Best markers to use/recs

[DOcandidate2016]

I am struggling to find some markers that work for writing on syringe labels. Everything I purchase either ends up smearing or being too thick to read. Does anyone have any good recommendations that work? The sharpie pens are all that I have found so far. thanks!

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[MirrorTodd]

Get blank sheets of stickers or write it on silk tape. I don't think any marker will reliably stay on.

 

[NICMAN]

Sharpie industrial ultra fine.
If you can get them scientific labeling markers capable of writing on frozen cryotubes and greasy slides are the best.

 

[NICMAN]

But you have to usually write on stickers or pink tape. Writing on the tube probably not going to work all that well and it looks messy.

 

[vector2]

Sharpie Ultra fine Tip Retractable Markers Ultra Fine Fine Marker Point Yes Black 1 Each - Office Depot

Remarkably resilient ink dries quickly and resists fading and water AP certified Conveniently retractable and precise ultra fine point has a precise narrow tip for extreme control Proudly permanent ink marks on paper plastic metal and most other surfaces Intensely brilliant colors create eye...

www.officedepot.com

 

[Iso4ane]

Thinking about it now, haven't tried it yet, but I bet a Crayon would work nicely.

 

[deleted162650]

Are your labels not pre-printed?

 

[GassYous]

I don't label syringes. I just draw up how much I need and use maybe 2 syringes a case.

 

[nimbus]

I don't label syringes. I just draw up how much I need and use maybe 2 syringes a case.

I used to have a partner who would do a heart with a single 35ml syringe.

 

[anaesthetic]

.

 

[deleted162650]

they last for at least half a year to a year depending on how well you can keep up with your pens.

I bought an $8.00 pen ‘cuz I always lose pens, and I got tired of not caring.

-Mitch Hedburg

 

[Hork Bajir]

I used to have a partner who would do a heart with a single 35ml syringe.

How? And, why?

I can see mixing up all of the induction drugs in one syringe (I do that for fun sometimes)... but what about running infusions? Using the same syringe for heparin and protamine???

 

[Mehd School]

Sharpie markers.

Also mixing up induction drugs in one vial is a bad idea. Propofol doesn't play well with others if you get what I mean.

 

[GassYous]

How? And, why?

I can see mixing up all of the induction drugs in one syringe (I do that for fun sometimes)... but what about running infusions? Using the same syringe for heparin and protamine???

I have used the same syringe for heparin and protamine many times, zero adverse effects. I rinse it out with some LR though.

Sharpie markers.

Also mixing up induction drugs in one vial is a bad idea. Propofol doesn't play well with others if you get what I mean.

If you leave lido and prop in the same syringe, the concentration of propofol decreases linearly after about 30 minutes in a time dependent fashion. However, lido can lower the ph of propofol if you mix them, decreasing the pain on injection since it drops the ph (lidocaine is around 6 while propofol is 7-8.5). It's actually better for pain on induction than pushing lido in a separate syringe then propofol. This is even if you do a mini bier with the lido.

The only drugs that we use regularly that I don't mix are zofran and mannitol.

 

[nimbus]

How? And, why?

I can see mixing up all of the induction drugs in one syringe (I do that for fun sometimes)... but what about running infusions? Using the same syringe for heparin and protamine???

I think because he was bored and liked to try different things. He’d draw stuff up as he needed it using the one syringe. And our drips come in bags.

 

[deleted162650]

It's actually better for pain on induction than pushing lido in a separate syringe then propofol.

Fully agree with this from an anecdotal standpoint.


Decadron also likes to precipitate when given with some other things.

 

[anbuitachi]

Fully agree with this from an anecdotal standpoint.


Decadron also like to precipitate when given with some other things.

yea agree. i dont mix dex and zofran.. since it turns white...

 

[DocVapor]

yea agree. i dont mix dex and zofran.. since it turns white...

I have never seen this. Different formulation of one or the other than I'm used to maybe?

 

[Hork Bajir]

Didn’t know about lidocaine decreasing the concentration of prop, that is interesting. I was experimenting with mixing all of my induction drugs into one 50 mL syringe when I was covering Covid airways, since it would usually be just a floor nurse assisting me... I could ask them to push the drugs while I focused my complete attention on the airway, and not need to worry about giving detailed and complex instructions regarding how many cc to push out of each syringe and in what order. 200 prop, 150 sux, 160 phenylephrine, 50 esmolol, 100 lido all in one syringe and bang the whole thing in. Obviously not a great cocktail for the sicker patients, but the majority of Covid intubations I did were otherwise healthy people with single organ system pathology. Seemed to work well.

 

[chocomorsel]

I used to have a partner who would do a heart with a single 35ml syringe.

I have never seen a 35 ml syringe. I am gonna start using less. I have been using four per General/paralysis; three per GA/LMA and two per MAC.
Today I thought two for MAC was too much and I just need to use one.
Tomorrow I am gonna do just two.
I really hate it when I go into a room to relieve someone and see that there is no syringe anywhere in sight, or there are way too many syringes on the cart ready to go. Like six or more.
Either way they are wasting syringes. I tell people to not throw away my syringes.

 

[Iso4ane]

Also mixing up induction drugs in one vial is a bad idea. Propofol doesn't play well with others if you get what I mean.

Sorry, for the weird tangent. But, have anyone of you made mayonnaise from scratch. It's essentially just egg proteins and oil. You know what happens when you add water? It separates. You know what else is made from egg protein and oil? Propofol. So yeah, no mix-y mix-y with water.

 

[deleted162650]

Sorry, for the weird tangent. But, have anyone of you made mayonnaise from scratch. It's essentially just egg proteins and oil. You know what happens when you add water? It separates. You know what else is made from egg protein and oil? Propofol. So yeah, no mix-y mix-y with water.

It no longer contains any egg protein nor is there any cross-allergenicity with egg.

 

[Iso4ane]

It no longer contains any egg protein nor is there any cross-allergenicity with egg.

Sorry, I misspoke. You're right, eggs proteins are not used, but AFAIK, egg lecithin (which is still probably one of the primary emulsifiers in mayo, as one tend to use the yolk) still plays a role in some propfol emulsions (at least as late as 2014).

Regardless, I agree there in no evidence of cross-allergenicity with eggs or soybeans (soybean oil is the oil used), even if it was still being used.

Per websites, Diprivan in addition to Propofol has:

6.1 List of excipients
Glycerol
Purified Egg Phosphatide
Sodium Hydroxide
Soya-Bean Oil, Refined

 

[nimbus]

I have never seen a 35 ml syringe.

Now you have

 

[chocomorsel]

How? And, why?

I can see mixing up all of the induction drugs in one syringe (I do that for fun sometimes)... but what about running infusions? Using the same syringe for heparin and protamine???

Flush out the syringe with saline?
Obviously the others get a pump or drippity drip gravity.

 

[chocomorsel]

I have never seen this. Different formulation of one or the other than I'm used to maybe?

It takes a few seconds. If you draw it up and immediately push it, you may not notice it.
Or it could be different formulations.
I just don’t mix the two because Dex needs a lot more time to kick in so it’s given in beginning of case. I have done it a few times in some short cases. I think the precipitates are small enough and get diluted enough with the LR or NS that there are no adverse effects.

 

[chocomorsel]

Didn’t know about lidocaine decreasing the concentration of prop, that is interesting. I was experimenting with mixing all of my induction drugs into one 50 mL syringe when I was covering Covid airways, since it would usually be just a floor nurse assisting me... I could ask them to push the drugs while I focused my complete attention on the airway, and not need to worry about giving detailed and complex instructions regarding how many cc to push out of each syringe and in what order. 200 prop, 150 sux, 160 phenylephrine, 50 esmolol, 100 lido all in one syringe and bang the whole thing in. Obviously not a great cocktail for the sicker patients, but the majority of Covid intubations I did were otherwise healthy people with single organ system pathology. Seemed to work well.

What’s with the Esmolol and Phenyelephrine combo?

 

[DocVapor]

It takes a few seconds. If you draw it up and immediately push it, you may not notice it.
Or it could be different formulations.
I just don’t mix the two because Dex needs a lot more time to kick in so it’s given in beginning of case. I have done it a few times in some short cases. I think the precipitates are small enough and get diluted enough with the LR or NS that there are no adverse effects.

Sure, I only do it for short cases. Longer cases dex at start, zofran prior to wakeup. I don't generally pre-draw them but have during residency had room swaps where the other resident had pre-drawn them into the same syringe. No issues that I saw prior to injecting (and I always triple check the labels on syringes drawn up by someone else). No guarantee there wasn't any precipitation but I'm pretty confident there wasn't any.

I'll write it up to the formulations.

 

[deleted875186]

What’s with the Esmolol and Phenyelephrine combo?

Agreed, prop and sux, +/- phenylephrine, all the other stuff unnecessary.

 

[Arch Guillotti]

Didn’t know about lidocaine decreasing the concentration of prop, that is interesting. I was experimenting with mixing all of my induction drugs into one 50 mL syringe when I was covering Covid airways, since it would usually be just a floor nurse assisting me... I could ask them to push the drugs while I focused my complete attention on the airway, and not need to worry about giving detailed and complex instructions regarding how many cc to push out of each syringe and in what order. 200 prop, 150 sux, 160 phenylephrine, 50 esmolol, 100 lido all in one syringe and bang the whole thing in. Obviously not a great cocktail for the sicker patients, but the majority of Covid intubations I did were otherwise healthy people with single organ system pathology. Seemed to work well.

I have never given 200 of propofol for an out of OR intubation.

 

[GassYous]

A lot of these covid patients are pretty healthy otherwise with good hearts and few comorbidities. Many of them also happen to be fat. 200 of prop is not an abnormal dose for them, especially since the icu nurses take forever to set up sedation. You'd think they'd get the idea after taking care of hundreds of these people for weeks but nah they never do.

Problem is that the ICU docs think that the covid lungs will do better if they run them dry so they have them huffing on bipap while npo for days with no maintenance fluid. By the time they ask for intubation, the patients are very intravascularly dry and tired from prolonged respiratory distress. Then they crash on induction. So I liked to use etomidate.

Esmolol is good because it's fast on/fast off and helps with the sympathetic surge with laryngoscopy/intubation. I like to use 1/kg.

 

[2Fast2Des]

How? And, why?

I can see mixing up all of the induction drugs in one syringe (I do that for fun sometimes)... but what about running infusions? Using the same syringe for heparin and protamine???

It's a lot easier to use 1 syringe. No labeling, speeds up inducing especially since I am doing own case so less work is faster, no labeling for a one time use syringe. I'll use 50cc syringe for my lido\prop\keta\esmolol\roc, use that syringe for rest of case. I'll use extra syringes only if I need other stuff, so usually max 2 syringes on a routine case for me.

 

[Mehd School]

I have used the same syringe for heparin and protamine many times, zero adverse effects. I rinse it out with some LR though.



If you leave lido and prop in the same syringe, the concentration of propofol decreases linearly after about 30 minutes in a time dependent fashion. However, lido can lower the ph of propofol if you mix them, decreasing the pain on injection since it drops the ph (lidocaine is around 6 while propofol is 7-8.5). It's actually better for pain on induction than pushing lido in a separate syringe then propofol. This is even if you do a mini bier with the lido.

The only drugs that we use regularly that I don't mix are zofran and mannitol.

https://www.researchgate.net/publication/8993968_Physicochemical_Compatibility_of_Propofol-Lidocaine_Mixture

This was what I was hinting towards.

 

[Hork Bajir]

What’s with the Esmolol and Phenyelephrine combo?

Phenylephrine to counteract vasodilation from the prop, esmolol for response to laryngoscopy. Obviously not a great combo for all patients, but for those with healthy hearts and intact autonomic nervous systems, can titrate this to a perfect train tracks induction for most. Most people use prop, neo, and fent without thinking twice- the esmolol just takes the place of the fent.

Not saying this is the best way or the only way... It is just one way that works for me. That’s the fun thing about anesthesia, many ways to skin a cat

 

[Twiggidy]

I bought an $8.00 pen ‘cuz I always lose pens, and I got tired of not caring.

-Mitch Hedburg

Damn that dude was funny

 

[TheLoneWolf]

sharpie fine point

 

[jillyjelly]

Sharpie 32724pp. The good point about the retractable pen is that the caps never get lost. I've used this brand and style for a few years and the ink does not dry out

 

[DocMcCoy]

Staedtler permanent 0.4mm. Used these as map markers in military. Work pretty good on labels too.

I like the retractable idea though.