Clinical Skills - Using Ampules and Multidose Vials

Hi. I'm Ellis with Level Up RN. In this video, I'll be demonstrating how to access medication in a glass ampule and how to use a multidose vial. I'll be following along on the steps that we've included in our clinical nursing skills deck. So if you have this deck, grab this card, and you can follow along. If you don't have the deck, then you can head on over to leveluprn.com to check them out.

To take medication out of an ampule, I'm going to, of course, get my ampule. And then I'm going to tap this top part that's called the neck a little bit just to make sure that all the medication is actually in this bottom part of the ampule or the body of the ampule. I'm going to tap it a few times, make sure it's empty. Once I've confirmed that it's empty, I'm going to take a piece of gauze, a two by two. I'm going to wrap the top of the ampule, and I'm going to snap the neck off away from my body. Just in case there's any glass particles, they would then go out in front of me instead of towards my face. So I'm just going to snap that right off. It's very satisfying, that crunch, I think. And then my ampule is now open.

When I'm withdrawing the medication from the ampule, I must use a filter needle. So this is a special needle that will filter as the medication is drawn, making sure again that no glass particles will be drawn up into that syringe. So I just remove the cap from my filter needle. And I can get this out of the ampule a number of ways. I can place it on the table like I would a vial and insert the filter needle that way. I personally prefer to invert all of my vials and ampules. I just find it easier to handle. So I'm going to insert my needle, withdraw the correct amount which we'll say is two milliliters. Once I've gotten the correct amount, I'm going to recap the filter needle. This is one of the few times you'll be recapping here. I'm doing the scoop method, so I can safely recap my needle. The reason I need to actually recap the filter needle is because I cannot use the filter needle when I'm administering this medication. So especially if I'm going to be giving this medication with a needle - say, I'm doing an intramuscular injection - I need to remove and waste the filter needle. And I need to attach a different needle before I use it to inject into my patient.

And the final tip I've got for you about ampules is you never inject air into them. As you saw, you can hold these upside down, and it's magic. All right. It's surface tension. But it's magic, and it doesn't fall through the opening I've made. However, if you disrupt that surface tension by inserting air into this vial, it will start leaking and it will get everywhere. So just make sure that all you do is insert your needle and withdraw your medication. I know I'll be using a multidose vial today because there's no cap on my vial. And that means, my vial is no longer sterile. So this is a multidose vial, which means it's already been opened and used by someone else. So that first step I have to take, after my hand hygiene and gloving, is going to be to clean the top of the vial. So I'll get my antiseptic swab, and I'll scrub the top of the vial to make sure that it's clean before I insert my needle.

I'll then get my needle and syringe. I'm going to remove my needle cap, pull up the amount that I'll be withdrawing. So let's say we'll do one milliliter today. So I'm going to pull that plunger back to one milliliter. I'm going to hold my vial steady on a stable and solid surface so that I don't miss the vial when I go in with my needle. And I'm going to insert my needle at a 90-degree angle. So I pop that right in. And in this open surface at the top, so above the medication liquid, I'm going to inject my air. I will then invert my vial. And I like to show you that we can see the level of the liquid inside the vial. That's important, especially if you're working with a longer needle because as you're withdrawing, if your needle goes above the level of that liquid, guess what you're going to be pulling out? Air. And it can be really confusing for students and new nurses because they're pulling, pulling, pulling or it's displacing this air, and all that's going into their syringe is air. So make sure that sometimes you have to actually drop your needle out of the vial a little bit, not completely. We want that tip of the needle still be in. But if this is running low on medication, I might need to drop my needle out a little bit to make sure I am in fact getting medication from the vial. So I'm going to make sure I've got that one milliliter. And I'll remove it from my syringe using the scoop method so that I'm not at danger of sticking myself, pick up that cap, and I've prepared medication from a multidose vial.