Ancillary Supplies
Along with your supply of allergen extracts, you will need to stock your clinic with additional supplies to support the practice of immunotherapy. The following is a basic list of products that will be useful for the handling and preparation of your extracts:
- Sterile empty vials with color-coded vial caps and patient vial labels
- Bulk vials of diluent
(either saline or HSA) - Pre-filled vials with diluent (either saline or HSA)
- Mixing syringes (26- to 27-gauge, 1/2-3/8 inch non-removable needle)
- Alcohol swabs
- Storage trays
- Non-latex medical gloves
- Washable skin marking pen
- Wheal ruler and timer
Vials
The Allergen Immunotherapy Practice Parameters (2010) recommends a consistent coloring scheme, from highest to lowest concentration, of: Red, Yellow, Blue, Green, and Silver. In addition, the Parameters recommend a consistent numbering scheme with #1 as the highest concentration (e.g. Red vial) with an increasing sequence until the lowest concentration (e.g. #5 for the Silver vial).
For an example of this, please review the section How to Perform Dilutions.
Labels
The content of the vial labels should be consistent and include, at a minimum:
- Patient Name
- Date of Birth
- Vial Designation (e.g. Color, Number, Concentration)
- Content of Vial (e.g. Dust Mites, Grass Mix)
- Expiration Date
- Physician Name and Contact Information
These are just recommendations and adjustments can be made at the physician’s discretion. However, it is important that consistent procedures be established and followed for all vials to reduce possible documentation and administration errors.
Syringes
Larger needles are not recommended since they may core the vial’s rubber stopper during repeated insertions (e.g., break off small particles of rubber that end up in the extract). For more information on coring, review the section Quality Concern – Coring.
Syringe sizes can be confusing. The LOWER a syringe’s gauge, the LARGER its needle size. For example, an 18-gauge syringe has a needle with almost twice the diameter of a 22-gauge syringe. Besides increasing the chance of coring the rubber stopper, lower gauge syringes lack the precision of the higher gauge syringes. This is significant when precise volumes are needed for dosing (e.g., 0.1 cc during build-up). A larger syringe may contribute to inadvertent overdosing of allergens in highly sensitive patients.
For more information see the following sections: