Technical problem in withdrawing drugs

[Student Cheryl]

Here i am in my final year practical. Just started to serve medication. Yesterday,

i found a technical problem in withdrawing the drugs from vials.

Prescription: 2g IV cloxacillin

available: 500mg per vail

so, i open 4 vails to dilute each with 2ml water for injection each.

NOw, i suppose to change my needle how many times?

That day, i change 6 times.

4 needle for different vails. the last 5th one, i used to withdraw all diluted cloxacillin. THe last one i use to inject to the 100ml N/S.

i doesn't feel good with the technique, am i doing it right or there is a better solution?

[RescueNinja]

Here i am in my final year practical. Just started to serve medication. Yesterday,

i found a technical problem in withdrawing the drugs from vials.

Prescription: 2g IV cloxacillin

available: 500mg per vail

so, i open 4 vails to dilute each with 2ml water for injection each.

NOw, i suppose to change my needle how many times?

That day, i change 6 times.

4 needle for different vails. the last 5th one, i used to withdraw all diluted cloxacillin. THe last one i use to inject to the 100ml N/S.

i doesn't feel good with the technique, am i doing it right or there is a better solution?

I don't know anyone that switches needles between vials just for reconstitution of medication. As long as you don't touch the needle to anything other than the stopper (which should be wiped with alcohol if not freshly opened) your needle will remain sterile. Then after you reconstitute and withdraw all the medication change the needle (do you not use needless/plastic devices?) before infusing. So 2 needles total.

Here is a video showing you how to prepare meds. She is only using 1 vial, but you'll notice that she does not change her needle in between the N/S and the medication.

[manncer]

Good grief. Don't you have a pharmacy?

[Student Cheryl]

I don't know anyone that switches needles between vials just for reconstitution of medication. As long as you don't touch the needle to anything other than the stopper (which should be wiped with alcohol if not freshly opened) your needle will remain sterile. Then after you reconstitute and withdraw all the medication change the needle (do you not use needless/plastic devices?) before infusing. So 2 needles total.

Here is a video showing you how to prepare meds. She is only using 1 vial, but you'll notice that she does not change her needle in between the N/S and the medication.

Thanks :)

[Student Cheryl]

Good grief. Don't you have a pharmacy?

Pharmacy doesn't prepare the infusion for us in my hospital. Furthermore, cloxacillin half life is 30minutes to an hours only. Sometimes, i saw my staff nurse even left the antibiotic aside for quite a while.

[PetiteOpRN]

Pharmacy doesn't prepare the infusion for us in my hospital. Furthermore, cloxacillin half life is 30minutes to an hours only. Sometimes, i saw my staff nurse even left the antibiotic aside for quite a while.

Half life is the time it takes for the bioavailability to decrease to 50% after the patient has been administered the drug. The length of time between reconstitution and injection should not affect half life. In fact, for some antibiotics that foam quite a bit, the recommendation is to reconstitute and let sit for 20 minutes instead of shaking it.

And 2 needles is plenty. :)

[HamsterRN, ADN, RN]

I think there is some confusion about the type of needle being used to access the vials. At my hospital, you would have to use a different needle for each vial. This is because we use "needle-less vial access cannulas", when you remove one from a vial, the part with the sharp point gets left in the vial, meaning you'll need to replace it before moving on to the next vial. Are the majority of hospitals still using sharps for accessing vials?

[RescueNinja]

I think there is some confusion about the type of needle being used to access the vials. At my hospital, you would have to use a different needle for each vial. This is because we use "needle-less vial access cannulas", when you remove one from a vial, the part with the sharp point gets left in the vial, meaning you'll need to replace it before moving on to the next vial. Are the majority of hospitals still using sharps for accessing vials?

We use blunt tip metal needles for drawing up and mixing and then plastic blunt tips for accessing lines.

[Student Cheryl]

I think there is some confusion about the type of needle being used to access the vials. At my hospital, you would have to use a different needle for each vial. This is because we use "needle-less vial access cannulas", when you remove one from a vial, the part with the sharp point gets left in the vial, meaning you'll need to replace it before moving on to the next vial. Are the majority of hospitals still using sharps for accessing vials?

In my country, Yes. Majority of the hospitals still using sharp to access the vials. In my university hospital, i didn't see any plastic device present. So, total how many needle will you use in my condition with reference to my question.

[Student Cheryl]

Half life is the time it takes for the bioavailability to decrease to 50% after the patient has been administered the drug. The length of time between reconstitution and injection should not affect half life. In fact, for some antibiotics that foam quite a bit, the recommendation is to reconstitute and let sit for 20 minutes instead of shaking it.

And 2 needles is plenty. :)

Oh, now only i realized my misinterpretation. Thanks for the information.

My staff nurse said the cloxacillin will be expired in 30minutes time after we prepared. What does she means?

[netglow, ASN, RN]

"needle-less vial access cannulas" - HamsterRN

I call those "harpoons" and I don't like them.

[HamsterRN, ADN, RN]

In my country, Yes. Majority of the hospitals still using sharp to access the vials. In my university hospital, i didn't see any plastic device present. So, total how many needle will you use in my condition with reference to my question.

The main purpose of plastic vial access devices is to avoid "coring" which is where the sharp, round, end of a needle cuts out a piece of rubber from from the top of the vial. If this occurs, then you leave the same needle on the syringe when administering the fluid or transferring it to another vial, the rubber core could enter the bloodstream and cause a foreign body embolization. There are reports of this also occurring with the plain blunt plastic needles, although not with the vial access blunt plastic needles.

So, if you're using regular sharps, you would need to change the needle after each insertion through a rubber stopper, although you could do all your mixing and then do the final transfer through a filter needle.