Implementation of a system to assist in the preparation of vitamin-lipid syringes: an ampoule opener

In the parenteral nutrition unit, an average of 130 syringes of SMOFlipide^® and Vitalipide enfant® (SV) are prepared each week. This requires manually opening and removing the contents of approximately 100 glass ampoules of Vitalipide^®. This repetitive task is time-consuming and can cause musculoskeletal disorders (MSDs). A new preparation process using an ampoule opener has been implemented. The ampoule opener allows for the simultaneous opening of 20 Vitalipide^® ampoules.
The objectives are to evaluate the ampoule opener in routine practice, to demonstrate the stability of the Vitalipide^® emulsion, and to assess how hospital pharmacy technicians (HPT) feel about this new process.
From December 2024 to April 2025, the total times required for syringe preparation and for opening and drawing up ampoules were compared before and after the ampoule opener was implemented. A SV stock solution is dispensed into syringes using a Baxa Repeater^® peristaltic pump. A 5-µm filter is attached to the ampoule withdrawal needle to trap any glass particles.
A galenic stability test of Vitalipide^® after filtration was conducted on 3 bags, each containing 60 ampoules : macroscopic analysis, zeta potential measurement, and analysis of the average diameter of lipid globules using the Zetasizer nano ZS. Three samples per bag were analyzed, and the control was an unfiltered ampoule.
HPTs were trained, and those who used the ampoule opener completed a 9-question questionnaire divided into 3 parts: the ampoule opener, syringe preparation, and MSDs.
A meeting followed by individual training was held. Four HPTs were observed before and three after the ampoule opener was implemented. The average total preparation time decreased from 78 minutes to 60 minutes, and the time required to open and remove the contents of the ampoules decreased from 32 minutes to 10 minutes. Macroscopic examination revealed no creaming, precipitation, or coalescence. The zeta potential (-47 mV vs. -53 mV) and the average particle diameter (226 nm vs. 224 nm) were not altered by filtration.
Three HPTs responded to the questionnaire (100%). All three found the device easy to use and the training appropriate. No difficulties with handling the device—such as bulkiness or weight—were reported. All noted that it saved time and made opening ampoules easier.
All three PPHs had previously experienced pain in their hands during preparation. The pain level was rated between 1 and 2 by all three. They all found that the ampoule opener reduces repetitive motion, and none of them have experienced any pain since using it.
The ampoule opener optimises the preparation of SV syringes and helps improve working conditions and comfort for HPTs. The use of the ampoule opener and a 5 µm filter does not appear to alter the Vitalipide^® emulsion.

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