Medications and Syringes

Syringe Prep- Labeling

Nine classes of drugs commonly used in the practice of anesthesiology have standard background/text colors established for user-applied syringe labels by ASTM D4774-11, Standard Specifications for User Applied Drug Labels in Anesthesiology and ISO 26825:2008

Syringe Prep- Safety

Never reuse a needle, or needleless access device even on the same patient. Once a needle or access device has been used, it is considered contaminated and must be discarded in an appropriately identified sharps container. Access devices are single-use devices.

Never refill a syringe once it has been used, even for the same patient. Syringes are single-use devices. Once the plunger of a syringe has been completely depressed in order to expel the syringe contents (i.e., intravenous medication), the internal barrel of the syringe is considered contaminated and must be discarded in an appropriate fashion. A syringe must only be used once to draw up medication, and must not be used again even to draw up the same medication from the same vial for the same patient. CRNAs should weigh the risks of possible syringe contamination (e.g., from anesthesia workspace contamination) that may occur when repeatedly connecting and disconnecting a medication-filled syringe from an intravenous infusion set or other administration systems.

safe-injection-guidelines-for-needle-and-syringe-use.pdf

Pressor Mixing

Ephedrine

Mixing Instructions:

Take a 10 ml syringe with 9 ml of normal saline

Into this syringe, draw up 1 ml of ephedrine from the vial (vial contains Ephedrine 50 mg/ml)

Now you have 10 mls of Ephedrine 5 mg/ml


Phenylephrine

Pure alpha, so no intrinsic inotropy; it may increase coronary perfusion which can improve cardiac output.

Mixing Instructions:

Take a syringe and draw up 1 ml of phenylephrine from the vial (vial concentration must be 10 mg/ml)

Inject this into a 100 ml bag of NS

Now you have 100 mls of phenylephrine 100 mcg/ml

Draw up some into a syringe; each ml in the syringe is 100 mcg


Epinephrine

Do not give cardiac arrest doses (1 mg) to patients with a pulse

Has alpha and beta-1/2 effects so it is an inopressor

Mixing Instructions:

Take a 10 ml syringe with 9 ml of normal saline

Into this syringe, draw up 1 ml of epinephrine from the cardiac amp (amp contains Epinephrine 100 mcg/ml)

Now you have 10 mls of Epinephrine 10 mcg/ml


Infusion Pumps

Effect on Syringe Size vs Expected Dose with Common Syringe Pumps

syringesize_0811_p287-291.pdf

Recommended Concentrations

Recommended drug concentrations for select anesthesia drugs.pdf

Continuous Infusion Concentration Recommendations

Adult Infusion Standards.pdf


CV Medications