The horror...the horror AKA OMG why is this drug stored this way.

This forum made possible through the generous support of SDN members, donors, and sponsors. Thank you.
MirrorTodd

MirrorTodd

It's a gas.
Verified Member
Physician
15+ Year Member
Joined
Apr 23, 2006
Messages
17,870
Reaction score
10,450
Old residency bud is in Abu Dhabi.

image000000.jpeg
Members don't see this ad.
 
MirrorTodd said:
Old residency bud is in Abu Dhabi.

View attachment 376125
Click to expand...

Does anyone ever find floating pieces of glass in the glass vial?
I suppose that’s why all the spinal kits come with a filter needle?

I do find floating black pieces of stopper from the more conventional propofol bottles more than I like. If I have those plastic spikes, I would almost always use them.
 
  • Hmm
  • Like
Reactions: 1 users
Members don't see this ad :)
Yeah, that’s how it used to come. Same with fentanyl, etc. like a manual car, you learned how to open those vials pretty quickly.
 
I remember using those during the propofol shortage early 2010s
 
  • Like
Reactions: 1 users
DrOwnage said:
I would be bleeding from my hands daily
Click to expand...
I agree they're much less convenient, but you can't open glass vials without bleeding? I opened 20-30 of them every OB shift and haven't cut myself on them since residency.
 
  • Like
Reactions: 1 user
DrOwnage said:
I would be bleeding from my hands daily
Click to expand...
Same. As it stands, I am currently only bleeding from the ass daily from all the "in through the out door" action foisted upon me by administrators, surgeons, and smarmy know-it-all CRNAs.
 
IMGASMD said:
Does anyone ever find floating pieces of glass in the glass vial?
I suppose that’s why all the spinal kits come with a filter needle?

I do find floating black pieces of stopper from the more conventional propofol bottles more than I like. If I have those plastic spikes, I would almost always use them.
Click to expand...
yea need to use filtered needle for propofol
 
  • Like
  • Haha
Reactions: 2 users
Just opened a bunch of these last week here in Brazil. Also, never in my life have I seen a “filter needle”, wouldn’t even know what it looks like if I saw one. Fentanyl also comes in these breakable ampules, both small (2 ml) and big (10 ml) fentanyl.
 
  • Wow
Reactions: 1 user
Members don't see this ad :)
bourg said:
Just opened a bunch of these last week here in Brazil. Also, never in my life have I seen a “filter needle”, wouldn’t even know what it looks like if I saw one. Fentanyl also comes in these breakable ampules, both small (2 ml) and big (10 ml) fentanyl.
Click to expand...
A doc at my residency program, when he was a resident, did a project that involved slow-mo close-up video of glass ampules as they break. Consistently had small glass shards going into the ampules. You should definitely invest in filter needles if you can.
 
  • Like
Reactions: 1 user
What if you draw up from it with a 25-gauge needle? Slow as heck but I’ve done that in a pinch when I didn’t have a filter needle
 
This is the brand we use. Easy opening vial and never had one shatter or do weird things. Coming from someone who's cut themselves on the fentanyl ampules multiple times.
 
  • Like
Reactions: 1 users
Agast said:
I remember using those during the propofol shortage early 2010s
Click to expand...
Maybe that's why our hospital only let us check out 2 10cc syringes that they drew up for us. Propofol was controlled at my main hospital in residency, and they had a supply of it during those years, and we got 200mg/case in 2 syringes. Cases we needed more for we had to justify the use with the pharmacist.
 
  • Dislike
  • Haha
Reactions: 1 users
Ashers said:
Maybe that's why our hospital only let us check out 2 10cc syringes that they drew up for us. Propofol was controlled at my main hospital in residency, and they had a supply of it during those years, and we got 200mg/case in 2 syringes. Cases we needed more for we had to justify the use with the pharmacist.
Click to expand...

20 cc per patient?!
 
Ashers said:
Maybe that's why our hospital only let us check out 2 10cc syringes that they drew up for us. Propofol was controlled at my main hospital in residency, and they had a supply of it during those years, and we got 200mg/case in 2 syringes. Cases we needed more for we had to justify the use with the pharmacist.
Click to expand...
Lol what??? Seriously? Did your department chair just bend over to the pharmacy?
 
  • Like
Reactions: 1 users
Ashers said:
Maybe that's why our hospital only let us check out 2 10cc syringes that they drew up for us. Propofol was controlled at my main hospital in residency, and they had a supply of it during those years, and we got 200mg/case in 2 syringes. Cases we needed more for we had to justify the use with the pharmacist.
Click to expand...

Cause the pharmacist is the expert on administering anesthesia
 
  • Like
  • Haha
Reactions: 1 users
If pharmacy is cracking down on propofol that hard.. then somebodies must've been pretty frank with the med theft...
 
IMGASMD said:
20 cc per patient?!
Click to expand...
Yep back in the early 2010s yep. It was awful. We also had a Dilaudid shortage at the same time, and they got it compounded somewhere, and the vials looked super sketchy. There were many jokes made about needing a hammer to induce because we also had a sux shortage too. The propofol shortage lasted most of residency, but they 20cc/patient lasted a few months.
2Fast2Des said:
Lol what??? Seriously? Did your department chair just bend over to the pharmacy?
Click to expand...
No comment.
GassYous said:
Cause the pharmacist is the expert on administering anesthesia
Click to expand...
Yeah, of course they are /s... I still have to justify when I want to give sugammadex in some places.
ak_ps said:
If pharmacy is cracking down on propofol that hard.. then somebodies must've been pretty frank with the med theft...
Click to expand...
Not sure. I was a CA1, but the main hospital was the only hospital where it was controlled. The VA and childrens' hospital it wasn't controlled. This was before pyxis in that hospital, so we had to get a new tray for every patient, and fill out a form for controlleds for every patient.
 
www.apsf.org

Medication Errors Related to Look-Alike, Sound-Alike Drugs—How Big is the Problem and What Progress is Being Made?

Administering the wrong medication is one of the most feared complications in any field of medicine. Anesthesia professionals are some of the only providers who prescribe, prepare, and administer their own medications. Therefore, the perceived fear...
www.apsf.org www.apsf.org

The Pharmacy tech at my gig has stocked the wrong medications in the wrong slots in the Pyxis. The vials look alike and I guess the tech was sloppy. So, even if the Pyxis dispenses the vial you must verify the drug prior to administering it. You can't rely on anyone else period.
 
  • Like
Reactions: 1 users
MirrorTodd said:
Ya I've done that, some of those tops just don't "pop" off like they should.
Click to expand...
I did it in front of an attending, and it was after I took ibuprofen, so I just kept bleeding. That was a fun waste explanation to pharmacy since it was Dilaudid.

Edit: I think I was a CA-1. Then I started using gauze.
 
Ashers said:
Not sure. I was a CA1, but the main hospital was the only hospital where it was controlled. The VA and childrens' hospital it wasn't controlled. This was before pyxis in that hospital, so we had to get a new tray for every patient, and fill out a form for controlleds for every patient.
Click to expand...
This is still the case here. Every patient gets a baggie full of drugs. Makes turn over so much more efficient when you have to stop by pharmacy to have them waste your kit and issue you a new one before you can go back and get things set up for the next case. Because pharmacy is completely aware of the time crunch you're under.

In the past they would issue huge bags full of everything - you would use that one bag for all of your patients that day. Then there were diversion issues, so they went with the smaller baggie solution. This was back in the early-mid 2010s. It's now 2023 and we still don't have Pyxis systems or drug cabinets in the ORs to manage controlled substances. Every anesthesia provider is still walking around with vials of propofol, fentanyl, midazolam, etc....although in smaller amounts, but necessitating people to carry around drugs in the first place was one of the major issues with the "old" system.:shrug:
 
  • Wow
Reactions: 1 user
sakata8242 said:
This is still the case here. Every patient gets a baggie full of drugs. Makes turn over so much more efficient when you have to stop by pharmacy to have them waste your kit and issue you a new one before you can go back and get things set up for the next case. Because pharmacy is completely aware of the time crunch you're under.

In the past they would issue huge bags full of everything - you would use that one bag for all of your patients that day. Then there were diversion issues, so they went with the smaller baggie solution. This was back in the early-mid 2010s. It's now 2023 and we still don't have Pyxis systems or drug cabinets in the ORs to manage controlled substances. Every anesthesia provider is still walking around with vials of propofol, fentanyl, midazolam, etc....although in smaller amounts, but necessitating people to carry around drugs in the first place was one of the major issues with the "old" system.:shrug:
Click to expand...
lol I did some locums at a place where they gave you a mini tackle box with your narcs. It was like the dumbest system ever.
 
Haha....I would have insisted on an old school Star Wars or Thundercats lunch box instead.
 
MirrorTodd said:
lol I did some locums at a place where they gave you a mini tackle box with your narcs. It was like the dumbest system ever.
Click to expand...
I do locums at a place that does that too. The anesthesiologists are talking about how they are sad they will be getting pyxi soon.
nimbus said:
“Party pack”
Click to expand...
That's what we called the trauma pack in residency that we could pull from a pyxis after pharmacy hours or ask for from pharmacy when they were open
 
  • Like
Reactions: 1 users
I did some locums at a little community hospital in California that had a medicine cabinet on the wall behind the anesthesia machine with everything in it. Including topical cocaine. I think there was a paper sheet folded up in there you were supposed to document with.
 
  • Like
  • Wow
Reactions: 4 users
So I just spent the morning doing TIVA with these ampoules. These ones, specifically were made in South Korea.

IMG_9160.jpg
IMG_9163.jpg
IMG_9161.jpg
 
  • Wow
Reactions: 1 users
IMGASMD said:
You poor soul. You guys don’t have bigger bottles? In America, everything is big. This is one time I am excited we have something huuuugggggeeeeee?
Click to expand...
Not in this hospital, only 20 ml. But in other hospitals I have seen 50 ml bottles. I wish we had 2% propofol, that would definitely be a game changer.
 
bourg said:
So I just spent the morning doing TIVA with these ampoules. These ones, specifically were made in South Korea.

View attachment 376926View attachment 376927View attachment 376928
Click to expand...

bourg said:
Not in this hospital, only 20 ml. But in other hospitals I have seen 50 ml bottles. I wish we had 2% propofol, that would definitely be a game changer.
Click to expand...

I was going to say that looks like nonfat milk, not propofol, and then this followup post led me to look at the amps more closely. 1%

Neat
 
  • Like
Reactions: 1 user
You must log in or register to reply here.
Next unread thread

Similar threads

DocMcCoy
Drug induced sleep endoscopy
Replies
34
Views
2K
coffeebythelake
coffeebythelake
2010houston
Atlantic piece - “Headlines don’t capture the horror”
Replies
8
Views
2K
Katheudontas parateroumen
K
Dr. Anonymouss
Well that’s one way to throw away your career
Replies
29
Views
3K
aneftp
A
BLADEMDA
Blockbuster new Biologic Drug
Replies
14
Views
1K
2Fast2Des
2
DrAmir0078
We postpone an AKA case, but why? How would you deal with it?
2
Replies
62
Views
3K
DrAmir0078
DrAmir0078
Top