Thursday, May 3, 2018

Glass IV Bottles - Breaking Bad

Breaking a  glass IV bottle was the stuff nightmares were made of. There were three elements to
consider with shattering  old time glass IV bottles. The glass bottle, a liter of fluid (D5W took the prize for making the biggest mess due to it's inherent stickiness,) and an air gap. The air in the bottle served to amplify the crash of the glass breaking so as to sound almost like a rifle shot. Hearing that booming "CRACK" followed by a piercing scream alerted the entire floor of the mishap and summoned a legion of gawkers for the messy clean up. It was an unwritten rule that the clean up was the sole responsibility of the unfortunate breaker of the bottle - don't even thing about calling for a janitor, oops, I mean housekeeping person. An empty Cardboard IV case was placed on the floor close to the broken glass which was gingerly pushed  into the enclosure with a portion of the box top. The procedure always reminded me of catching a piranha  with your bare hands, a slippery mess with a laceration or bite close at hand.

Glass IV bottles were at risk for breakage because their girth made them difficult to grasp. When CDs were designed one of the goals to make them easy to handle. Designers of glass IV bottles were not concerned with ergonomics and the diameter of the glass  container expanded to fit the volume of the fluid. Thank heaven there were no 2 liter  IV bottles.

Another common mechanism of bottle breaking was undershooting the hanging notch on the IV pole. That thin wire hanger was difficult to see especially under bad lighting conditions and many an old nurse thought the bottle was about to nest safely on the pole only to have it come crashing down. A good luck/bad luck conundrum occurred when the rapidly descending bottle came crashing down on the nurse's foot. The bottle, cushioned by the nurse's toes remained intact but hobbled the hapless nurse. Maybe nurses should have worn steel toe shoes like heavy construction workers.

Miss Bruiser, my all time favorite nursing instructor had a favorite tactic for dealing with bottle breaking students. After haranguing and berating the student during the clean up she insisted the clumsy student carry a glass IV bottle with them for 24 hours. A unique combination of public humiliation and learning how to perform daily activities with an ever present glass IV bottle was an excellent deterrent.

Finally the rolly polly crash and break was another way to reduce the glass bottles to glistening shards.  Everyone was acutely aware that there was only one safe position for a glass IV bottle and that was vertical. Inadvertently setting a glass bottle on it's side resulted in it rolling away and crashing at some distance from the nurse. Nurses frequently turned the bottle to this vulnerable position to apply a timing strip or write a note on the bottle label. This unfortunate event almost always occurred at times of great stress when there was an unforeseen complication or unexpected event. An acute hypoglycemic crisis required an immediate IV and if that gigantic ampule of D50 rolled and shattered it was like having a bull in an IHOP restaurant with all those syrup bottles; sticky, gooey syrupy stuff everywhere.

Despite the potential for breaking, nurses hated to see those glass IV bottles morph into those silly looking flexible plastic bags. If the complaints and derisive comments about heavy duty enema cans being replaced by flimsy bags was bad, the ill will directed toward IV bags was even worse. Veteran nurses used to joke  ( I hope it was in jest)  about using those newfangled flexible plastic IV bags for enemas because that was about all they were suited for.


  1. Breaking a glass IV bottle was nothing compared to shattering a big old partially filled Gomco suction bottle. The mucoid properties of the contents congealed around the glass shards.

  2. After reading this I have no doubt whatsoever I would have broken several of these and your Miss Bruiser would have had me carry a bottle around with me for a week...

    I hope you do a post about Miss Bruiser we had one of her at my training hospital too - but Miss B sounds particularly brutal! Sue

  3. Miss Bruiser was a reverse sort of inspiration for me. I never wanted to treat people with such a lack of concern for their comfort. She insisted that student nurses practice procedures on one another because "If you are going to do this to someone you need to know what the experience is like." Thank heaven she was not a neurosurgery professor or we would have been doing cranies on each other. Of the procedures I experienced it would be a toss up which was more painful; an Imferon Z tract injection or a radial arterial puncture.

    I remember being nervous while starting an IV on my partner, Janess, with hands trembling. Miss Bruiser really unloaded on me for that, "What kind of a nurse does that? Now knock it off" - as if tremors are under voluntary control.

    Miss Bruiser's area of expertise was bedside Med Surg. She was no where near the OR and that might be what sparked my initial interest in that field.

  4. I had a Sister early on in my training who I swear was sadistic both to patients and nurses... she particularly enjoyed belittling nurses in front of their patient - she'd rip open the curtains I had around my patient's bed during a procedure and berate me for being "hopeless, lazy and incompetent" in front of the patient I was caring for - utterly humiliating for me and embarrassing for the patient. She said the same things to each nurse she chose to pick on so we knew it wasn't actually about us at all... she just enjoyed doing it to make us poor underlings who couldn't speak back, squirm. She'd particularly hunt out any nurse who appeared a bit uncertain, or was having a bit of a tough time adjusting to the work. Easy victims of course!

    We were extremely limited in what procedures nurses were permitted to carry out at my nursing school - venepuncture was strictly performed by medical officers only, NG tubes also were not permitted to be passed by a nurse. Wards were always staffed with wardsmen to spare female nurses embarrassing procedures with male patients...I got quite a shock when I discovered all this wasn't the case at other training hospitals. I have no idea why our was so limited, but at least we didn't have to try out any of these things on each other! I think I just trained at a terribly conservative hospital... Sue.

  5. I tried to post a reply on the previous post but the system says it hates me and won't let me do it. This is in response to the NZ video where no mention of insurance companies happened:

    Heck in NZ they still don't have to mention insurance companies since everyone has health care there. You can pay for extra on top of the basic but the basic is pretty darn nice to begin with.

    They still use glass IV bottles! Just not in the US. I've seen them used in hospitals in various locations across Africa. I've seen many plastic bottles used too. Best of both worlds, maybe?

    This company makes glass infusion bottles for the European and Indian markets, but not the US So I suspect that they are used much more often than we'd think because they just aren't used in the US anymore.

  6. I could understand them being used in regions in the African continent as they are often so poor - the wife of a friend works on the Mercy ships that leave Australia for African nations so now I have something to ask her about! New Zealand is a very sophisticated country so I'd be surprised to hear they still use them, at least not for IV infusions. I've certainly never seen one used here in Australia. Sue

    This article is interesting to read...

    Should we use closed or open infusion containers for prevention of ...

  7. Thanks for the link, Sue. when we used glass IV bottles the vent always had a filter, but this was removed every time we added something like KCl to the bottle. Having pharmacy add IV meds to closed containersunder a sterile hood is a big improvement.

    I was surprised that glass bottles are still in use in some parts of the world. They were extinct in the land of the free decades ago. I cannot tear myself away from that old New Zealand nursing video. That country looks like a paradise.

  8. OFRN apart from the cost of housing (exorbitant as in Australia) New Zealand is a glorious country! I was only recently having lunch with a friend here (she's a retired physiotherapist) and we both agreed that if we were young we'd be emigrating there. The scenery is stunning, the climate four seasons so beautiful autumns and springs and snowy winters, they have a young, female, progressive new prime minister... sigh. And yes, free hospital care as in Oz... and they've just reverted to making your first university degree free as well...

    When I was travelling over there some years ago we met a young Canadian woman guide who had visited NZ and decided to live there permanently she loved it so much.

    They do have a fun accent - as everyone here says, they don't say "fish and chips" they say "fush und chups"(they swallow their vowels) - but it sounds rather charming. (Apologies to any NZ nurses reading this!)

    And nursing really was more innocent back then - we never had to think about legal actions in cases of error/negligence. For some reason people were less litigious... and more courteous. Love that old video - don't they look smart in their white uniforms (sigh again).

    So I'll meet you in NZ any time OFRN! It's a deal... Sue

  9. And while we're going to NZ could we also go back to the days of that video, when patients were admitted the day before their surgery, and you helped them unpack their things and explained the ward routine and checked they understood everything and you took their metal water jug and glass off their locker at night and put up the "nil by mouth" sign above their bed - and told them after surgery that they absolutely could not leave until they were well enough... instead of admitting them the same morning as their surgery (and despite what you tell them, they think nil by mouth means it's ok to have a sandwich and coffee breakfast) and they get booted out of hospital almost as soon as they've come round from the anaesthetic... Paradise indeed in those days, OFRN.

    Type New Zealand into Google images and weep... cheers! Sue

  10. I suspect my traveling days are over, but it's nice to daydream.
    Your mention of physiotherapy brought back many old memories. My Mom graduated from a diploma nursing school in the late 1940s and worked as a physiotherapist with Polio patients. There were no physical therapists and nurses did it all from shoveling coal to janitorial work (that's putting it nicely.)

  11. I draw the line at shovelling coal OFRN!!! Crikey. Sue

  12. Sue, my Mom was a proud coal shoveling nurse and I vividly remember her shaking the coal dust from her cape. I have a post somewhere about "coal shoveling nurses." If you type the title in the search box the post pops up. I never shoveled coal either, but sometimes wish that I had just to connect with that older generation of nurses that were tough as nails. I
    was a wimp compared to some of them.

  13. Phew I just read your link OFRN - and I'm feeling glad I started training in 1975 and don't have any recollections of coal-shovelling nurses! Probably the mild Sydney climate spared them having to do that job... Your Mum sounds amazing.

    I do recall reading somewhere that trainee nurses in Canberra in the 1960s had to sleep in beds on open verandas outside the nurses' home - totally exposed to wind etc in a climate where the winters hit way below freezing and it snows... now I would find that tough ... so yep, I'll admit it - nurses by the 1970s had definitely gone soft!

    I am in awe of my predecessors! Sue