Glass Vials? Ouch!!!

[bbpiano1]

---

Members do not see this ad.

Nearly cut myself breaking open a glass vial in the epidural tray.....anyone know why they don't just use the regular vials with the rubber at the top that you eventually puncture?

 

[Gimlet]

I have cut myself and it sucked...now I use a 4x4 gauze over the top while breaking them to prevent that. I think they use ampules so you can't use the bottle as a multi-dose vial.

 

[pillowhead]

cutting yourself on that broken glass hurts like hell. and it bleeds like stink, too.

 

[bbpiano1]

Just asked an attending: Apparently glass-only bottles are needed just in case a patient has a latex allergy (rubber stoppers contain latex). Go figure.

 

[Bertelman]

Just asked an attending: Apparently glass-only bottles are needed just in case a patient has a latex allergy (rubber stoppers contain latex). Go figure.

That's B.S.

...actually, I guess it is true, that rubber stoppers do contain latex. But the vials you see in the drawer aren't stopped with rubber.

Those little vials haven't contained latex for years. Actually, you would be hard-pressed to find something containing latex in the OR, aside from latex gloves. If it does contain latex, it is clearly labeled as such.

 

[bbpiano1]

That's B.S.

...actually, I guess it is true, that rubber stoppers do contain latex. But the vials you see in the drawer aren't stopped with rubber.

Those little vials haven't contained latex for years. Actually, you would be hard-pressed to find something containing latex in the OR, aside from latex gloves. If it does contain latex, it is clearly labeled as such.

Hmmm.....so what do you think the real reason is? To keep them single-use?

 

[coprolalia]

Hmmm.....so what do you think the real reason is? To keep them single-use?

Cost and stability.

Glass ampules were traditionally used. Companies that manufacture them waiting to change to a crimped, stoppered vial would have to file a separate "supplemental" new drug application (SNDA) with the FDA stating that the materials in that vial don't interfere with the integrity of the drug inside. For a drug like lidocaine, this would cost money in additional testing. And, most companies simply do not want to file that study (along with the additional cost of doing it) with the FDA.

There are few older off-patent drugs, like fentanyl, that come in both the ampule and the crimped, stopppered vial... but if you check you'll see that they are almost certainly made by different manufacturers.

-copro

 

[Spandex]

Latex containing drugs (at least where I am):
Multi-dose atropine vials
Neostigmine
Glycopyrolate
Etomidate
Lidocaine

probably some others i'm forgetting off the top of my head

 

[pillowhead]

Latex containing vials where I am-

neostigmine
fentanyl
Amicar
atropine
furosemide
bupivicaine
edrophonium
heparin
mag sulfate
metoclopramide
naloxone
scopolamine

i know because the pharmacy list is sitting right next to my computer as i type this. latex containing vials are still ridiculously common and they aren't labeled. hopefully your pharmacy keeps a list to let you know what is and isn't latex containing

 

[huktonfonix]

Latex containing vials where I am-

neostigmine
fentanyl
Amicar
atropine
furosemide
bupivicaine
edrophonium
heparin
mag sulfate
metoclopramide
naloxone
scopolamine

i know because the pharmacy list is sitting right next to my computer as i type this. latex containing vials are still ridiculously common and they aren't labeled. hopefully your pharmacy keeps a list to let you know what is and isn't latex containing

so the question becomes, what do you do with a patient with latex allergy? I never really understood the whole taking off the stopper thing since the medication has been touching the rubber for entire time its been in the bottle. I just use the medication as is. No problems yet.

 

[Spandex]

Our pharmacy has latex free preparations and send them down in capped syringes. Problem is they need to be pre-ordered, which is ok for scheduled cases, but not so ok for emergencies etc. Agree with popping the tops. I do it because someone told me to once and I'm a sheep, but doesn't make sense to me either.

Journal of Allergy and Clinical Immunology - Volume 107, Issue 6 (June 2001)
Donald Y. M. Leung MD, PhD Harold S. Nelson MD Stanley J. Szefler MD
[SIZE=-1]1/89/116129[/SIZE]


Natural rubber vial stoppers: Potentially dangerous for patients with latex allergy?

There is widespread concern that pharmaceutical vial closures (stoppers) containing natural rubber might leach allergenic proteins into parenteral medications. This could cause life-threatening allergic reactions if the medication is administered to individuals who are latex-allergic. In this issue, Primeau et al (p 958) show that natural rubber closures can leach allergens in sufficient quantity to be detected by intradermal skin-testing. Skin test diluent was stored inverted in vials with either synthetic or natural rubber closures. Solutions were withdrawn from unpunctured/uncapped vials, mimicking a “pop-the-top-off” approach to latex avoidance. Alternatively, solutions were withdrawn from vials with closures prepunctured 40 times,…

Can't get full article from home, but you get the jist.

 

[SleeperHold]

I think there's also been some concern about a needle puncturing the rubber, being sucked into your syringe and then that rubber being introduced into the epidural, subarachnoid space.

 

[OB1🤙]

I asked one of our pharmacists this last year- he said that simple contact with the rubber does not impart any particles into the liquid, but that piercing the stopper with a needle can introduce some tiny amount into the liquid.

Sounded convincing.

 

[Old Timer]

Tell your institution to get some of these....

 

[Jeff05]

the 100mcg fentanyl ones are the worst. i have a ton of those cuts on my thumb. the rest of the damage is mostly from the 20mL 2% lido bullets.

 

[huktonfonix]

the 100mcg fentanyl ones are the worst. i have a ton of those cuts on my thumb. the rest of the damage is mostly from the 20mL 2% lido bullets.

the hemabate seems to get me.

 

[coprolalia]

the hemabate seems to get me.

There's a dot on "snap off" part of the vial. Put your thumb on the dot and break it away from yourself. The hemabate vials are actually just about the easiest and safest with least likelihood of being cut, if you do it this way.

-copro

 

[huktonfonix]

There's a dot on "snap off" part of the vial. Put your thumb on the dot and break it away from yourself. The hemabate vials are actually just about the easiest and safest with least likelihood of being cut, if you do it this way.

-copro

yeah, it took about 3 or 4 tries to figure that one out.

 

[CanGas]

My personal favorite? Guess what that little orange stopper in between the lyopholized solumedrol on the bottom and the solution on top is made of?

Yep, latex.

Check out this case report in A&A.
http://www.anesthesia-analgesia.org/cgi/reprint/80/5/1057.pdf

😱 Love the idea of causing anaphalaxis by giving a medication meant to prevent it.

CanGas

Latex containing vials where I am-

neostigmine
fentanyl
Amicar
atropine
furosemide
bupivicaine
edrophonium
heparin
mag sulfate
metoclopramide
naloxone
scopolamine

i know because the pharmacy list is sitting right next to my computer as i type this. latex containing vials are still ridiculously common and they aren't labeled. hopefully your pharmacy keeps a list to let you know what is and isn't latex containing

 

[jwk]

I think there's also been some concern about a needle puncturing the rubber, being sucked into your syringe and then that rubber being introduced into the epidural, subarachnoid space.

That's what filter needles are for - they come in every epidural/spinal kit.

 

[periopdoc]

That's what filter needles are for - they come in every epidural/spinal kit.

🙄

Yours must come with sildenafil too!?!?!?


🙄


- pod

 

[dfk]

Latex containing vials where I am-

neostigmine
fentanyl
Amicar
atropine
furosemide
bupivicaine
edrophonium
heparin
mag sulfate
metoclopramide
naloxone
scopolamine

i know because the pharmacy list is sitting right next to my computer as i type this. latex containing vials are still ridiculously common and they aren't labeled. hopefully your pharmacy keeps a list to let you know what is and isn't latex containing

good to know. thanks. i will check with my pharmacy now, since the list is much longer and more distinguished than previously thought.

 

[dfk]

I think there's also been some concern about a needle puncturing the rubber, being sucked into your syringe and then that rubber being introduced into the epidural, subarachnoid space.

FWIW, i usually have a tenth to two tenths of air in my syringe before going in to vial, and i inject that amt of air in vial. not only helps with quicker withdrawing of med, but i suppose getting rid of anything that might be in the syringe bore. who knows!

 

[coprolalia]

FWIW, i usually have a tenth to two tenths of air in my syringe before going in to vial, and i inject that amt of air in vial. not only helps with quicker withdrawing of med, but i suppose getting rid of anything that might be in the syringe bore. who knows!

When I draw up propofol with an 18g needle, I commonly see a little gray "plug" floating around in the bottle.

-copro

 

[Old Timer]

When I draw up propofol with an 18g needle, I commonly see a little gray "plug" floating around in the bottle.

-copro

While "coring" is more common with an 18G needle, you can reduce it with proper technique....

 

[coprolalia]

While "coring" is more common with an 18G needle, you can reduce it with proper technique....

Such as?

Pushing a little bit of air as you insert the needle? Actually using the vented plastic needles provided by the manufacturer?

All in all, I really don't think that it matters, clinically that is. I've given probably 2000+ anesthetics at this point. I haven't killed anyone yet... yet. 😀

-copro

 

[Old Timer]

Such as?

Pushing a little bit of air as you insert the needle? Actually using the vented plastic needles provided by the manufacturer?
-copro

If you place the needle as if it was going across the top of the vial with the canula facing up then turn the needle 90 degrees and push it in, you get less coring if my memory serves me correctly.

All in all, I really don't think that it matters, clinically that is. I've given probably 2000+ anesthetics at this point. I haven't killed anyone yet... yet. 😀

-copro

Glad to hear that......

 

[Bertelman]

When I draw up propofol with an 18g needle, I commonly see a little gray "plug" floating around in the bottle.

-copro

You don't use blunts to draw up drugs?

 

[periopdoc]

We have 16g needles for drawing up drugs at my place. If I am in a real hurry, I use a 14g angiocath FTW. Oh and I usually pressurize the vial with about 1/2to 3/4ths the volume of air as I have volume of drug to extract. Much more effective than the 1/10 to 2/10 volume.

As far as the "correct way" for inserting a needle into a vial through a rubber stopper, you can't publish this stuff...

Oh wait, you can...

The needle should be inserted at a 45–60° angle with the opening of the needle tip facing up (i.e., away from the stopper). A small amount of pressure is applied and the angle is gradually increased as the needle enters the vial. The needle should be at a 90° angle just as the needle bevel passes through the stopper.

Just some thoughts


- pod

 

[coprolalia]

You don't use blunts to draw up drugs?

No, I save those for the weekends for when I'm rollin' with my homies.

-copro

 

[Bertelman]

I would have been disappointed with any other response.

 

[coprolalia]

As far as the "correct way" for inserting a needle into a vial through a rubber stopper, you can't publish this stuff...

Oh wait, you can...

This is what makes this forum great. Almost 4 years of residency, and no one before has taught me this trick. I will definitely try it tomorrow.

Nice post, man.

-copro