Disposal of IV tumescent bags containing epinephrine

AORN Journal,  March, 2008  by Mary Ogg

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QUESTION: The nurses at my surgery center have been discussing proper disposal of the empty IV tumescent bags that contain epinephrine from liposuction procedures. One of the nurses read that epinephrine is considered a hazardous waste requiring special disposal If this is correct, how should we dispose of the empty bags, the empty vials of epinephrine, and the empty bottles of lidocaine with epinephrine?

ANSWER: The Environmental Protection Agency (EPA) listed the commercial chemical product epinephrine as a hazardous waste in the Federal Register in 1980. (1) Since that time, the EPA has received inquiries from states, EPA-regulated communities, and EPA regions regarding proper disposal of epinephrine used for medical procedures. According to the EPA, the type of epinephrine used for most medical applications is epinephrine salts. The scope of the 1980 designation of epinephrine as hazardous waste does not apply to epinephrine salts. (2)

Pure epinephrine ([C.sub.9][H.sub.13]N[O.sub.3]) is listed as a hazardous waste. Epinephrine in this form is a weak nitrogenous base and secondary amine. It has low solubility in water. When epinephrine is used as a medication, it is used as a water-soluble salt. An epinephrine salt is the listed ingredient in the solutions used, such as epinephrine hydrochloride ([C.sub.9][H.sub.14]N[O.sub.3] HCl) or epinephrine bitartrate ([C.sub.9][H.sub.13]N[O.sub.3] [C.sub.4][H.sub.6][O.sub.6]). (3,4) An epinephrine salt is not considered hazardous waste by the EPA. (2)

The National Institute for Occupational Safety and Health (NIOSH) and the Occupational Health and Safety Administration (OSHA) also issue guidelines for handling hazardous agents, but there are variations between the EPA, NIOSH, and OSHA hazardous agent guidelines. (5) Epinephrine is not included on the NIOSH and OSHA lists of hazardous agents; (6,7) NIOSH defines a hazardous medication as one that is "known or suspected to cause adverse health effects from exposure in the workplace." (6) Types of hazardous medications include chemotherapeutic agents, antiviral medications, hormones, some bioengineered medications, and other miscellaneous medications. (6)

Intravenous bags containing epinephrine, epinephrine vials, and bottles of lidocaine with epinephrine may be disposed of according to applicable state regulations and pertinent health care organization policies and procedures. Glass ampules, vials, and bottles should be disposed of in a puncture- and leak-proof sharps container to prevent possible injuries that could result from broken glass. (8)

When in doubt about the proper handling of any chemical (eg, disinfectants, sterilants, antiseptics, adhesive agents, environmental cleaning agents, chemotherapeutic agents, tissue preservatives, methyl methacrylate), refer to the instructions on the label and the material safety data sheet (MSDS) provided by the manufacturer. The MSDS identifies hazards, precautions, special handling needs, signs and symptoms of toxic exposure, and first aid treatments for exposure. (9)

There are variations in regulations from locality to locality and from state to state. Check with your local and state regulatory agencies for their interpretations regarding disposal. The most stringent regulation takes precedence, whether it is local, state, or federal.

REFERENCES

(1.) Laws and regulations. Chapter 1--Environmental Protection Agency. Subchapter I--solid wastes. Parts 260-270. Environmental Protection Agency. http:// www.epa.gov/docs/epacfr40/chapt-I.info/.Accessed December 28, 2007.

(2.) Scope of hazardous waste listing P042 (epinephrine). Environmental Protection Agency. http://www.epa .gov/region1/healthcare/pdfs/EpiMemo_Final.pdf. Accessed December 28, 2007.

(3.) Hazardous waste determination for epinephrine. Hazardous Materials and Waste Management Division, State of Colorado. http://www.cdphe.state.co .us/HM/epinephrinewhtpaper.pdf. Accessed December 5, 2007.

(4.) O'Neil MJ. Merck Index. 13th ed. Whitehouse Station, NJ: Merck & Co; 2001:618.

(5.) Drug Information Handbook for Perioperative Nurses. Hudson, OH: Lexi-Comp; 2007:24.

(6.) Preventing occupational exposures to antineoplastic and other hazardous drugs in healthcare settings. National Institute for Occupational Safety and Health. http://www.cdc.gov/niosh/ docs/2004-165/. Accessed December 28, 2007.

(7.) Controlling occupational exposure to hazardous drugs. In: OSHA Technical Manual. US Department of Labor, Occupational Safety and Health Administration. http://www.osha.gov/dts/osta/otm/otm_vi/otm_vi _2.html#app_vi:2_1. Accessed December 28, 2007.

(8.) Sharps injury prevention. In: Perioperative Standards and Recommended Practices. Denver, CO: AORN, Inc; 2008:251.

(9.) Hazard communication OSHA standards. US Department of Labor, Occupational Safety and Health Administration, http://osha.gov/SLTC/hazardcommunications/standards.html. Accessed December 5, 2007.

MARY OGG

RN, MSN, CNOR

PERIOPERATIVE NURSING SPECIALIST