Patent Description:
Vascular access devices (VADs) are commonly used therapeutic devices, which include intravenous (IV) catheters. If not properly maintained or if exposed to a non-sterile environment, the VADs can become contaminated, sealed with blood clots or spread infection. To ensure VADs are used properly and do not become sealed or infected, protocols to ensure sterile practice have been developed. These protocols include sterilizing the VAD and flushing the catheter with a flush solution. Catheters are flushed using syringe assemblies filled with various fluids. In some cases, different fluids are injected sequentially in accordance with the protocol. For example, a saline solution followed by an anticoagulant such as heparin. The size of the syringe used to flush intravenous (I. ) lines varies by various factors including the size and length of the catheter. Typically syringes of <NUM>, <NUM>, <NUM> and <NUM> volume are used. VAD protocols usually recommend flush procedures be performed after catheter placement, before fluid infusion, and before and after drug administration, blood sampling, transfusions and parenteral nutrition. The goal of these flush procedures is to confirm catheter patency, avoid drug incompatibilities, ensure the complete drug dose administration, prevent thrombus formation and minimize the risk of blood stream infections.

Conventional flush syringes have a barrel with a luer tip at one end which is exposed to the non-sterile environment once the syringe tip is removed from packaging thus providing an opportunity for undesired contamination.

Current "recommended practice" for aseptic IV line maintenance and IV drug delivery practices require adherence to a stepwise process referred to as "SASH. " During the first step of the process, the clinician cleans/disinfects (generally with an alcohol swab) the VAD connector. Second, a syringe containing saline is used to flush the IV line or catheter (Saline flush), and then the VAD connector is disinfected a second time. Third, the fluid or pharmaceutical therapy is administered through the IV line or catheter (Administer therapy), the VAD connector is disinfected a third time, followed by a second Saline flush step. The final step, which is dependent upon the patient's need and institutional poilcy, is a final disinfection of the VAD connector followed by a Heparin lock step, where a small amount of heparin is injected into the IV line or catheter to prevent the formation of thrombi or blood clots. At the conclusion of this tedious stepwise process, the inlet port of the VAD connector is left exposed to the environment. This "recommended practice" requires disinfecting the VAD connector after each access makes IV line maintenance a very burdensome and time consuming process. Because the process is so cumbersome, clinicians very rarely implement this "recommended practice" in its entirety, and, thus, patients are exposed to the risk of contracting CRBSIs. Microorganisms populate exposed connector inlet surfaces, and, when the "recommended practice" is not adhered to, the microorganisms can enter the IV line during flushing. Furthermore, blood reflux into the IV line or catheter can cause clot formation inside the lines, and microorganisms from the connector inlet surfaces can colonize blood clots inside the lines and infect the patients during flushing.

Documents <CIT>, <CIT> and <CIT> all disclose typical prior art syringe assemblies.

There is a need, therefore, for a flush syringe assembly that promotes compliance with aseptic technique by eliminating the additional swabbing and disinfecting steps.

One aspect of the present disclosure pertains to a flush syringe assembly including a barrel including a side wall having an inside surface defining a chamber for retaining a fluid, an open proximal end, a distal end including a distal wall with an elongate tip extending distally therefrom having a passageway therethrough in fluid communication with said chamber. A collar extends from the distal wall of the barrel and surrounding the elongate tip, the collar including at least one side wall having an inside surface defining a compartment, an open distal end, a proximal end adjacent the distal wall of the barrel. A disinfectant-loaded swab may be disposed in the collar. An elongated plunger rod may be disposed within the barrel, the plunger rod comprising a distal end and a proximal end, the distal end including a stopper slidably positioned in fluid-tight engagement with the inside surface of the barrel for drawing fluid into and driving fluid out of the chamber by movement of the stopper relative to the barrel, the elongated plunger rod extending outwardly from the open proximal end of the barrel, the stopper having a distal surface.

In one or more embodiments, the fluid is a flush fluid.

In one or more embodiments, the disinfectant-loaded swab has one or more openings or slits on a top surface of the swab.

According to the invention, the compartment of the collar surrounds the elongate tip.

Another aspect of the present disclosure pertains to a flush syringe assembly comprising a barrel including a side wall having an inside surface defining a chamber for retaining a fluid, an open proximal end, a distal end including a distal wall with an elongate tip extending distally therefrom having a passageway therethrough in fluid communication with said chamber. A collar extending from the distal wall of the barrel and surrounding the elongate tip, the collar including at least one side wall having an inside surface defining a compartment, an open distal end, a proximal end adjacent the distal wall of the barrel. A disinfectant-loaded swab may be disposed in the collar. A removable cap having a body, a proximal end, and a closed distal end, the removable cap being mounted on the distal end of the collar. An elongated plunger rod may be disposed within the barrel, the plunger rod comprising a distal end and a proximal end. A stopper slidably may be disposed on the distal end of the plunger rod and positioned in fluid-tight engagement with the inside surface of the barrel for drawing fluid into and driving fluid out of the chamber by movement of the stopper relative to the barrel.

According to the invention, the distal wall of the collar includes a plurality of threads to connect the collar to the removable cap.

In one or more embodiments, the removable cap includes an outward protrusion extending from the body of the removable cap and corresponding with the passageway on the distal end of the elongate tip.

In one or more embodiments, the removable cap has a cross-sectional shape that is triangular, square, pentagonal, hexagonal, heptagonal, octagonal, symmetric or non-symmetric polygonal.

In one or more embodiments, the collar has a cross-sectional shape that is triangular, square, pentagonal, hexagonal, heptagonal, octagonal, symmetric or non-symmetric polygonal.

In one or more embodiments, the disinfectant-loaded swab is made of an absorbent material.

In one or more embodiments, the disinfectant or antimicrobial agent may be ethanol, <NUM>-propanol, butanol, methylparaben, ethylparaben, propylparaben, propyl gallate, butylated hydroxyanisole (BHA), butylated hydroxytoluene, t-butyl-hydroquinone, chloroxylenol, chlorohexidine, dichlorobenzyl alcohol, dehydroacetic acid, hexetidine, triclosan, hydrogen peroxide, colloidal silver, and mixtures thereof.

Before describing several exemplary embodiments of the present disclosure, it is to be understood that the disclosure is not limited to the details of construction or process steps set forth in the following description. The disclosure is capable of other embodiments and of being practiced or being carried out in various ways.

With respect to terms used in this disclosure, the following definitions are provided.

Reference to "flush syringe assembly" includes syringes that are indicated for use in the flushing of VADs. The practice of flushing ensures and maintains catheter patency and helps prevent the mixing of incompatible pharmaceuticals.

As used herein, the use of "a," "an," and "the" includes the singular and plural.

As used herein, the term "catheter related bloodstream infection" or "CRBSI" refers to any infection resulting from the presence of a catheter or IV line.

As used herein, the term "microorganism" refers to a microbe or organism that is unicellular or lives in a colony of cellular organisms. Microorganisms are very diverse; they include, but are not limited to bacteria, fungi, archaea, and protozoans. Microorganisms are often the cause of CRBSIs. The most common microorganisms associated with CRBSIs include, but are not limited to, Staphylococcus aureus and epidermis, Enterococcus faecalis, Escherichia coli, Pseudomonas aeruginosa, and Candida albicans.

As used herein, the terms "antimicrobial agent" or "antimicrobial" refers to substances that kill or inhibit the growth of microorganisms such as bacteria, fungi, archaea, or protozoans. Antimicrobial agents either kill microbes, or prevent the growth of microbes.

As used herein, the term "disinfectant" refers to antimicrobial substances that are used on non-living objects or outside the body, e.g., on the skin.

In one or more embodiments, disinfectants or antimicrobial agent include, but are not limited to, ethanol, <NUM>-propanol, butanol, methylparaben, ethylparaben, propylparaben, propyl gallate, butylated hydroxyanisole (BHA), butylated hydroxytoluene, t-butyl-hydroquinone, chloroxylenol, chlorohexidine, dichlorobenzyl alcohol, dehydroacetic acid, hexetidine, triclosan, hydrogen peroxide, colloidal silver, and mixtures thereof.

As used herein, the term "absorbent material" refers to a material having capacity or tendency to absorb or soak up another substance. In one or more embodiments, the absorbent material has a tendency to absorb a disinfectant or antimicrobial. Absorbent materials may include sponges, absorbent cottons.

As used herein, the term "Luer connector" refers to a connection collar that is the standard way of attaching syringes, catheters, hubbed needles, IV tubes, etc. to each other. The Luer connector consists of male and female interlocking tubes, slightly tapered to hold together better with even just a simple pressure/twist fit. Luer connectors can optionally include an additional outer rim of threading, allowing them to be more secure. The Luer connector male end is generally associated with a flush syringe and can interlock and connect to the female end located on the VAD. A Luer connector comprises a distal end, a proximal end, an irregularly shaped outer wall, a profiled center passageway for fluid communication from the chamber of the barrel of a syringe to the hub of a VAD. A Luer connector also has a distal end channel that releasably attaches the Luer connector to the hub of a VAD, and a proximal end channel that releasably attaches the Luer connector to the barrel of a syringe.

Clinical best practice requires that clinicians disinfect the needleless connector with an alcohol swab, disinfectant cap, etc. before each flush, drug, and lock syringe, requiring the clinician to perform the disinfecting process multiple times for each catheter line access. In practice, there are low (<NUM>-<NUM>%) compliance rates to this disinfecting protocol. Embodiments of the present disclosure provide the advantage of increased and enforced compliance with the need to disinfect needless connectors which ultimately reduces the chances of hospital acquired infections. Use of embodiments of syringe assemblies disclosed in the present disclosure will require the clinician to open fewer packages and does not require the clinician to carry alcohol swabs. Moreover, use of embodiments of syringe assemblies disclosed in the present disclosure results in the combination of two existing steps into one step, thus simplifying workflow for the clinician. Embodiments of the present disclosure pertain to prefilled flush or lock syringes with an integrated swab that combines the two steps of disinfecting the hub and connecting the syringe into one, thus greatly improving compliance to best practices.

Provided are syringe assemblies that include a plunger rod and a syringe barrel having an open proximal end and a distal tip, the distal syringe tip surrounded by a collar that extends from the distal wall of the syringe barrel to form a compartment to house a disinfectant-loaded swab. The collar also facilitates alignment of the syringe with a catheter hub or needle-free connector, as well as, reducing contamination of the syringe by preventing contact of the syringe tip with the surrounding non-sterile environment.

Referring to <FIG>, a syringe assembly <NUM> according to the present disclosure generally comprises a barrel <NUM>, including a side wall <NUM> having an inside surface defining a chamber <NUM> for retaining a fluid. In one or more embodiments, the fluid is a flush fluid. The barrel <NUM> further includes an open proximal end <NUM> and a distal end <NUM> having a distal wall <NUM>. A collar <NUM> extends from the distal wall <NUM> of the syringe barrel <NUM> to form a compartment <NUM> to house a disinfectant-loaded swab <NUM>. the collar surrounds an elongated tip <NUM> extending distally from the distal wall of the barrel <NUM>. The elongated tip <NUM> having a passageway <NUM> therethrough in fluid communication with the chamber <NUM>, the collar extending from the distal wall <NUM> of the barrel to surround the elongated tip. The collar <NUM> surrounds an elongate tip adapted for connection to the hub of the vascular access devices, wherein the tip is a Luer tip.

As shown in <FIG>, collar <NUM> is disposed on the distal end <NUM> of the barrel, the collar <NUM> including at least one side wall <NUM> having an inside surface <NUM> defining a compartment <NUM> surrounding the elongated tip <NUM>, a open distal end <NUM>, and a proximal end <NUM> adjacent the distal wall <NUM> of the barrel. The compartment <NUM> houses the disinfectant-loaded swab <NUM>. The open distal end <NUM> of the collar comprises a plurality of threads <NUM> on the outside surface for attachment to a removable cap <NUM>. Elongated tip <NUM> is adapted for connection to a hub of a vascular access device. The shape of the collar <NUM> can vary. Collar <NUM> may have shapes including, but not limited to, a convex inner surface (for example a paraboloid), concave inner surface, with a straight profile (i.e., semi conical shape), or have the shape of a trapezoidal prism. The length of this extension from the main body of syringe and the degree of openness/ straightness of the profile (how wide the collar is at the end farthest from the syringe barrel) can vary.

The collar <NUM> surrounds an elongate tip adapted for connection to the hub of the vascular access devices. In one or more embodiments, the elongate tip is a Luer tip.

Disinfectant-loaded swab <NUM> may comprise an absorbent material <NUM> for soaking up the disinfectant or antimicrobial agent that is housed within the compartment <NUM>. The disinfectant or antimicrobial agent can be a fluid or a gel selected from the group consisting of selected from the group consisting of IPA, ethanol, chlorhexidine, <NUM>-propanol, butanol, methylparaben, ethylparaben, propylparaben, propyl gallate, butylated hydroxyanisole (BHA), butylated hydroxytoluene, t-butyl-hydroquinone, chloroxylenol, chlorohexidine, dichlorobenzyl alcohol, dehydroacetic acid, hexetidine, triclosan, and mixtures thereof. The disinfectant or antimicrobial agent can be a fluid or a gel.

In one or more embodiments, disinfectant-loaded swab <NUM> has one or more openings or slits on the top surface to allow a needleless connector to go through to connect to the elongate tip <NUM>. The disinfectant-loaded swab <NUM> will deform in way so as to create sufficient friction and scrubbing between the VAD connector and disinfectant-loaded swab <NUM>, and to release the disinfectant as it gets compressed in order to disinfect the needleless connector surfaces. Following full engagement of the syringe assembly and VAD connector, the fluid in the chamber of the syringe barrel <NUM> can be administered.

Disinfectant-loaded swab <NUM> can have a near cylindrical or hexagonal outer surface, as seen in <FIG> and <FIG>. The purpose of the hexagonal shape combined with the barrel <NUM> with the collar <NUM> is to provide a strong grip between the barrel and disinfectant-loaded swab <NUM> and prevent disinfectant-loaded swab <NUM> from rotating as the syringe assembly <NUM> gets twisted onto a VAD connector. The inner surface of the collar <NUM> can be cylindrical or hexagonal or any other geometry to increase friction between the disinfectant-loaded swab <NUM> and barrel <NUM>. The opening at the top of the disinfectant-loaded swab <NUM> can be a single slit, two or more slits. Alternatively, as seen in <FIG>, the top surface disinfectant-loaded swab <NUM> can be with a number of overlapping flaps <NUM> at the top surface. A portion of each flap <NUM> overlaps with the next and so on. In one or more embodiments, the thickness of disinfectant-loaded swab <NUM> can be adjusted to enable absorbance of sufficient amounts of disinfectant. Further, the inner surface of the disinfectant-loaded swab <NUM> may have various forms of cut-outs to allow for the disinfectant-loaded swab <NUM> to buckle and fold on itself and allow the penetration of needleless connector. In one or more embodiments, as shown in <FIG>, there is some open space inside of the swab to create space for the pieces of the swab that enter that space as the disinfectant-loaded swab <NUM> opens. In an alternate embodiment, the disinfectant-loaded swab <NUM> fully rolls up on the sides of the needleless connector like a sleeve. The porosity of the disinfectant-loaded swab <NUM> can be different throughout the disinfectant-loaded swab <NUM> (e.g. a radial or axial gradient or else) to allow for controlling the absorbance and release of the disinfectant. Additionally, the top surface can bear additional surface features for improving the scrubbing. A range of disinfectants (e.g. IPA, ethanol, chlorhexidine, etc.) at various concentrations can be loaded into the swab.

In one or more examples not representing the invention, the disinfectant-loaded swab <NUM> can sit on top of the syringe tip without lateral support. In such embodiments, a tip cap <NUM> can be threaded onto the distal end of the barrel near the swab. The distal end of the barrel will have one or more plurality of threads. In one or more embodiments, the distal end <NUM> of the collar <NUM> may comprise a removable seal <NUM>. The removable seal <NUM> can comprise an aluminum peal back top. The seal can be a plastic sealed aluminum, and can be chemically-resistant, light-blocking, non-permeable, or sterile.

In one or more embodiments, the collar <NUM> may also comprise an aluminum lining adhered to the inside surface of at least one side wall <NUM>. The aluminum lining can prevent degradation of the disinfectant or antimicrobial agent, and can also provide a mechanism for ensuring compliance with aseptic conditions.

As shown in <FIG>, the open distal end <NUM> of the collar <NUM> may comprise a removable cap <NUM>. The removable cap <NUM> includes a body with a proximal end <NUM>, a closed distal end <NUM>. The distal end <NUM> and the proximal end <NUM> define the length of the cap <NUM>. Upon assembly, the proximal end <NUM> of the cap <NUM> is adjacent the distal end <NUM> of the collar <NUM>. As shown in <FIG>, cap <NUM> comprises an outward protrusion that extends from the body <NUM> of the cap <NUM> and corresponds with the opening of the distal end of the elongate tip <NUM>. The proximal end <NUM> of removable cap <NUM> comprises a plurality of threads on the outside surface of the cap for attachment to corresponding grooves disposed on the inside surface of the distal end of the collar <NUM>.

The cross-sectional shape of the cap <NUM> can be any suitable shape including, but not limited to, triangular, square, pentagonal, hexagonal, heptagonal, octagonal, symmetric or non-symmetric polygonal. The shape of the cap <NUM> can provide a comfortable feel for the user and enhanced gripping ability to allow the user to easily connect or disconnect the cap from the collar <NUM>.

The syringe assembly <NUM> having collar <NUM> and disinfectant-loaded swab <NUM> surrounding tip <NUM> that is rendered antimicrobial because the tip is surrounded by an absorbent material <NUM> that soaks up disinfectant or antimicrobial agent contained within compartment <NUM>. The now antimicrobial tip <NUM> can be connected to a vascular access device. In necessary, cap <NUM> or seal <NUM> is removed from the distal end <NUM> of the collar <NUM>, exposing the tip <NUM>. As the syringe assembly <NUM> is connected to the hub of a vascular access device <NUM>, the disinfectant-loaded swab <NUM> compresses creating friction. The disinfecting properties of the disinfectant or antimicrobial agent contained within the disinfectant-loaded swab <NUM> disposed in compartment <NUM> that has been absorbed by absorbent material <NUM>, disinfect the hub <NUM> of a vascular access device, thus ensuring compliance with aseptic technique. The friction created by the compression of the disinfectant-loaded swab <NUM> is necessary to provide disinfection of the hub <NUM>. Once the connection of the syringe assembly <NUM> to the hub <NUM> is completed, the hub is properly disinfected, and fluid communication from the barrel <NUM> of the syringe to the vascular access device can occur. Fluid is drawn from the barrel <NUM> through the passageway <NUM> through the hub <NUM> and into the IV or catheter. Because of the presence of the collar <NUM> and disinfectant-loaded swab <NUM>, fluid communication through a vascular access device and into a patient is conducted under aseptic conditions without any additional swabbing steps and diligence on the part of the clinician.

In example not representing the invention, as shown in <FIG>, the syringe assembly has a disinfectant cap <NUM> attached to the front of the syringe, which creates a visual reminder to clinician to disinfect the surface before using the syringe content, but it will not combine the two steps into one. As shown in <FIG>, a clinician will remove the tip cap or peel, disinfect the hub with the syringe and cap attached by scrubbing the surface, then detaches the cap which then exposes the syringe tip, then connects the syringe to the connector and continues as normal. The cap can be snapped onto the barrel or can get threaded onto the outside surface of the collar around the luer tip as seen in the image named 'detachable cap'. Other embodiment is one where the swab is not porous and only the surfaces that come into contact with the needleless connector are coated with an antimicrobial coating.

A seal <NUM> will contain the disinfectant or antimicrobial agent within the chamber until the seal <NUM> is removed and the syringe assembly <NUM> is connected to a vascular access device <NUM>. The absorbent material of disinfectant-loaded swab <NUM> will soak up the disinfectant or antimicrobial agent and will disinfect the hub of a vascular access device upon connection.

The syringe assembly <NUM> may be filled with flush solution using known methods. Additionally, the syringe assembly <NUM> may be provided pre-filled from the manufacturer or supplier. The flush solution may be any solution intended for flushing or maintaining performance of VAD's. It is preferred that the flush solution be selected from the group consisting of saline flush solution and heparin lock flush solution. These solutions are known in the art and are readily available. An example of a saline flush solution includes, but is not limited to, <NUM>% sodium chloride USP for injection. An example of a heparin lock flush solution includes but is not limited to <NUM>% sodium chloride with <NUM> USP units of heparin sodium per mL or <NUM> USP units of heparin sodium per mL.

Once the connection of the syringe assembly <NUM> to the VAD is completed, fluid communication from the barrel <NUM> of the syringe to the vascular access device can occur. Fluid is drawn from the barrel <NUM> through the integral passageway <NUM> into the IV or catheter. Because of the presence of the disinfectant-loaded swab <NUM> in the collar <NUM>, fluid communication through a vascular access device and into a patient is conducted under aseptic conditions without any additional swabbing steps and diligence on the part of the clinician.

In one or more embodiments, the collar <NUM> is integrally formed on the distal wall <NUM> of the syringe barrel <NUM> for fluid communication to the vascular access device.

The barrel <NUM> may also include an elongate tip <NUM> which extends distally from the barrel. The tip <NUM> can have an outer diameter that is different from or the same as the outer diameter of the rest of the barrel. The tip of the barrel may include a luer slip connection or a locking luer type collar concentrically surrounding the tip or within the tip.

As shown in <FIG>, an elongated plunger rod <NUM> may include a distal portion and a proximal portion, the plunger rod further comprising a distal end including a stopper slidably positioned in fluid-tight engagement with the inside surface of the barrel for drawing fluid into and driving fluid out of the chamber by movement of the stopper relative to the barrel, the elongated plunger rod extending outwardly from the open proximal end <NUM> of the barrel, the stopper having a distal surface.

An elongate plunger rod <NUM> may be disposed within the barrel <NUM>. The plunger rod includes an elongate body portion with a proximal end and a distal end.

The elongate body portion of the plunger rod has an axial length extending from the proximal end to the distal end. The body portion may include a single beam or features, which may have cylindrical or other shapes. The body portion may be formed by two perpendicularly intersecting beams.

The plunger rod may also include a thumbpress at the proximal end of the elongate body portion. The shape of the thumbpress can vary depending on the desired usage of the flush syringe assembly. The shape of the thumbpress may be round, square, rectangular, triangular, oval, pentagonal, hexagonal and cruciform.

A stopper is connected to the distal end of the plunger rod. The shape and size of the stopper can be any suitable shape or size depending on, for example, the shape and size of the barrel and plunger rod. The plunger rod is slidably positioned in the barrel so that the stopper is in fluid-tight contact with the inside surface of the barrel and so that distal movement of the plunger rod relative to the barrel causes the stopper to push the fluid out of the barrel. The stopper is slidably positioned in fluid-tight contact with the inside surface of the barrel for driving fluid out of the chamber by movement of the stopper relative to the barrel. The stopper can be connected to the distal end of the elongate plunger rod by any suitable means. In some embodiments, the stopper is connected by a mechanical connection such as interaction of complementary screw threads and press-fit connections. The stopper is slidably positioned in fluid-tight engagement with the inside surface of the barrel for drawing fluid into and driving fluid out of the chamber.

The stopper may be made of any material suitable for providing a seal with the inside surface of the barrel. For example, the stopper may be made of thermoplastic elastomers, natural rubber, synthetic rubber or thermoplastic materials and combinations thereof. The stopper may be integrally formed or composed of separate components of the same or different materials joined together. The plunger rod may be made of material which is more rigid than the stopper such as polypropylene, polyethylene and the like. Materials should be chosen to be compatible with the procedure being used.

Claim 1:
A flush syringe assembly comprising:
a barrel (<NUM>) including a side wall (<NUM>) having an inside surface defining a chamber (<NUM>) for retaining a fluid, an open proximal end (<NUM>), a distal end (<NUM>) including a distal wall (<NUM>) with an elongate tip (<NUM>) extending distally therefrom having a passageway (<NUM>) therethrough in fluid communication with said chamber (<NUM>);
a removable cap (<NUM>);
a collar (<NUM>) extending from the distal wall (<NUM>) of the barrel (<NUM>), the collar (<NUM>) including at least one side wall (<NUM>) having an inside surface (<NUM>) defining a compartment (<NUM>), an open distal end (<NUM>), a proximal end (<NUM>) adjacent the distal wall (<NUM>) of the barrel (<NUM>); the collar (<NUM>) having grooves on an outside surface, the grooves on the outside surface of collar (<NUM>) correspond to threads (<NUM>) on the removable cap (<NUM>);
a disinfectant-loaded swab (<NUM>) disposed in the collar (<NUM>);
an elongated plunger rod (<NUM>) disposed within the barrel (<NUM>), the plunger rod (<NUM>) comprising a distal end and a proximal end, the distal end including a stopper slidably positioned in fluid-tight engagement with the inside surface of the barrel (<NUM>) for drawing fluid into and driving fluid out of the chamber (<NUM>) by movement of the stopper relative to the barrel (<NUM>), the elongated plunger rod (<NUM>) extending outwardly from the open proximal end (<NUM>) of the barrel (<NUM>), the stopper having a distal surface; and
another collar disposed on the distal end of the barrel (<NUM>), the other collar comprises a plurality of threads on the inside surface for connection to a vascular access device;
the collar (<NUM>) surrounds the swab (<NUM>), the other collar and the elongate tip (<NUM>), the swab (<NUM>) surrounds the other collar and the elongate tip (<NUM>), and the other collar surrounds the elongate tip (<NUM>).