WO2022253450A1

WO2022253450A1 - Booth for the automated administration of a medication by intramuscular injection or the like

Info

Publication number: WO2022253450A1
Application number: PCT/EP2021/074102
Authority: WO
Inventors: Sergio Enrico OREFICE
Original assignee: Orefice Sergio Enrico
Priority date: 2021-06-01
Filing date: 2021-09-01
Publication date: 2022-12-08

Abstract

A booth (1) for the automated administration of a medication by intramuscular injection or the like, having a region (2) for the automated handling of syringes (9) and a station (3) for a patient. The dividing wall (4) interposed between the two has a slit (41) along which a needle (91) can be made to pass and against which an arm (34) of the patient can be rested in alignment. The handling region (2) comprises a syringe magazine (6) and a robotic arm (5) provided with a gripper tool (53) adapted to grip a syringe (9) and to keep it fixed along a clamping direction (I). A linear actuator (55) is associated with, and can move with respect to, the gripper tool (53) along the clamping direction (I) and is engageable with a plunger (93) of the syringe (9). The robotic arm (5) is configured to move the gripper tool (53) between predetermined positions comprised between the syringe magazine (6) and an injection point (P) along the slit (41), at which the clamping direction (I) is substantially perpendicular to the slit (41).

Description

BOOTH FOR THE AUTOMATED ADMINISTRATION OF A MEDICATION BY INTRAMUSCULAR INJECTION OR THE LIKE

The present invention relates to a booth for the automated administration of a medication by intramuscular injection or the like, particularly for the automated inoculation of vaccines or the like, and to a corresponding syringe handling method.

One limitation to the number of daily vaccinations of a population is the need to have one or more healthcare professionals available for each patient at inoculation time. This limitation becomes a problem in mass vaccination situations, for example in periods of greatest circulation of influenza viruses, epidemics or pandemics.

The aim of the present invention is to provide a booth for the automated administration of medications by intramuscular injection, particularly for the automated inoculation of vaccines or the like, that is capable of improving the prior art in one or more of the aspects indicated above.

Within the scope of this aim, an object of the invention is to reduce the number of healthcare professionals required for the parallel injection of a medication, particularly of a vaccine, to a plurality of patients.

Another object of the invention is to obtain a booth for the automated administration of medications by intramuscular injection that is suitable for a plurality of patients having different builds.

A further object of the invention is to minimize the number of interventions of a healthcare professional on a booth for the automated administration of medications by intramuscular injection.

An object of the present invention is to overcome the drawbacks of the prior art in a manner that is alternative to any existing solutions.

Not least object of the invention is to provide a booth for the automated administration of medications by intramuscular injection that is highly reliable, relatively easy to provide and at competitive costs. This aim, as well as these and other objects which will become better apparent hereinafter, are achieved by a booth according to claim 1, optionally provided with one or more of the characteristics of the dependent claims.

Further characteristics and advantages of the invention will become better apparent from the description of a preferred but not exclusive embodiment of the booth for the automated administration of medications by intramuscular injection according to the invention, illustrated by way of non-limiting example in the accompanying drawings, wherein:

Figures la and lb are views of a booth according to the invention, taken from the side of the patient station;

Figure 2 is a top view of the booth of Figures la-lb;

Figure 3 is a view of the handling region of the booth of Figure la- lb;

Figure 4 is a detail view of the gripper tool and of the linear actuator of the robotic arm of the preceding figure;

Figure 5 is a view of the manner of fitting the linear actuator on the robotic arm of the preceding figure;

Figure 6 is a view of the open bottom of the ampoule magazine of Figure 3;

Figure 7 is a detail view of the cap retention element of the handling region of Figure 3.

With reference to the cited figures, a booth for the automated administration of medications by intramuscular injection according to the invention is generally designated by the reference numeral 1.

The invention may also consist of a set of a plurality of booths 1 such as the one described hereinafter in order to be able to perform injections in parallel to a plurality of patients.

The booth 1 is particularly suitable for the automated inoculation of vaccines or the like and comprises a region 2 for the automated handling of syringes and a station 3 for a patient, which are separated by a vertical dividing wall 4.

The station 3 can comprise a seat 32, which is optionally adjustable in height, and an armrest 31 for resting the forearm and elbow 34 of the patient, in a flexed position. The armrest 31 may be a shelf which protrudes from the dividing wall 4, as in the illustrated case, or may be fixed (for example on a footing of the booth 1 or on the seat 32) in a position that is in any case closely adjacent to the wall 4 so that the patient, while sitting, can rest his/her arm on the dividing wall 4.

The dividing wall 4 interposed between the handling region 2 and the station 3 is provided with a through slit 41, on which it is possible to rest the arm of the patient aligning the arm therewith (the term "arm" being understood to refer to the part that spans substantially from the elbow to the deltoid muscle).

The slit 41, which is substantially at a higher elevation than the armrest 31 with respect to the footing of the booth 1, may be essentially rectilinear and/or directed upward away from the armrest 31. For example, as in the illustrated case, the slit 41 is rectilinear and substantially vertical.

The lowest elevation 41a and the longitudinal extension of the slit 41 are such as to allow arms of different length to be visible (and therefore reachable by a hypodermic needle) through the slit 41 from the side of the handling region 2, when they are rested along the slit 41.

The handling region 2 comprises a robotic arm 5 which is suitable for the manipulation of disposable syringes 9 and a syringe magazine 6 adapted to support disposable syringes 9 so as allow their automated individual pickup by means of the robotic arm 5.

The syringe magazine 6 can comprise a rack 61 provided with a plurality of seats 62 which are mutually laterally spaced and are adapted to each keep a respective disposable syringe 9 in a substantially vertical position and spaced from the others. The rack 61 may be shaped like a circular arc which is coaxial to a vertical rotation axis of the robotic arm 5.

The seats 62 are distributed in an orderly manner on the rack 61 so as to define a plurality of predetermined pickup positions, which are stored in the robotic arm 5 and can be reached by an end effector of the robotic arm 5.

The robotic arm 5, which is preferably a collaborative robot or so- called “cobot”, can comprise a manipulator 51, for example with 6 or 7 axes, and associated control means.

The manipulator 51 of the robotic arm 5 is preferably a mechanism with an open kinematic chain, in which all the kinematic pairs have a single degree of freedom and are of the rotary type. Each axis of the manipulator 51 is advantageously provided with its own actuation system, in particular with its own servomotor.

The control means of the robotic arm 5 can comprise a robot controller, adapted to interpret the source code of a stored application program and to convert the corresponding commands into position and/or speed instructions for the individual servomotors of the axes of the manipulator 51. In the illustrated example, the control means are enclosed in a control cabinet 52 at the base of the manipulator 51, and the first rotation axis of the manipulator 51 can be perpendicular to the upper surface of said control cabinet 52.

The robotic arm 5 is configured to move, by means of the robot controller 52, the gripper tool 53 in the handling region 2 between said predetermined pickup positions (at the syringe magazine 6) and an injection position along the slit 41, at which the syringe must be kept substantially perpendicular to the slit 41, i.e., substantially horizontal or parallel to the footing of the booth 1.

The end effector of the robotic arm 5 comprises a gripper tool 53 (EOAT or End Of Arm Tooling) adapted to grip a single syringe 9 and to keep it fixed with respect to said gripper tool 53 along a direction I which is termed herein "clamping direction I" and which corresponds to the central axis of the syringe 9 when the syringe is retained by the gripper tool 53 and which will correspond to a direction that is substantially perpendicular to the slit 41 during the injection of the medication in the patient.

The gripper tool 53 is preferably fixed to an end wrist of the manipulator 51, so that it can rotate about the rotation axis of said wrist, which as mentioned is actuated by a respective servomotor.

The gripper tool 53 can be a robot gripper and can comprise two jaws 54 a- 54b which can mutually move in order to clamp between them the individual syringe 9 along its barrel 92. The clamping space between the jaws 54a and 54b defines an axis that corresponds to the clamping direction I, which coincides with the central axis of the syringe 9 when the syringe is retained by the jaws 54a-54b.

The jaws 54a-54b may optionally have a resting saddle (which is substantially coaxial to the clamping direction I) adapted to align automatically the central axis of the picked-up syringe 9 with the clamping direction I.

The gripper tool 53 can optionally be provided with an object detection characteristic in order to detect whether the syringe 9 has been picked up from the syringe magazine 6.

The gripper tool 53 is associated with a linear actuator 55 which can move in a linear manner, with respect to the gripper tool 53, along the clamping direction I, a direction which corresponds to the axial movement direction of the plunger 93 of the syringe 9 within the barrel 92 and is perpendicular to the direction of mutual approach of the jaws 54a-54b.

The linear actuator 55 preferably comprises an electric motor 55a and a corresponding stem 55b which is actuated in a linear manner by the electric motor 55a and which is the portion of the linear actuator 55 that can move in a linear manner, with respect to the gripper tool 53, along the clamping direction I. The translation of the stem 55b along the clamping direction I can be obtained by means of a mechanism of the screw-and-nut type or by magnetic induction.

The linear actuator 55 is mounted on the robotic arm 5 so that it is rigidly integral with the gripper tool 53. For example, as in the illustrated case, the linear actuator 55 is fixed directly to the gripper tool 53 by means of a bracket 57, but it might instead be fixed to the same wrist of the manipulator 51 on which the gripper tool 53 is fixed.

The linear actuator 55 is adapted to engage the plunger 93 of the syringe 9 when the syringe 9 is retained along the clamping direction I by the gripper tool 53, so as to be able to move the plunger 93 back and forth along the direction I with respect to the barrel 92 of the syringe 9.

For this purpose, the stem 55b of the linear actuator 55 can advantageously comprise a tip provided with a recess 56 in which it is possible to insert radially the terminal flange 94 of the plunger 93 when the gripper tool 53 grips the corresponding syringe 9 from the syringe magazine 6. The recess 56 preferably has such a size as to retain axially but not radially the terminal flange 94 of the plunger 93, so that the syringe 9 can slide away when it is no longer retained by the gripper tool 53. The flange 94 is preferably circular.

The robotic arm 5 may furthermore comprise, at the end effector, sensor means (not shown) adapted to identify a marking P through the slit 41 and is configured to associate the marking P with a medication injection position. In particular, the control means of the robotic arm 5 are adapted to align the clamping direction I of the gripper tool 53 substantially at right angles to the marking P identified by the sensor means and to translate the gripper tool 53 in a linear manner toward the marking P so as to perform the injection.

The marking P can be applied, by coloring with a felt pen or with a sticker, to the arm of the patient at the desired injection point, particularly on the deltoid muscle, so that it can be recognized optically by the sensor means. The sensor means can be constituted by a video camera which is controlled by the control means of the robotic arm 5. Said control means advantageously have appropriate image processing software (if it is not already incorporated in the video camera) in order to detect the marking P from the images acquired by the video camera.

The handling region 2 furthermore comprises an ampoule magazine 7, which is preferably cooled internally and can be a refrigerator or a chiller.

Said ampoule magazine 7 (shown schematically in phantom lines in the figures) is provided with an open bottom 71 above which, inside the magazine 7, multiple supports 74 for ampoules 73 are arranged which are adapted to keep all the ampoules in an upside-down vertical position. The ampoules 73 are preferably of the type with a rubber stopper and a metallic capsule which is crimped on a vial, so as to keep the medication inside the ampoule 73 even following a piercing of the rubber stopper with a needle 91.

Each one of the supports 74 communicates with the open bottom 71 of the ampoule magazine 7 to allow the passage of a needle 91 from the open bottom 71 into the support 74 and consequently into a respective ampoule 73. In the preferred embodiment, the supports 74 for the ampoules 73 are provided on at least one tray 72, which is preferably extractable from the ampoule magazine 7 and is provided with a plurality of through holes which face toward corresponding openings 71a of the open bottom 71. The openings 71a of the bottom 71 and the through holes of the tray 72 preferably have an array-like arrangement and each opening 71a, or each through hole of the tray 72, is preferably matched by a respective spatial coordinate which is known to the control means of the robotic arm 5, so that it can be reached precisely by the gripper tool 53 without having to be identified.

According to the type of medication and the number of doses contained in each ampoule 73, it is possible to provide such a number of supports 74 as to minimize the number of replacements in bulk of the depleted ampoules remaining in the supports 74.

For example, with a tray 72 adapted to support forty ampoules 73, each containing three doses of medication, it is possible to perform 120 injections, i.e., to use by way of indication the booth 1 for almost half a day without having to replace the tray 72 of depleted ampoules with another tray filled with a new set of ampoules 73.

The robotic arm 5, and in particular its control means 52, is configured to move the gripper tool 53 from at least one of the predetermined pickup positions at the syringe magazine 6 (in which the clamping direction I is substantially vertical) toward a plurality of predetermined coordinates on a substantially horizontal geometric plane which is parallel to the open bottom 71 of the ampoule magazine 7. These coordinates correspond to the projection of a respective ampoule 73 on said geometric plane, i.e., of a respective through hole of the tray 72 and/or of the corresponding opening 71a of the open bottom 71 of the ampoule magazine 7.

The robotic arm 5 is configured to orient the clamping direction 1 substantially at right angles to the horizontal open bottom 71 at each one of said predetermined coordinates and to translate the gripper tool 53 vertically toward the open bottom 71 so that the needle 91 of the syringe 9 can penetrate into one of the supports 74.

The gripper tool 53 is thus brought below the ampoule magazine 7 and is moved toward one of the ampoules 73 coaxially thereto. With this movement, the needle 91 of the syringe 9 retained by the gripper tool 53 is inserted in the rubber stopper of the ampoule, piercing it. After this movement, the linear actuator 55 is actuated by the control means so as to retract the stem 55b along the direction 1, moving the plunger 93 away from the barrel 92 of the syringe 9 and drawing the medication from the ampoule 73.

The control means of the robotic arm 5 can contain stored information on the capacity of the ampoules 73, so as to optionally return one or more times the gripper tool 53 below the ampoule magazine 7 toward the same coordinate of the previous mini-cycle, for a new withdrawal with a new syringe 9 from the same ampoule 73, for the subsequent patient.

The handling region 2 of the booth according to the invention advantageously also comprises a waste container 8 which is laterally adjacent to the robotic arm 5 and is preferably surmounted by a retention element 81 which is adapted to remove the cap 95 of the needle 91 of the syringes 9.

The retention element 81 can be provided by means of a plate which protrudes in a cantilever manner from an internal side wall of the handling region 2 of the booth 1 and is provided with a notch 82 that is smaller than the diameter of the open base of the cap 95, so as to be able to extract the cap 95 from the syringe 9 (just picked up from the syringe magazine 6) with an upward movement of the gripper tool 53, after the region between the cap 95 and the barrel 92 of the syringe 9 is inserted laterally into the notch 82 by the same gripper tool 53, as shown in Figure 7 with an example syringe.

In an alternative embodiment (not shown), a cap retention element can be arranged in the syringe magazine 6, for example below each seat 62 of the rack 61, so that the cap 95 of each syringe is retained by friction on said element when the syringe is extracted from the seat 62, leaving the syringe thus extracted with the needle exposed.

The spatial position of the waste container 8 with respect to the robotic arm 5 also is stored in the control means of the robotic arm 5 and can be reached by it, particularly at the end of each injection as well as optionally to extract the cap 95.

The operation of the booth 1 according to the invention provides for a main cycle formed by a sequence of mini-cycles, i.e., a sequence of steps which is repeated cyclically and stored by means of appropriate instructions of the application program in the control means of the robotic arm 5.

Prior to the start of the main automatic operation cycle, for example once a day, an operator inserts in the seats 62 on the rack 61 of the syringe magazine 6 a plurality of disposable syringes 9. Furthermore, the operator loads a batch of upside-down ampoules 73 on the tray 72 and then inserts the tray in the ampoule magazine 7.

Starting from a predetermined zero position of a mini-cycle of the method, the robotic arm 5 moves the gripper tool 53 toward one of the predetermined pickup positions at the syringe magazine 6. For example, the gripper tool 53 is moved toward one of the outermost seats 62 of the rack 61 that are occupied by a syringe 9 and that thus leave to the syringe one side free, from which the gripper tool 53 can approach the syringe 9 radially.

Subsequently, the gripper tool 53 is actuated to pick up the syringe 9, approaching it radially so that the terminal flange 94 of the plunger 93 enters the recess 56 of the stem 55b of the linear actuator 55. In particular, the barrel 92 of the syringe 9 is firmly clamped between the jaws 54a-54b.

With this pickup, the central axis of the syringe 9 gripped by the gripper tool 53 is aligned coaxially with the clamping direction I of the gripper tool 53.

With a substantially vertical upward lifting movement of the gripper tool 53 by means of the robotic arm 5, the gripped syringe 9 is extracted from the seat 62.

In the embodiment, not shown, in which the syringe magazine 6 incorporates the needle cap retention element, the cap 95 of the syringe 9 that is picked up in this step is extracted by this upward movement, remaining in the syringe magazine 6.

In the embodiment shown, instead, after the upward movement the gripper tool 53 is moved by the robotic arm 5 so as to advantageously bring the syringe 9 to the retention element 81, inserting it laterally in the notch 82 at such a height that the notch 82 straddles between the barrel 92 and the base of the cap 95. The gripper tool is then moved transversely away from the retention element 81, thus extracting the cap 95 from the syringe 9 and allowing it to fall by gravity into the waste container 8.

From this intermediate position, the gripper tool 53 is moved by the robotic arm 5 to another intermediate position of the handling region 2, and in particular below the open bottom 71 of the ampoule magazine 7, at one of the predetermined extraction coordinates of the medication which are known to the control means of the robotic arm 5.

In this position, the gripper tool 53 is oriented so that the grip direction I (and therefore the exposed needle 91 of the syringe 9) is substantially perpendicular to the open bottom 71 and aligned with one of the openings 71a and the respective through hole of the overlying support 74 on the ampoule tray 72.

The gripper tool 53 is then moved in a linear manner, again by the robotic arm 5, closer to the open bottom 71 up to a predetermined stroke limit position. With this linear movement, the needle 91 is thus inserted in the ampoule 73 of the support 74 which is coaxial to the clamping direction I. Figure 6 shows, by way of indication, a syringe 9 in this situation.

In the stroke limit position thus reached, the control means of the robotic arm 5 activate the linear actuator 55 so as to translate in a linear manner the corresponding stem 55b away from the open bottom 71 of the ampoule magazine 7 by a predetermined and controlled extent. With this linear translation, the plunger 93 of the syringe 9 retained by the gripper tool 53 is retracted, filling the barrel 92 of the syringe 9 with a dose of medication drawn from the ampoule.

The control means of the robotic arm 5 then move the gripper tool 53 away from the open bottom 71 and toward the slit 41, in a position in which the sensor means mounted at the end effector can identify (preferably optically and with image processing means) the marking P beyond the slit 41. The marking P can be identified by moving the sensor means on the end effector to such a distance from the slit as to substantially view the entire slit 41 and identify the corresponding height along the slit 41 at which the marking P is identified.

Following the identification of the marking P, the gripper tool 53 is translated in a linear manner by the robotic arm 5 toward the slit 41 and for a predefined stroke, so that the clamping direction 1 is substantially perpendicular to the wall 4 at the slit 41 and is incident to the identified marking P The needle 91 is thus inserted at right angles into the arm of the patient at the marking P

The control means then actuate the linear actuator 55 in order to move the stem 55b by a predetermined extent, such that the plunger 93 is pushed into the barrel 92 to expel from the syringe 9 the previously drawn dose of medication and thus perform inoculation in the patient.

At the end of the predetermined stroke of the stem 55b of the linear actuator 55, the control means of the robotic arm 5 move the gripper tool 53 above the waste container 8 and move mutually apart the jaws 54a-54b, thus making the depleted syringe 9 fall into the container 8.

Finally, the gripper tool 53 is returned to a new predetermined pickup position of the syringe magazine 6, thus ending the mini-cycle and starting a new mini-cycle such as the one that has just been described.

In the subsequent mini-cycle, according to the settings of the application program stored in the control means, which depend on the capacity of the ampoules 73 and/or on the corresponding number of doses of medication that they contain, the robotic arm 5 can move the gripper tool 53 (with a new syringe 9) to the same coordinate below the open bottom 71 of the magazine 7 of the preceding mini-cycle, so as to draw the dose of medication for the next patient from the same ampoule as the preceding mini-cycle, or to a new coordinate below the open bottom 71 and below a new ampoule, if the maximum number of doses of medication taken from the ampoule used in the previous mini-cycle has been reached.

Once the syringes 9 of the syringe magazine 6 have been depleted and/or all the ampoules 73 have been emptied, the cycle is ended and the robotic arm 5 stops. The operator can then fill again the syringe magazine 6 and the ampoule magazine 7 with new loads of syringes 9 and ampoules 73, respectively, and make the main cycle of automatic operation restart.

In the example mentioned earlier, with one tray 72 with 40 ampoules 73, each containing three doses of medication, it is possible to perform 120 injections and the main cycle can last approximately half a day, without interventions of the operator on the booth 1.

Even with a certain number of booths 1 according to the invention arranged in the same space, only one healthcare professional may be sufficient to perform a large number of injections in parallel, while the elimination of the depleted components and the loading of the new syringes and ampoules can be performed even just once a day.

In practice it has been found that the invention achieves the intended aim and objects.

The invention thus conceived is susceptible of numerous modifications and variations, all of which are within the scope of the appended claims; all the details may furthermore be replaced with other technically equivalent elements.

In practice, the materials used, as well as the contingent shapes and dimensions, may be any according to the requirements and the state of the art.

The disclosures in Italian Patent Application No. 102021000014315 from which this application claims priority are incorporated herein by reference.

Where technical features mentioned in any claim are followed by reference signs, those reference signs have been included for the sole purpose of increasing the intelligibility of the claims and accordingly such reference signs do not have any limiting effect on the interpretation of each element identified by way of example by such reference signs.

Claims

1. A booth (1) for the automated administration of a medication by intramuscular injection or the like, characterized in that it comprises a region (2) for the automated handling of syringes (9) and a station (3) for a patient, a dividing wall (4) being interposed between said handling region (2) and said station (3), said dividing wall (4) having a slit (41) along which a needle (91) can be made to pass and against which an arm (34) of the patient can be rested in alignment, said handling region (2) comprising a robotic arm (5) for the manipulation of syringes (9) and a syringe magazine (6), said robotic arm (5) comprising a gripper tool (53) adapted to grip a syringe (9) and to keep it fixed along a clamping direction (I), said gripper tool (53) being associated with a linear actuator (55) which can move, with respect to said gripper tool (53), along said clamping direction (I), said linear actuator (55) being engageable with a plunger (93) of said syringe (9), said robotic arm (5) being configured to move said gripper tool (53) in said handling region (2) between predetermined positions comprised between said syringe magazine (6) and an injection point (P) along said slit (41), at which said clamping direction (I) is substantially perpendicular to said slit (41).

2. The booth (1) according to claim 1, wherein said handling region (2) further comprises an ampoule magazine (7), which is preferably cooled inside, said ampoule magazine (7) being provided with an open bottom (71) above which multiple ampoule supports (74) are arranged which are adapted to keep ampoules (73) stationary in an upside-down vertical position, each one of said supports (74) communicating with said open bottom (71) of the ampoule magazine (7) in order to allow the passage of a needle (91) of a syringe (9) from said open bottom (71) inside said support (74).

3. The booth (1) according to the preceding claim, wherein said ampoule supports (74) are provided on at least one tray (72), which is preferably detachable and is provided with a plurality of through holes which face said open bottom (71) of the ampoule magazine (7).

4. The booth (1) according to claim 2 or 3, wherein said robotic arm (5) is configured to move the gripper tool (53) from at least one predetermined pickup position at said syringe magazine (6) toward a plurality of predetermined coordinates below said open bottom (71) of the ampoule magazine (7), said robotic arm (5) being further configured to orient said clamping direction (I) substantially at right angles to said open bottom (71) at each one of said predetermined coordinates and to translate said gripper tool (53) vertically toward said open bottom (71).

5. The booth (1) according to one or more of the preceding claims, wherein said linear actuator (55) comprises a stem (55b) which can move in a linear manner along said clamping direction (I) and which has a tip provided with a recess (56) adapted to contain axially a flange (94) of a plunger (93) of a syringe (9).

6. The booth (1) according to one or more of the preceding claims, wherein said syringe magazine (6) comprises a rack (61) provided with a plurality of seats (62) which are mutually laterally spaced and are adapted to each keep a respective syringe (9) in a substantially vertical position, said robotic arm (5) being configured to arrange the gripper tool (53) at each one of said seats (62) and with said clamping direction (I) substantially vertical.

7. The booth (1) according to one or more of the preceding claims, wherein said robotic arm (5) comprises sensor means adapted to identify a marking (P) through said slit, said robotic arm (5) being configured to associate said marking (P) with said injection point and to move said gripper tool (53) so that said clamping direction (I) is substantially perpendicular to said marking (P).

8. The booth (1) according to one or more of the preceding claims, wherein said handling region (2) further comprises a retention element (81) adapted to remove caps (35) for needles of syringes.