Q: Do you have a protocol for administering epinephrine in vials?

drawing epinephrineQ: We are moving from epi auto injectors to epi vials and I am working on updating our protocol.  Do you have a protocol for vials?

The protocol for treatment would be the same except for the actual steps of drawing up the medication.  You might want to consider a policy that addresses purchase, storage, disposal, training (I would refresh yearly), monitoring for expiration dates, and usage review (all allergic reactions whether or not meds were used).  With vials, I would suggesting adding that each should be discarded after being used for an episode of anaphylaxis (however many are needed for the episode).  With amps, I would use each for one injection.  In both cases, medication will be wasted but you will decrease the likelihood of contamination.  Given the relative costs compared to autoinjectors, they still remain very cost effective.

Click here to access the Wilderness Medical Associates’ Field Protocols, including Protocol 1: Anaphylaxis.

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2 Responses to “Q: Do you have a protocol for administering epinephrine in vials?”

  1. daniel hagaman

    Where can you buy epi vials or ampules? I’m having a hard time finding places that will fill the prescription. We use them for field classes that we teach in Patagonia. Also we are having trouble finding individual epi-pens they are now selling them as packs of two…only for 280 dollars!

    Daniel
    Graduate of WMA classes

  2. David Johnson

    Daniel,

    I don’t like to promote one company over another. If you enter epinephrine or adrenaline into your search engine, you will find a number of companies selling epinephrine in a variety of forms. Sometimes local pharmacies will as well.

    Regardless of where you buy whatever format you want, you will need a prescription. Remember to ask for 1/1000. Typically you can purchase it as 30 mL vials or 1mL ampules. For the first time in a long time, at least one company is also selling it in 1mL vials. If my only options were 1mL vials versus 1mL amps, I would take the vials.

    When I saw what you are being asked to pay for EpiPens, I was astounded. In looking around on the internet, that price is somewhere in the middle range. All other things being equal, autoinjectors are the easiest and safest route. Given the price, the other options are very attractive alternatives.

    Remember, nothing substitutes for good training and retraining. In addition, make sure you understand the local legal climate regarding the administration of a prescription medication by non-licensed medical practitioners. This is especially true as you travel outside of North American.

    DJ

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