Organizing and labeling vials in allergy practice

I understand how confusing this can be, Jean. Oranizing and labelling those vials properly is very important.

If you are new to allergy, it is critical that you get some help, especially if you will be responsible for mixing extracts as well. Allergy injections can cause serious reactions. You need to know what you are doing. See:
Educational Requirements for Allergy Nurses

There are several suppliers who offer a variety of trays to fit whatever size vials you are using. Arrangement of vials and trays will depend on the system you are using to mix extracts.

Labels are available but I usually make my own. It's easy to do if you have access to Word Perfect or Microsoft Word. We use 20mm vials. I use 1" x 2-5/8" labels and it's a perfect fit. Here is how I set up the labels:

Patient_____________________________
Dilution____________Exp. ____________
Extract_____________________________
Clinic Name/Logo
Dr. John Doe, M.D.

Fill in the blanks for each patient and wrap a piece of clear tape around it to help secure it as well as to prevent bleeding of the ink.

Alternatively you could type labels individually for each patient, but this method seems quicker to me.

When I worked for a General Allergist/Immunologist, I mixed each patient's extracts from concentrate and added a small amount from that vial into the next vial. A portion from that vial was added to a third vial, etc. Once I had the specified number of dilutions, I'd arrange them in the tray with the weakest at the front.

Allergists who employ this method differ in the exact dilution strength and number of vials. But, for example, your first vial may be labeled 1:20 and Vial #1. If you take 0.05 cc of that and add to 4.5 cc of diluent, the resulting vial will be labeled 1:200 and Vial #2. The last vial might be Vial #6 at 1:2,000,000.

For this system, you will need to add a space for a vial # on each label. Most trays hold 60 vials. Set the trays crosswise, with ten wells across the front and six wells at each side. Arrange vials alphabetically by patient. Vial #6 (or the weakest vial mixed) will be at the front with the others in order back to Vial #1 in the back. Of course as the patient progresses through each dilution, he or she will have less vials.

If you are working for an ENT Allergy Specialist, as I do now, you will need a little different scheme.

I still arrange alphabetically by patient, but I only mix one vial at a time for each extract. However I still sometimes have several vials for a patient. If I have to dilute a vial to back a patient's dosage up, I usually hang onto the first vial. If a patient's vial is near it's expiration date, or almost empty, I'll have a new one ready. If the patient receives more than one injection, vials can add up.

When a patient has only one or two vials, I often place another patient's vials behind the first patient's vials, on the back two rows of the trays. By skipping one or more wells between patients, individual patient's vials are still easy to locate, and this method conserves space.

Once you've got your trays set up, label the trays on the front edge with alphabet guides so it will be easier to find vials quickly. You can overlap the trays so the front of one rests on the back of another, making the alphabet labeling easier to see.

If you've made a new vial of extract but the old one is not yet empty, here's a neat trick I use:
I place a 1/4" round color coding label on the top of each new vial. The package I have has 4 colors in it, but I don't assign any special reference to the color. Of course you'll still check expiration dates, but this method does let me know at a glance if I'm using a new vial.

This is important, because we always back the dosage up slightly when starting a new vial. The newly prepared vial not only has potential for error in mixing, but it will be stronger since it is mixed from newer extracts.

I arrange mixing vials alphabetically, or in some cases in the order in which they are on my testing trays. For ENT specialty you will also have SET testing/mixing boards, but if you are using these you will have had some sort of training in the use and organization of them.

Streamline as much as possible, and it will save you time when things are hectic. Don't be afraid to ask for help when you need it. Your physician is your most important resource. He is responsible for the practice. But you are responsible for making sure YOU provide patient care safely, competently, and efficiently.

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