How to draw up tricky anaesthesia medications!
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- Опубликовано: 27 июл 2020
- Watch this before your first anaesthesia rotation!
NB: Skip to 1:44 for tips on drawing up cefazolin and propofol.
I go through the subtle techniques I wish I knew on how to draw up anaesthesia medications.
Also I often get asked with diluent or solution to use for each medication.
First, check your local guidelines for the latest protocols and procedures!
But here are a few general rules:
Antibiotics: Generally use water for injection and it is easier to dissolve antibiotics in this. This will become obvious when trying to dissolve timentin and vancomycin.
For most other medications, use normal saline. This decreasing the chance of precipitation.
For most inotropes (adrenaline, noradrenaline), use 5% dextrose.
Thanks for watching!!!
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Always better to use a needle to draw medications from a 'snap off' glass ampoule. Prevents tiny glass shards from getting into the syringe.
it isn't part of our guidelines, but do you also use a filter needle?
Need to use a filter needle, not a regular one
some hospitals have this guideline. Be aware that for drawing Propofol you need a particulate filter needle >1.2µm (not a bacterial filter, which is finer!)
Addicted to this channel.. so much to learn.. thank you so much!
great to hear!
I did Nursing in India, and learnt to improvise with minmal supplies in govt hospitals. 4:35 was one of it. :)
Fantastic , good job
Excellent technique sir..keep posting this type of video’s. Thank you very much
So nice of you!
Just what I was looking for. Thanks very much. Very promising channel. Buy a mic if you can. Nice accent by the way.
GREAT GREAT GREAT PEARL with the Propofol, i often struggled when trying it with the needle, will try it like this next time, thank you very much🙏🔥🔥🔥
Thank you! Cheers! when someone first showed me that in 2008 I was so impressed!
So.. In case of propofol... You have to insert air into vial!! Right?? And then after that we have to withdraw ...
With the big propofol I just apply a little lateral pressure on the syringe and that stops any air lock and simple to draw up. 50ml of air in the bottle makes me nervous.
Great video. Very helpful
Glad it was helpful!
Dont you need filter blunt needle on glas ampuls?
looks good, except the lack of a filter needle with ampules. Policy varies depending on where you I suppose. The facilities I have worked it is mandatory.
Wow! Thank you x
You’re welcome 😊
thank you
You're welcome
loved it
thanks so much! :)
Thank you sir move videos expected
Please share about label.
would be cool to see some inductions
thats coming! but will have to be simulated with a mannequin!
I just started md anesthesia week back and hurt my finger 2 days in row while braking ampule with bare hands. 😂need to be more careful from now on.
Dazzle 'em with Midazolam!!
Wondering who was blown away with that milk 😀
great
thanks!
6:03 ooooooh boi that's nice
Do you use filter needles with glass ampules?
Good question! The current practice is that we don’t use filter needles for any intravenous meds. But we always use filter needles for neuraxial (spinal and epidural) meds.
I used to also question why we didn’t but I haven’t seen any guidelines or evidence of morbidity from this
what is your practice?
@@ABCsofAnaesthesia Student registered nurse anesthetist.
Not using any sort of filter with the glass propofol is definitely not something to recommend, and is not practiced in my region. At least use at needle with a high gauge. Doesn’t matter if the glass broke of clean or not.
@@kaspervesterholm4910 Same in my practice. Can’t recommend the practice shown here.
Nice techniques! 2 questions however regarding propofol
1. What absolut risk of drawing up small peices of glass when drawing up propofol from a vial to a 20cc syringe? (When not using a needle with filter)
2. What is your conclusion about air sterility (specifically when injectiong air into the 50cc propofol vial)
great questions! I havent seen any recommendations about 1). Are local hospital guidelines use a filter needle for medications for neuraxial techniques but not for intravenous. Have you seen any recommendations?
And same with air sterility, its common practice for many medications to be exposed to air. we don't have specific guidelines for this... however I wouldn't leave some medications left open to air for long periods due to risk of infection. do you know of any guidelines?
@@ABCsofAnaesthesia Re: particulate contamination: it wouldn´t be Germany if there wasn´t to be a recommendation there ... see: www.cirs-ains.de/files/spezial/CIRS-AINS_Spezial_PartikelkontaminationnachdemAufziehenvonArzneimitteln.pdf . This is not an official guideline, just a recommendation.
Be aware that besides of glass splinters there can be plastic coring from the large needle diameters supplied with the motor pump syringes.
As for drawing Propofol (or any fluid from glass bottles): there are 2 methods:
1) fill the syringe with air of the amount you want to draw fluid from the bottle, insert needle in glass bottle, then flip the bottle upside-down (so the syringe is at the bottom) and apply boli (about 10-20ml) of air, then draw fluid from the bottle. Repeat until required amount is in the syringe. Please don´t do it in one big push like shown in the vid - you might end up with a big mess.
2) use a special spike system that vents the glass bottle as you draw fluid from it (that´s actually the manufacturers recommendation for bottles larger than 50ml).
That was a Wowww technique
@ABCs of Anaesthesia would have gotten a slap on the wrist by a nurse for non-sterile technique in opening syringe and needle packages as well as for not desinfecting the plastic membranes of the glass bottles!
In a nursing exam this would have been reason to fail the candidate...
Aaaand yes, I know, it takes time and is cumbersome, and most of the time nobody says anything. Guilty myself.
What kind of tricky medications 💊you can draw up quickly.
Isn’t it dangerous to get a single drop of propofol on your skin ?
You are thinking of Fentanyl
No
neither Propofol, Fentanyl nor any of the muscle relaxants are a problem if you get a drop on your skin. The skin is too good a barrier for this...
@@lisalisa6840 As for Fentanyl, there are TTS (transdermal therapeutic systems) patches that absorb the fentanyl through the skin - but there the concentration is much higher and they take ages (about 6 hours) to start working. So your tiny drop on the skin is not a problem.
@@tammybambini1096 Not to mention that from nearly all transdermal preparations it’s difficult to even get a drop of anything from them. Specifically, if using newer matrix style patches, it’s not possible for any of the medication to form a drop or fall out and with reservoir style patches one still has to consciously squeeze the patch for there to be enough in one region to form a droplet and then actually drop off. Certainly not something I’ve ever heard of anyone needing to be aware of, just doesn’t happen imho.
nice
Thanks!
Pushing air may not contaminate the Drug.¿
No. Air has not a lot of bacteria in it per se, and in OT air is highly filtered, so even less risk of contamination. But you have to use any drawn medications in a certain timeframe (most 24h if kept cooled from time of drawing) to reduce risk of bacterial growth. In OT you usually draw the medications immediately before the procedure, so the bacteria (if there are any in it) have no time to multiply/grow.
NO ONE uses Luer slip syringes anymore, except if you're a 40+ year old anaesthetist, we only Luer Lock syringes, so your little trick of doing 20 ml Propofol direct to syringe isn't gonna work there. Also, for 50 ml or 100 ml Propofol bottles, just use a mini spike to draw up the drug. way easier and efficient
Luer conus syringes are still a thing worldwide.
Only recently manufacturers of motor infusion pumps have started to push for luer-lock syringes when using their pumps with the reasoning that the line might get disconnected from the syringe on high pressures/infusion rates. While there might have been some cases of this happening, it´s also a marketing /business thing - luer-lock syringes are more expensive.
Also in the last couple of years there is a push for NRFit®connectors to prevent inadvertently injection into neuraxial catheters.