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Opening snap off ampoules – a safer and uncomplicated method

Dear Editor,

Anaesthetic drugs are often available in glass ampoules which need to be ‘snapped open’ along the coloured bands or dot around the neck. Different manoeuvres can be employed for opening these ampoules like snapping with thumb and index finger (with or without using gauze pieces), scratching the neck of the vial with file or base of another vial and snapping open,1. Cohen Y, Glantz L, Ezri T. Breaking glass vials. Anaesthesiology. 1997;86:1215. using scissors2. Koga K, Hirose M. Scissors as a propofol ampoule‘snapper’? Anaesthesia. 1999;54:919–20. or knife. If done properly, the neck of the ampoules snap open cleanly without producing spikes or glass shards. However, quite often serious cuts can occur on the fingers, ensuing lacerations necessitating suturing, infection susceptibility, loss of work days, rehabilitation, and residual pain.3. Bajwa SJ, Kaur J. Risk and safety concerns in anesthesiology practice: the present perspective. Anesth Essays Res. 2012;6: 14–20. Ampoule opening is classified as a high risk event4. Smith DR, Leggat PA. Needlestick and sharps injuries among nursing students. J Adv Nurs. 2005;51:449–55. with broken ampoules causing 54% of the reported incidents in anaesthesia personnel.5. Pulnitiporn A, Chau-in W, Klanarong S, et al. The Thai Anesthesia. Incidents Study (THAI Study) of anesthesia personnel hazard. J Med Assoc Thai. 2005;88: S141–4. Ampoule cuts are known to occur in 6% anaesthetic sessions.6. Parker MR. The use of protective gloves, the incidence of ampoule injury and the prevalence of hand laceration amongst anaesthetic personnel. Anaesthesia. 1995;50: 726–9. Even though specialized ampoule opening devices exist, they may not be always available, which can prove dangerous during emergencies. We describe a simple, inexpensive and safe method of opening ampoules, using the barrel of a syringe which is being routinely practiced in our institution thereby preventing possible sharp injuries.

The barrel of a syringe (plunger removed from the syringe) is taken in the dominant hand and inverted and with the non-dominant hand. The conical tip of the ampoule is inserted inside the hollow cylindrical space inside the barrel (Fig. 1). The depth of insertion of the ampoule inside the hollow is so adjusted that the constricted neck of the ampoule having the coloured marking is in close proximity to the lower circumferential edge of the barrel’s hollow. Holding the base of the ampoule steady with the non-dominant hand, a steady pull is applied towards the clinician while the barrel is pushed away with dominant hand (with the conical head inside it) with continuous and even pressure, keeping the edge in contact with the neck. A light pressure applied correctly will cleanly crack the ampoule open along the coloured line. The sharp broken conical tip of the ampoule and the glass shards remain inside the hollow barrel which can be tapped out and discarded safely without bringing them in contact with the fingers (Fig. 2).

Figure 1
Inserting the conical tip of the ampoule inside the hollow cylindrical space of the barrel
Figure 2
The sharp broken conical tip of the ampoule and the glass shards remaining inside the hollow barrel after a clean break for which can tapping out and discarding without bringing them in contact with the fingers

Advantage of this technique includes low cost, easy availability of syringes in the hospital, utilization of a single barrel for multiple ampoules and keeping fingers clear of glass shards and slivers. However, limitation of this method is that only those ampoules which have volumes less than 5 mL with etched rings on the neck can be opened easily. It is not feasible to open larger ampoules (greater than 5 mL volume) with this method. For bigger ampoules, a larger syringe (of 10 mL) can be possibly used. A slightly higher degree of pressure may be required for snapping off the ampoule by this method as compared to manual snapping of the neck with fingers which more than compensates for the advantage of averting sharp injuries.

References

  • 1
    Cohen Y, Glantz L, Ezri T. Breaking glass vials. Anaesthesiology. 1997;86:1215.
  • 2
    Koga K, Hirose M. Scissors as a propofol ampoule‘snapper’? Anaesthesia. 1999;54:919–20.
  • 3
    Bajwa SJ, Kaur J. Risk and safety concerns in anesthesiology practice: the present perspective. Anesth Essays Res. 2012;6: 14–20.
  • 4
    Smith DR, Leggat PA. Needlestick and sharps injuries among nursing students. J Adv Nurs. 2005;51:449–55.
  • 5
    Pulnitiporn A, Chau-in W, Klanarong S, et al. The Thai Anesthesia. Incidents Study (THAI Study) of anesthesia personnel hazard. J Med Assoc Thai. 2005;88: S141–4.
  • 6
    Parker MR. The use of protective gloves, the incidence of ampoule injury and the prevalence of hand laceration amongst anaesthetic personnel. Anaesthesia. 1995;50: 726–9.

Publication Dates

  • Publication in this collection
    Nov-Dec 2014
Sociedade Brasileira de Anestesiologia R. Professor Alfredo Gomes, 36, 22251-080 Botafogo RJ Brasil, Tel: +55 21 2537-8100, Fax: +55 21 2537-8188 - Campinas - SP - Brazil
E-mail: bjan@sbahq.org