microscopic glass fragments from breaking an ampule," says Dr.
Gonzalez, who offers these buying tips:
• Only purchase prefilled syringes of medications intended for injec-
tion. A syringe is not a proper vessel to administer a topical eyedrop,
for example.
"Over my career, I've seen some crazy examples of healthcare pro-
fessionals accidently injecting a drug that was intended for oral or
topical routes of administration," says Dr. Gonzalez. "That's why I
generally stay away from purchasing medications such as eye drops
— such as povidone-iodine, anesthetics and dilating drugs — that
come in a prefilled syringe."
• Buy drugs that are known to be stable and compatible with the
syringe as a storage vessel. Ask the compounding pharmacy for a cer-
tificate of analysis and stability data to support the storage of the drug
in a specific syringe, says Dr. Gonzalez.
• Are there any unique considerations for that syringe? Dr. Gonzalez
cites as an example a syringe that's intentionally packaged with an air
bubble at the tip. In some cases, you need to expel the air bubble
prior to administration. In other cases — for example, the anticoagu-
lant Lovenox (enoxaparin sodium injection) — you should inject the
medication with the air bubble. Another example: Does the prefilled
syringe come with drug overfill to prime the syringe hub and needle,
or should all the contents be injected for the desired dosage?
Prefilled syringes are also a good way to deal with medication short-
ages. When the Nashua (N.H.) Ambulatory Surgical Center was having
trouble recently finding lidocaine with epinephrine, it turned to a
compounding pharmacy. "Usually we are able to get what we need,
though in very limited supply, by shopping around with wholesalers
and compounding pharmacies," says nurse director Christina Dawson,
RN, BSN, MBA, CCRN.
8 2 • O U T PA T I E N T S U R G E R Y M A G A Z I N E • F E B R U A R Y 2 0 1 9
