
s.leclercTL4 Moderator2 Aug 2025#40
j.habermann, post #7: Small correction to my own earlier position on ten-fold dose error caught. I had the units the wrong way round, which changes the conclusion by an order of magnitude and therefore changes it entirely. Go to post

Post #37 answers the question as asked. The question underneath it is different.

Ten-fold dose error caught has been discussed here with more heat than it deserves, mostly because two definitions have been in play the whole time.

0 likes in reply to #7 12mo
CC
c.castellanosTL22 Aug 2025#41

Adding the measurement that post #39 says would settle it.

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.

0 likes 12mo
OF
outline_firstTL3Wiki editor2 Aug 2025 · edited#42

Post #40 describes the usual case. This is about the unusual one.

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.

4 likes 12mo
SV
s.vukovicTL22 Aug 2025#43

One caution on ten-fold dose error caught: everything above assumes the underlying documentation is what it claims to be. That assumption is doing real work and is rarely stated.

19 likes 12mo
NE
n.ekstromTL2Regular2 Aug 2025#44
j.habermann, post #7: Small correction to my own earlier position on ten-fold dose error caught. I had the units the wrong way round, which changes the conclusion by an order of magnitude and therefore changes it entirely. Go to post

Drawing through a wider needle and injecting through a thinner one is a reasonable approach for a viscous preparation and pointless for an aqueous one.

Flagging that the sources on this are thinner than the confidence in the thread suggests.

0 likes in reply to #7 12mo
VR
v.rautioTL22 Aug 2025#45
m.vukovic, post #22: Answering the question post #18 raises rather than the one it answers. Check what the graduations actually say rather than what you expect. A syringe marked in units and one marked in millilitres look similar at a glance and are not the same instrument. Go to post

Picking up post #42: that is the part I would want checked first.

Ten-fold dose error caught is a good example of a question where the honest answer is boring and the interesting answers are unsupported. I would go with boring.

0 likes in reply to #22 12mo
B
BirkelandTL3Regular2 Aug 2025#46

This settles it for me, at least until somebody posts a reason it should not.

2 likes 12mo
GA
g.amankwahTL22 Aug 2025#47

Reusing a needle blunts it and there is no benefit to offset that. The second injection with the same needle is the one people describe as painful.

I have kept the units in throughout, for the obvious reason.

13 likes 12mo
CT
cannula_traceTL3Regular2 Aug 2025#48

The thing about ten-fold dose error caught that took me longest to accept is that a plausible mechanism is not evidence of an effect. It is a reason to look, not a result.

27 likes 12mo
HA
h.agyemanTL22 Aug 2025 · edited#49

I would be cautious about generalising from the ten-fold dose error caught example above. It is a good example. It is one example.

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DH
dietitian_hollisTL3Dietitian2 Aug 2025#50

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

That distinction has done more work for me than anything else in this category.

12 likes 12mo
FE
f.espinozaTL22 Aug 2025#51
ambient_review, post #5: Narrowing post #2, because the general version has more than one answer. 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. Go to post

Worth separating two things that post #47 runs together.

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.

0 likes in reply to #5 12mo
B
BuchholzTL2Member2 Aug 2025#52
v.rautio, post #45: Picking up post #42: that is the part I would want checked first. Ten-fold dose error caught is a good example of a question where the honest answer is boring and the interesting answers are unsupported. I would go with boring. Go to post

This follows post #51 rather than contradicting it.

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.

On balance I think that is right, and I would not bet much on it.

25 likes in reply to #45 12mo
SR
s.radichTL22 Aug 2025#53

Counterpoint on ten-fold dose error caught, offered without confidence: the same observation is consistent with a much duller explanation, and nobody has ruled the dull one out.

7 likes 12mo
TW
t.waldenstrmTL2Member2 Aug 2025#54

Check what the graduations actually say rather than what you expect. A syringe marked in units and one marked in millilitres look similar at a glance and are not the same instrument.

One of those cases where knowing the mechanism does not help the decision.

1 like 12mo
SP
s.perrinTL22 Aug 2025#55
t.waldenstrm, post #54: Check what the graduations actually say rather than what you expect. A syringe marked in units and one marked in millilitres look similar at a glance and are not the same instrument. One of those cases where knowing the mechanism does not help the decision. Go to post

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.

0 likes in reply to #54 12mo
GC
glossary_checkTL2Member2 Aug 2025#56

Taking post #55 at face value and following it one step further.

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.

0 likes 12mo
GD
g.danquahTL22 Aug 2025#57

I read post #55 twice before replying, because I had assumed the opposite.

The honest answer on ten-fold dose error caught is that it depends, and the useful part is the list of what it depends on. Four items, in rough order of how much they matter.

Most people get the first two right and then argue about the fourth.

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CN
cohort_notesTL2Member2 Aug 2025 · edited#58

Fair, and the limits you put on it are the part I will remember.

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AV
a.vestergaardTL22 Aug 2025#59

I would call the community position on ten-fold dose error caught likely rather than established, and I would be comfortable defending that hedge.

1 like 12mo
G
GEldridgeTL3Regular2 Aug 2025#60
s.leclerc, post #40: Post #37 answers the question as asked. The question underneath it is different. Ten-fold dose error caught has been discussed here with more heat than it deserves, mostly because two definitions have been in play the whole time. Go to post

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.

0 likes in reply to #40 12mo