hi my name is max feinstein and i'm an anesthesia resident at the mount sinai
hospital in new york city in this video i'm going to be showing you how to quickly and safely draw
medications into syringes and explaining why it is such a crucial skill for anesthesiologists to have
particularly in emergency situations if you find this video interesting or helpful
i'd really appreciate it if you liked it and subscribe to the channel let's dive in
one way that anesthesiology is commonly characterized is that it's 95% boredom and
5% sheer terror and that 5% refers to emergency situations that can unfold very quickly in the
operating room that necessitate immediate workup of what's going wrong and treatment so that
the patient can make it safely through surgery. anesthesiology is actually one of very few medical
specialties where doctors are directly drawing up medications and administering them to patients
so doing this skill isn't something that's taught widely outside of anesthesiology nor is it really
taught in medical school. in addition to being able to draw up drugs quickly in emergency
situations it's also just useful to be able to draw up drugs quickly on a regular basis because
it's not unreasonable to think that i might be drawing up drugs maybe a hundred times in a day
and if i'm working five or six days a week that's 500 or 600 times that i'm drawing up medications
in a week so if i can do this quickly i'm going to save myself quite a bit of time
while i'm in the operating room. and while speed is important safety is even more important for a
number of reasons. the first is that it's actually easier than you'd think to make
a medication error where you would say draw up the wrong drug or the wrong dose of medication
so being able to draw up drugs safely can help avoid medication errors and as you can imagine
since you're using a needle to draw medications there's always a risk of causing an inadvertent
needle stick either to yourself the patient or someone else who's in the operating room
and keep in mind that a lot of the drugs that we're using commonly in anesthesiology
include paralytics and other drugs that can cause really serious problems if
accidentally administered. for all those reasons it's really important to be able to safely and
quickly draw medications into syringes which i'll get into step by step right now. and if you
wait around to the very end i'll show you a way to make this a little bit more fun while you're at it
the very first thing you need to do before you start handling any medications
or anything involved with patient care is wash your hands and grab a pair of gloves
next grab an appropriately sized syringe for the medication you're going to draw up and
also a blunt tip needle to draw the medication into the syringe. next get the actual medication
that you're going to draw up in this case we're going to be using succinylcholine which
is a paralytic that comes in a 10cc vial so i grabbed a 10cc syringe. i will point
out and especially because it's been in the news recently that paralyzing agents do have warnings
on top of the vials that indicate that they are paralyzing agents and they look just like this
next connect your syringe to the blunt tip needle. you can either do this very slowly
and painstakingly where you try to find the crease in between the two layers peel it back
and then do the same thing with your blunt tip needle.
where's that crease? uhh.. right there. okay. and then you can connect them like this.
that took me about 15 seconds to do. alternatively you can pop open the packaging on your syringe,
pop open the packaging on your needle, connect them like this and now you've got them connected.
an extremely important next step is to take your syringe and label it with the medication
that you intend to draw into it this step goes way further than you'd think for preventing medication
errors you'll also notice that medications are grouped by color where red is for paralytics,
blue is for opioids, purple slash purpley-white is for pressors, and so forth. now that i've got
my vial of medication and i've also got my labeled syringe i'm going to do my first of
three safety checks where i'm going to compare both the medication name and the concentration
on the vial and the syringe to make sure that they're exactly the same which in this case is
succincoline chloride 20 milligrams per ml. same, same. next open your medication vial which you can
either do slowly and painstakingly by popping it off like that, or if you want to look cool (even
though nobody sees you behind the blue drapes and your patient who's back there with you is asleep)
you can just pop the top off like that. just make sure you either have good enough aim to get the
top into the garbage can, or if you get it on the floor clean up after yourself after you do that
because leaving things on the floor is not cool. next uncap your blunt tip needle which i like to
do by taking the cap in between my ring finger and my pinky just like that. next i flip my medication
vial upside down like this where i'm able to very safely put my syringe on my palm and aim it at the
medication vial in a controlled fashion. at this point i also draw back on my syringe to fill it
about halfway with air so that i can push this air into the vial so that there's a little bit of back
pressure to push medication from the vial into the syringe. this is also where i perform my second
of three safety checks where i again check the name of the medication in the syringe in my hand
and also the name of the medication in my vial now in a very controlled fashion
i can put the syringe inside of the vial and this is where i inject air that looks just like this
the medication vial is now pressurized so when i let go of the syringe it actually fills up part
way by itself. as you can see without me doing any work there's already about five CCs of medication
that's been drawn up into the syringe and then i can go ahead and just draw back on the plunger
to fill up the rest of the syringe. it's important to try to avoid getting air into the syringe,
but you can always get air out of the syringe once you're done drawing up the medication.
once i've completely drawn up the medication into the syringe i will do my third safety check by
taking the vial off of the needle again putting my vial side by side with the syringe and double
checking succinylcholine, succinylcholine. i know that it's really redundant to do that three times
but it's extremely important to set a habit of being very safe and drawing up your medication,
triple checking everything, and just making that your standard of practice
so that you can dramatically reduce the likelihood of a medication error. the last thing that you'll
need to do at this point is safely protect this needle tip that you have exposed. perhaps the
safest way to do that is the one-handed scoop technique where you take your cap like this,
set it down on a flat surface, and then take your syringe and scoop up the needle tip
just like this which allows you to then cap like that. i will point out that that's not
necessarily the fastest way to do it but it's probably the safest particularly compared to
taking the needle cap in your hand and then placing the needle back into it where it's
much easier in a situation like that to accidentally poke yourself with the needle,
and you can imagine that poking yourself with a paralytic like this is probably not
a recipe for success in the operating room. just to show you what it looks like all put together:
imagine we're in a situation where there's a cardiac arrest out of nowhere and i quickly have
to come to the medication cart and draw up code dose epinephrine, so we can do that really quickly
and safely using the techniques that i just showed you right now. start by grabbing my syringe,
a blunt tip needle, open them both, get them connected just like this. medication label
one CC vial of epinephrine. double check,
double check. pop everything open. a little bit of air in here, draw it up safely like this,
and double check, double check. medication's ready to go, air is out, and i can give it
the thing that i mentioned that can be fun is if you set up a little target
over your garbage can and throughout the course of your day see if you
can get your target practice by popping the tops of your vials.
and like i said you really should clean up after yourself if you're going to do anything like this
if you would like to learn more about the medications shown in the anesthesia cart
behind me right here check out this video that i made where i go through
all of the medications in the anesthesia cart with the help of Dr. Erica Fagelman.
thanks very much for watching this video i hope you found it helpful