Administering meds

jnette, ASN, EMT-I · Mar 24, 2005

Working with EPO is such a pain... don't feel bad.. we all deal with this every day. Used to be able to turn the vial upside down and suk out the last minute fraction of a droplet, but no more. It is SUCH a waste of time, in my opinion, the constant attempts at keeping overfill numbers high, I understand that EPO is outrageously expensive, but dang.. we DO have more important things to do than stand in the med room fighting with EPO !

We use the special syringes made specifically for low air space.. and I'll be darned if I can remember the name right now.. use them every day, and now can't thing of the name ! Something "low deadspace". Very long, fine needles. They do work quite well, but still you're going to have a droplet left in the vial that you just can't seem to get.

I am careful not to shake or jostle the vial, because then you DO get airbubbles in it and it makes it all that much harder to withdraw without getting air in the syringe. We just stand there and keep tapping that syringe until the tiny bubble dissipate and then go for more. It's not easy, it's not fun, and it's really just something we have to put up with.

I still wish they'd let us use the multidose vials.. would make things SO much easier on all of us. But these don't have as much overfill, so of course they'll keep using the "single dose".. which are never used as "single" dose. Have often wondered about the "legality" of that, too.

Hang in there.. don't feel alone in this. We all struggle with it, and hate it just as you do. :rolleyes:

Dormkare1 · Mar 24, 2005

We use the dead space needles also but I still feel as tho I am not giving the accurate amount of EPO sometimes because of those air bubbles. Another "new" dialsysis nurse is having the same problem. Must be doing something right as our Hgb stay pretty stable. :rolleyes: Hard time adjusting to new job:uhoh21: Thanks again.

RRN · Mar 24, 2005

We use the dead space needles also but I still feel as tho I am not giving the accurate amount of EPO sometimes because of those air bubbles. Another "new" dialsysis nurse is having the same problem. Must be doing something right as our Hgb stay pretty stable. Hard time adjusting to new job:uhoh21: Thanks again.

Don't get discouraged. It really takes a year to "get" dialysis..So much to learn..Epo is a pain...Try drawing it up really slowly..And taking it out ahead of time, even 10 minutes helps I think...

What I hate is having to draw up 20,000 of 4000:1 Fresenius doesn't want to buy the 10000:1...And Amgen has reduced the overfill recently ..Only about 0.1 ml now instead of the 0.2 we used to get...

Maybe someday they'll put the exact amount in there and save us some time...

jnette, ASN, EMT-I · Mar 24, 2005

Don't get discouraged. It really takes a year to "get" dialysis..So much to learn..Epo is a pain...Try drawing it up really slowly..And taking it out ahead of time, even 10 minutes helps I think...
What I hate is having to draw up 20,000 of 4000:1 Fresenius doesn't want to buy the 10000:1...And Amgen has reduced the overfill recently ..Only about 0.1 ml now instead of the 0.2 we used to get...
Maybe someday they'll put the exact amount in there and save us some time...

Yes.. we always set the EPO out to warm to room temp, and I agree that drawing it up slowly helps reduce the bubbles.

We get the 20,000:1 vials, but we can only use them for our very last dose of the day..so as not to have to waste any residual in the last opened 4000:1.

RRN · Mar 25, 2005

Yes.. we always set the EPO out to warm to room temp, and I agree that drawing it up slowly helps reduce the bubbles.
We get the 20,000:1 vials, but we can only use them for our very last dose of the day..so as not to have to waste any residual in the last opened 4000:1.

Yeah that's Fresenius' policy.... Just much easier using 10000:1 like we did at Davita.

imperial · Mar 27, 2005

Working with EPO is such a pain... don't feel bad.. we all deal with this every day. Used to be able to turn the vial upside down and suk out the last minute fraction of a droplet, but no more. It is SUCH a waste of time, in my opinion, the constant attempts at keeping overfill numbers high, I understand that EPO is outrageously expensive, but dang.. we DO have more important things to do than stand in the med room fighting with EPO !
We use the special syringes made specifically for low air space.. and I'll be darned if I can remember the name right now.. use them every day, and now can't thing of the name ! Something "low deadspace". Very long, fine needles. They do work quite well, but still you're going to have a droplet left in the vial that you just can't seem to get.
I am careful not to shake or jostle the vial, because then you DO get airbubbles in it and it makes it all that much harder to withdraw without getting air in the syringe. We just stand there and keep tapping that syringe until the tiny bubble dissipate and then go for more. It's not easy, it's not fun, and it's really just something we have to put up with.
I still wish they'd let us use the multidose vials.. would make things SO much easier on all of us. But these don't have as much overfill, so of course they'll keep using the "single dose".. which are never used as "single" dose. Have often wondered about the "legality" of that, too.
Hang in there.. don't feel alone in this. We all struggle with it, and hate it just as you do.

Happy BUnny Day:

What do you mean 'overfill" and am confused re; 'single dose'.. arent single dose vials used one time for one patient?

imperial · Mar 27, 2005

Yeah that's Fresenius' policy.... Just much easier using 10000:1 like we did at Davita.

Can you explain. I was told that EPO was now given only in single dose vials and that multidose vials were not being used anymore. Is this correct?

nosonew, BSN, RN · Mar 28, 2005

Can you explain. I was told that EPO was now given only in single dose vials and that multidose vials were not being used anymore. Is this correct?

My facility uses the S10- 10000u/1cc vials of epo and M10-20,000/2cc vials. We ONLY use the multidose vials at the end, so as not to open a single dose vial and not use it all up.

The multidose vials are only good for 7 days.

We have patients that range from 500u to 25,000u with at least 5 getting 15-20 thou units! We are going through ALOT of epo right now and since Amgen decreased the overfill... we are feeling it!

Only suggestion, once you have pulled up all you can, let the vial just sit for awhile...then try to pull up more (new syringe of course)...sometimes you can get 200-500 u. :)

Dormkare1 · Mar 29, 2005

Yeah, The math at the end f a 12-13 hour day does stink. We also have to use the 20000 vial at the end only and do all the calculating. Glad calculators were invented!!:chuckle

Don't get discouraged. It really takes a year to "get" dialysis..So much to learn..Epo is a pain...Try drawing it up really slowly..And taking it out ahead of time, even 10 minutes helps I think...
What I hate is having to draw up 20,000 of 4000:1 Fresenius doesn't want to buy the 10000:1...And Amgen has reduced the overfill recently ..Only about 0.1 ml now instead of the 0.2 we used to get...
Maybe someday they'll put the exact amount in there and save us some time...

RRN · Mar 29, 2005

Happy BUnny Day:
What do you mean 'overfill" and am confused re; 'single dose'.. arent single dose vials used one time for one patient?

The 4000:1 vial have about 1.1 cc's in them .. So there is an overfill..

The 20000:1 vials have perservative in them so they can be stored in the fridge until all used up.

If you have a dose of 8000 you would draw up 1 cc from a vial.. Then draw up the other .1 cc in a new needle.. Once a vial is punctured the second time that dose can't be mixed with another. So then you would take a new needle and puncture a new vial and take .9 cc's from that one. That would be your 8000 unit dose for that patient.

If you use a syringe that is bigger than 1 cc then you can go from vial to vial until you get the whole 3 cc's.. or 12000 units...

A lot of fussing and alot of needles...

RRN · Mar 29, 2005

:coollook:

Can you explain. I was told that EPO was now given only in single dose vials and that multidose vials were not being used anymore. Is this correct?

I believe the only vials that are multi-dose are the 20000:1.. They have perservative in them .. So they can be stored until all used up.

This is how it works.. You give all your epo's except the last 2 or 3 at the end of the day... You have these three doses left:

3000, 15000 and 25000.

You would give the smaller two first.. Let's say that at the end of those two doses you have .5 cc's in a 4000:1 vial... I would draw up that dose in a new syringe and that dose is 2000. Now I have 23000 as a left over. I would draw that amount from a 20000:1 vial.. If I had a partial 20000:1 vial open I would use that amount and then use a new needle to puncture a new vial.

Heck sometimes I think you have to be a Philadelphia Lawyer ( tongue in cheeK) to draw up Epo or at least Einstein.. :coollook: