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Is an 18G drawing needle the right choice for drawing orforglipron at 20 mg/mL?

Asked 29 Jul 2024Modified 21 months agoViewed 34k times
37

Numbers first: an 18G drawing needle · orforglipron · 20 mg/mL.

I want to know what the trade-off actually is rather than which option is fashionable.

I would rather have a defensible reason than a marginal improvement.

Which axes does this decision turn on?

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BD
askedb_delacroix43k3829 Jul 2024

5 Answers

Accepted answer first, then by votes
72

Accepted answer

At 20 mg/mL a 1 mg dose is 0.05 mL — 5 units on a U-100 barrel — and no needle gauge changes that number. Gauge changes three other things: how long the draw takes, how much stays behind in the hub, and how much rubber you core out of the stopper. On the 18G scale a larger number is a finer needle, so an 18G drawing needle is coarse enough to draw quickly and coarse enough to cut a visible plug from the stopper. If you are drawing 5 units at a time, the dead space matters more than the bore: a fixed-needle barrel loses microlitres, a luer hub loses tens of them, and at 20 mg/mL each microlitre is 20 µg.

Answer first: use the largest bore you tolerate for drawing and the smallest for injecting, because the two operations have opposite requirements.

Very fine needles are more prone to bending and to blocking with any particulate, which is a practical argument for inspecting the solution before drawing.

On the detail: fixed-needle insulin syringes are supplied in 29G to 31G and cannot be swapped for drawing, which is the trade-off against their much lower dead space.

Coring risk as a function of needle gauge and insertion technique is documented in pharmacy compounding guidance.

Big to draw, small to inject, never the same one twice.

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DL
answered · acceptedDr_Otto_Lindqvist72k583 Aug 2024
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62

The honest answer is that injection gauge is a comfort decision and drawing gauge is a stopper-coring decision.

Flow through a needle scales with the fourth power of the internal radius under the Hagen–Poiseuille relation. Halving the radius reduces flow sixteen-fold at the same pressure, which is why a 31G needle draws so much more slowly than a 21G.

Concretely, for injecting, 29G to 31G is the usual range and the difference in perceived discomfort between them is small. Needle length matters more than gauge for comfort at these volumes.

Needle gauge to outer diameter correspondence is standardised and published; the inverse relationship between gauge number and diameter is the reason for the counter-intuitive labelling.

Length affects comfort more than gauge does at these volumes.

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SC
answeredstopper_core28k12714 Aug 2024
33

The short version: 21G to 23G to draw, 29G to 31G to inject, and never the same needle for both.

Typical outer diameters: 21G is about 0.82 mm, 23G about 0.64 mm, 25G about 0.51 mm, 29G about 0.34 mm and 31G about 0.26 mm. The gauge number and the diameter move in opposite directions.

More usefully, a 30G or 31G needle through a butyl stopper leaves a track that reseals, which is why fine-gauge repeated entry is tolerable and coarse-gauge repeated entry is not.

The Hagen–Poiseuille relation gives flow proportional to the fourth power of radius, which is the quantitative basis for every gauge recommendation here.

Gauge numbers run backwards. Higher number, thinner needle.

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DV
answereddead_volume56k485 Sept 2024
3Minor: the filter membrane chemistry matters as much as the pore size for adsorption. – bridget_nyathi 7 months ago
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27

The part that matters: for a 4 mm pen-style needle the gauge options are narrow and the choice is nearly made for you.

Stopper coring — punching a disc of rubber into the solution — is a large-bore phenomenon. An 18G or 21G needle inserted straight and fast is the classic way to do it; inserting at a slight angle with the bevel up reduces the risk.

Butyl rubber closures are specified for resealing after piercing up to a stated gauge, which is the basis for the fine-gauge repeated-entry practice.

Angle the bevel and insert gently to avoid coring the stopper.

edited 11 Sept 2024 by ines_brandt — added the method parameters

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IB
answeredines_brandt113k25725 Aug 2024
23

Start with the fact that gauge numbers run backwards — a higher number is a thinner needle — which is the source of half the confusion in this tag.

Drawing a viscous or foamy solution through a fine needle takes long enough that people rush the plunger, which causes more foaming. Using a wider drawing needle is the fix.

Higher gauge is not automatically better; it is thinner, which has costs as well as benefits.

Flow goes as the fourth power of radius. That is why the difference feels so large.

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TM
answeredthermal_mass13k1729 Oct 2024

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