OUCH!!!! Ampule issues. Anyone else have problems?

[notyourordinarymom]

I attempted to open an ampule with no succes, so I rotated it and tried again. I had my alcohol wipe in package around it to "protect" me from the glass. I know that ampules are scored in a certain spot so they will break, and break clean at that. Well, it broke on the second attempt. However, instead of breaking clean and flat it had a big old jagged sharp that sliced my thumb right open.

After bleeding for 55 minutes the house supervisor sent me to the ER. I ended up recieving 5 stiches on the side of my thumb, about 3/4 inch long. It spanned my thumb joint, so it ended up needing to be splinted. I missed 2 days of work because of the injury (I work 4 12's and then I am off for 10). The physician said I needed to keep my thumb dry and not use my hand since moving the other fingers in effect pulls some of the tendons/ligaments in the thumb and would cause the cut to dehisce (sp?) more.

First off, I filed all of the paperwork required by my facility and was not held financially liable for the medical bills which totalled $653.45 (in the ER they x-rayed my thumb to check for glass fragments that could be present). However, workman's comp in my state will not reimburse me for the days of work I missed because I wasn't out of work for 3 or more days. That's 24 hours of pay I missed out on! Since I'm part time that's half of my paycheck!

I'm mad. In nursing school I learned how to open ampules, we used alcohol wipes in their package and ampule breakers so we'd know how to do both. I figure I've opened around 30 ampules since I've been a nurse (3 years). When I got home I got out my old nursing book and reviewed the procedure of breaking an ampule to see if I had missed some step. Upon review I know my technique was textbook perfect.

At my first job, a large regional hospital of 350 beds we had plastic disposable ampule breakers. This is my second job with the same company but at a small community hospital of theirs. Often nurses here complain that since they are the small community hospital they don't have the same supplies, pharmacy staffing at night, diagnostic staffing on the weekends etc. At this hospital we do not have ampule breakers, we are to use the alcoholl wipe method.

I checked out the price of plastic ampule breakers online, I found them for less than 7 cents each. For 7 cents, this whole mess could have been avoided! 2 days of missed work, the pain in the butt that it was to keep my thumb dry and not use my hand, with a 18 month old to take care of at home could have been avoided. The $653.45 cents the company spent to treat my thumb should have been spent prior to my cut on preventing things like this from happening.

If I can buy a pack of 1000 ampule breakers on my own for 7 cents each Couldn't a large company with 13 hospitals have some bargening power on the price when buying in large quantities? Not very many drugs even come in ampules the only one's I've dealt with have been vit k and nubain.

Have you ever been sliced by an ampule? Do you know someone who has? How often does this happen?

Does your facility provide plastic ampule breakers?

I guess it must happen often enough that someone invented the plastic ampule breaker and was able to sell it to hospitals.

P.S. I checked CINAHL and MEDLINE databases for more info to try and get some hard core data to present to my manager. I wanted to help her see the need to make this small investment. All I found was info on spikes on ampules. In manufacturing the ampules sometimes the glass gets pulled while still hot and forms a glass spike that cools. A bunch of anesthesiologist journals had complaints and info on how often they've been cut by a spike and how often the spikes occur.

[nrsang97, BSN, RN]

I haven't cut myself on ampules at all. I use the alcohol swipe method or the same thing with a 2x2. I have sliced my thumb open on the liquid tylenol as have many other nurses at work. We have them in packs of 10 and they are in plastic with a foil lid. I cut myself on the plastic part. I also was opening a nimodipine capsule. I had to pierce the capsule and squeeze out the liquid and stabbed my thumb with one of those blunt needles. OMG! that hurt like hell. I bled for at least 10 minutes. I felt like a dork.

[stripedsock]

We have the same problem with ampules too, but have also been getting injured by mucomyst vials. If you pop the cap off too quickly, it will leave a big snag in the metal that can catch on your thumb. Even if you get the cap off nicely, the metal ring around the top is sometimes tricky to take off and you can get cut on the edge of that too. We brought it up to the pharmacist who almost cut her finger opening up a vial. Their solution? Make RT do the mucomyst SVNs, so they can get their fingers sliced up instead of ours. Nice.

[justme1972]

The best way to open them is quickly and with confidence...if you do it slow, it's much harder to break and yes, you will cut yourself (gee...wonder how I know this? )

[FERN-tastic]

I've never cut myself on ampules, but I know people that have. I think it's stupid that meds still come in glass ampules. They're dangerous.

It took me a year to be able to open an ampule without an alcohol wipe around it. I find it easier to open them without it, but I'm still scared I'll cut myself sometime.

[NotReady4PrimeTime, RN]

The first time I ever sliced open a digit with an ampule, it was a 10 mL amp of etoposide.

Over the years I've opened thousands of amps and only infrequently draw blood. One tip I've used a lot is to use a baby bottle nipple (the ordinary kind, not the Nuk) to protect my fingers. They're a little awkward with the 1 mL amps because of their size, but still better than getting epi in a cut. Awhile back there was a back order on the 30 mL vials of epi 1:1000 that we use to make infusions for our larger patients. Of course we just happened to have a teenaged football-playing trauma victim who needed an epi infusion, and there I was cracking 31 of the 1 mL amps to make an infusion. The stuff of nightmares!

[zamboni]

To this day, I still carry a tiny shard of glass in my right thumb from an ampule of Brethene that I was opening on an EMS call one night, about 12 years ago. There's scar tissue over it and I can feel it. If I push down on it just right, I can feel the glass in there.

We still use some ampules in my ER, and I've always said that it's an awfully stupid way to package drugs. I use the alcohol wipe method if I have time, but I usually forget. So far, I haven't been tagged again.

I'll tell you what I have cut myself on though...the foil packages that our cardiac enzyme cartridges come in. :stone For years, when I would run enzymes, I would open the package, remove the cartridge, and wad up the package with the other hand to sail it across to the trashcan. Until one night it sliced my hand like I was being field dressed. Now, the stupid things feel like razor blades in my hands. Ditto for those infernal metal caps/rings that seal the nitro drip bottles (I usually grab my shears and just start hacking away at it like some kind of psycho!).

You would think with all the precautions they take with safety in our jobs today, that breaking glass and battling with uncooperative razor sharp metal would be a thing of the past.

[barefootlady, ADN, RN]

A small fingernail file carried in your pocket to gently file the edge of the ampule is commonly carried around here.

[irish123]

I frequently use ampules. I take a paper towel and fold it over to make it thicker and then break it. Alcohol wipes are to small and thin for me.

[wooh, BSN, RN]

I'm loving the baby bottle nipple idea. Being peds hospital, they're always around!

But really, I have to agree, in this day and age, why are they still packaging drugs this way? I've still got a scar from the big metoprolol ampule that got me. (Not to mention a dilaudid ampule that got me but stopped bleeding without having to pressure dress it.) When there's obviously a better way (not even talking about the plastic things to open them, a better way to package them all together), why does OSHA let this continue? (Other than the fact that nurses won't get together and complain about it. Instead we just go and tell people they should have been safer when they were breaking glass in their hands.)

[AnnieOaklyRN, BSN, RN, EMT-P]

thank you all for your thoughts and ideas...

I usually use an alcohol pad still in the wrapper to break them, and I thought to myself to use one prior to breaking the darn thing and I didnt. I should learn to listen to my intuition I guess, although this ampule was so big it may not have done me any good anyway.

On a happier note two more days and I get rid of my threads.

Sweetooth

[wooh, BSN, RN]

Ironically, day after I post on this thread, I get a pt on dilaudid, supplied in ampules. Sooooo, I tried the baby bottle nipple idea. A wee bit ackward for the little ampules, but definitely works!

[MadisonsMomRN, BSN, RN]

You would figure they would have come up with something else other than ampules... ugh.

I have never cut myself as of yet. I use either gauze or paper towels.