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.

[CarVsTree]

Does your facility provide plastic ampule breakers?

Don't even know what they look like! And yes, I know ppl that have been cut opening ampules. I haven't... Yet!

[fetch33]

Was the offending ampule Phenergan? I've had Phenergan ampules break jaggedly more often than other drugs. I've cut myself numerous times in 20 years of nursing.

[Reno1978, BSN, RN]

Ouch! Considering how cheap these are online, I may consider buying a supply if my future employer doesn't provide them. The decision between 7 cents and 5 stitches isn't a tough one! I'm sorry that happened to you, that sounds absolutely awful.

I remember practicing opening these with 2x2s recently...luckily no one was injured!

[SCRN1]

I've seen several drugs come in ampules and we use them all the time. I cringe whenever I see nurses open them without using either an unopened alcohol pad or some kind of protective barrier. I got cut one time, but it was so tiny, it didn't need any further attention than cleaning it off and applying a bandaid. I'm so sorry yours was much worse. That is so unfair to you that you didn't get paid for the time you had to take off. Even though you work part-time, the hospital should have at least paid you. I'm sure there's lots out there who would've tried to sue for that. They were lucky it was you, who isn't that way.

[TazziRN, RN]

Sorry you cut yourself, but what your comp carrier did is the norm for the industry. The same thing happens when you take sick leave, probably...the first three days are paid out of your PTO, then your sick leave kicks in. At least, that's how it is around here. I'm sorry you lost out on pay, but I don't see the sense in getting angry about it since the practice is the norm.

And yes, I've been cut by ampules many times.

[augigi, CNS]

Why not write to your management and suggest an ampoule-opening device if you don't have them? Attach a copy of your incident report and suggest a way to avoid it in future. Once they have it on paper, it's a lot harder to dismiss the idea. Or else make a petition for nurses on the ward to sign stating that they do not want to continue the unsafe practice of opening these things by hand. The mere fact we have to pad them with alcohol pads etc to open them is ridiculous - obviously they are a (worse) accident waiting to happen. Imagine if a nurse on coumadin did what you did... can you say hemorrhage?

[CVICURN2003]

Luckily I have never cut myself. We use ampules of fentnyl often(like everyday x3-) for our post op CABG delirium/pain pts. And sometimes we are popping them VERY quickly. I do know a nurse who was out of work for SIX months and required two surgeries becasue a solumedrol bottle broke (you know the kind you push the powder into the solution and it mixes) and she cut a bunch of tendons and nerved in her thumb/forefinger area. She actually got a large workers comp settlement. But, she was miserable and in pain for a LONG time.

[Ivanna_Nurse, BSN, RN]

We have ampule breakers where I work. They are in a box in each charting area. We are a small hopsital, and was suprised to see them. They look like a white chap stick cap. ~Ivanna

[rnin02]

Oh, how awful! I have cut myself, but never like that, it sounds so painful. and so does the solumedrol story, yuck! Anyway, we do not have ampule breakers, I've never even seen one. Personal, I do not open my alcohol swap package, I just wrap it around the top of the ampule and partially over the scored part and the majority of the time there's no problem. I know some people open their package and put the top of the ampule inside the alcohol package, I feel that makes it more likely to cut thru the package and cut you. Being part-time, aren't you eligible for some sick time to use for your paycheck? I believe our part-time employees get some sick and vacation time, they just don't get as much per year as full time employees do.

[Hoozdo, ADN]

In one of the first days of oreintation as a new grad, I cut my my finger quite badly on a Fentanyl ampule. I was using the alcohol pad method. I no longer use that method........I grab a few paper towels, wad them up to make a thick cushion and THEN break the ampule.

Since then, we have plastic ampule openers. They don't work very well - you have to apply a LOT of force to break the ampule. I am sticking with my paper towel method :trout:

[Ayvah, RN]

What is the rationale for still having glass ampules as opposed to other storage methods? Why not small bottles (like heparin) or plastic containers? I, and several other people I know of, have gotten cut on glass ampules as well.