The preparation and administration of adrenaline, also known as epinephrine, are critical skills for medical professionals. Different clinical scenarios, such as anaphylaxis, cardiac arrest, and continuous infusion, demand specific concentrations and preparation methods. A failure to properly dilute or select the correct concentration can lead to serious adverse outcomes. This guide outlines the essential steps and considerations for preparing adrenaline, emphasizing safety and accuracy.
Essential Adrenaline Concentrations and Indications
Adrenaline is primarily available in injectable concentrations designed for different routes of administration. Understanding the difference is paramount for patient safety.
1:1,000 Concentration (1 mg/mL): This is a more concentrated form, often used for intramuscular (IM) injection in conditions like anaphylaxis. It can also be a starting concentration for dilution when preparing for other uses.
1:10,000 Concentration (0.1 mg/mL): This is a more dilute form, used for intravenous (IV) or intraosseous (IO) administration, such as during cardiac arrest. Administering the more concentrated 1:1,000 solution intravenously without proper dilution is extremely dangerous.
Preparing Adrenaline for Anaphylaxis (Intramuscular)
For anaphylaxis, intramuscular injection is a standard approach, typically into the anterolateral aspect of the thigh. Medical professionals may need to draw the medication from a vial.
Drawing from a Vial and Syringe
Using a 1:1,000 vial requires strict sterile technique. Essential equipment includes a vial of 1:1,000 adrenaline (1 mg/mL), a syringe, and appropriate needles. Verify the medication's label and inspect the solution before drawing the appropriate amount. After drawing, change to the injection needle and administer intramuscularly into the anterolateral thigh, avoiding the buttocks. Document the administration details.
How to Prep Adrenaline for Cardiac Arrest (Intravenous/Intraosseous)
During cardiac arrest, the dilute 1:10,000 solution is typically given IV or IO at intervals. Dilution is often necessary if only the 1:1,000 solution is available.
Diluting 1:1,000 to a 1:10,000 Solution
To accurately dilute, gather a syringe, 1 mL of 1:1,000 adrenaline, and 9 mL of 0.9% Normal Saline. Draw 1 mL of the 1:1,000 adrenaline into the syringe and then add 9 mL of saline to create a final 10 mL volume with a 1:10,000 concentration. Label the syringe clearly as "Epinephrine 1:10,000" and administer according to protocol, followed by a saline flush.
Creating a Continuous Adrenaline Infusion
Continuous IV infusions are used in critical care for conditions like septic shock. To prepare, dilute 1 mg (1 mL) of 1:1,000 adrenaline into 250 mL of Dextrose 5% in Water (D5W) or Normal Saline, resulting in a specific concentration. Thoroughly label the bag with patient and medication details and administer via a dedicated infusion pump and IV line. Close patient monitoring is essential.
Comparison of Adrenaline Preparation Methods
| Method | Concentration | Primary Indication | Context | Key Steps |
|---|---|---|---|---|
| Auto-injector | Varies | Anaphylaxis (First-line) | First aid, pre-hospital | Check expiry, remove cap, inject into thigh, hold |
| Vial to Syringe (IM) | 1:1,000 (1 mg/mL) | Anaphylaxis (Alternative) | Clinical, pre-hospital | Draw appropriate volume, inject into thigh |
| Vial to Syringe (IV Push) | Diluted to 1:10,000 (0.1 mg/mL) | Cardiac Arrest (ACLS) | Clinical, resuscitation | Dilute 1 mL of 1:1,000 with 9 mL saline |
| Continuous Infusion | Specific concentration after dilution | Septic Shock, Refractory Anaphylaxis | Critical care, ICU | Dilute 1 mg with 250 mL fluid, use infusion pump |
Key Safety Protocols in Adrenaline Preparation
Careful adherence to safety protocols is essential. Always double-check the concentration on the vial to avoid errors between 1:1,000 and 1:10,000. Maintain sterile technique. All prepared syringes and bags must be clearly labeled immediately. Do not pre-mix or store diluted solutions. Follow IV push administrations with a saline flush, and use a dedicated IV line for continuous infusions. Inspect the solution for discoloration or particulates before use.
Conclusion
Mastering how to prep adrenaline is a fundamental skill in emergency medicine and pharmacology. The specific method depends on the clinical situation and the required route of administration. Strict adherence to safety protocols, including verifying concentrations and proper labeling, is critical to prevent dangerous medication errors and ensure effective treatment for patients in crisis. For comprehensive resuscitation guidelines, medical professionals should always refer to the latest American Heart Association (AHA) recommendations.
