Administration devices for oral compounding

Purpose
The choice of the device allowing the closure of the vials and the administration is important to guarantee the safety of use of the oral compounding. ANSM has published recommendations for manufacturers, which are difficult to apply in hospital, although many devices are available from suppliers. The objective of this work is to carry out an inventory of the use of devices for the administration of oral forms in different hospitals.

Methods
A questionnaire (google form) was sent to 36 hospitals in 2021. Different topics were addressed: type of stopper ensuring the closure of the vial (child-resistant, tamper-evident), type of syringes that can be used with the device and the presence of a possible device facilitating sampling (adapter to be inserted into the neck of the vial, access for sampling by syringe on the stopper).

Results
67% (n=24) of the requested hospitals responded to the questionnaire. A tamper-evident cap was used in 77% of cases (n=17) and only one hospital used a child-resistant cap. 37% (n=9) of the hospitals used a cap that allowed direct access for syringe sampling (3 references cited were captive to ENFIT^® syringes, 1 reference was captive to Nutrisafe^®2 syringes and the last one was used with luer or luer-lock syringes). Otherwise, either no other device was used, or it was a press-in-bottle-adapter (PIBA) system that is inserted into the neck of the vial. The references indicated for the latter device were captive either ENFIT^® syringes or laboratory pipettes.
Compounding was administered using ENFIT^® syringes (67% of respondents), luer or luer-lock syringes (21%), Nutrisafe^®2 syringes (4%), no-ENFIT^® oral administration syringes (4%), ENFIT^® and luer or luer-lock syringes (4%). One hospital used another device if the compounding was intended for a patient in retrocession with a reference combining a tamper-evident ring, child-resistant and captive dosing pipettes form the laboratory.

Conclusion
This state of play revealed a great heterogeneity of practices. Our university hospital wanted to combine a child-resistant cap and an ENFIT^® PIBA in order to maximize the safety of the packaging and administration of oral compounding. We met with various problems with suppliers: order volume was too low or it was impossible to send samples. National recommendations would make it possible to harmonize practices and have a greater impact to the suppliers of these devices.

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