Introduction
In this video, we will describe the process of drawing up epinephrine from a vial and from an ampule. The best practice as stated by both Dr. Stanley F. Malamed and the ADA is to use an epinephrine autoinjector in the event of anaphylaxis. But when one isn’t available, the next best option is to be ready to use a needle and syringe for administration.
Drawing Epinephrine from a Vial
Preparation of the Vial
First, let’s talk about the epinephrine vial. The epinephrine 1 to 1000 mg 1 mL vial is covered with a plastic dust cover that must be removed prior to inserting a needle. The first step will be to remove it like so.
Injection of Air into the Vial
Secondly, in order to remove fluid from a vial, we first need to inject an equal volume of air into that vial as the amount of fluid we wish to withdraw. This compensates for negative air pressure that would be created by attempting to remove fluid. The exact amount will depend on the size of the dose you intend to inject.
Dosage Guidelines
According to the package insert for the epinephrine vial, the dose for adults and children weighing 66 pounds or more is 0.3 to 0.5 mg, which is 0.3 to 0.5 mL, administered every 5 to 10 minutes as necessary. The dose for children weighing 66 pounds or less is 0.01 mg per kilogram, up to a maximum of 0.3 mg, which is 0.3 mL. The adult epinephrine autoinjector dose is 0.3 mg.
Drawing the Dose
In this case, we will draw up 0.3 mL of air before injecting it into the empty space above the fluid line, then draw up your intended dose. Lastly, make sure you express any air before administering an injection.
Injection Procedure
The appropriate injection route for epinephrine 1 to 1000 is intramuscularly or subcutaneously into the anterolateral aspect of the thigh, which is midway down the side of the thigh.
Drawing Epinephrine from an Ampule
Introduction to Ampules
Now let’s talk about the epinephrine 1 to 1000 mg 1 mL ampule. While this product has been recently discontinued, some emergency medical kits will have ampules instead of vials. Ampules are similar in injection site and dosing but do have a couple of special considerations.
Opening the Ampule
First, it is important to know how to open an ampule of epinephrine. To do this, we have to break open a sealed glass ampule. A good technique is to wrap one piece of gauze around the narrow part of the ampule and another piece around the fat part of the ampule. Holding the ampule upright, snap the ampule open by pushing the top away from us.
Drawing the Dose
Next, take one of the syringes from your emergency medical kit and draw up the contents of the ampule by holding the ampule relatively horizontal to the ground. Express any air bubbles from the syringe by holding it vertically.
Injection Procedure
We then inject the appropriate dose for the age and weight of the patient into the outer thigh. When done, discard the broken ampule and used syringe into a sharps container.
Conclusion
Again, this is not the ideal method for a response to an anaphylaxis emergency. But when autoinjectors are unavailable, it is good to understand the alternatives and how to administer them. Thank you for watching, and if you have any further questions, please call a HealthFirst representative at 800-331-1984.
