Normal saline bag.

I don't understand why in the world you are doing this. If you are giving a drug and you want it diluted in a diluent, and you have a 250 bag, why draw out 50?? Use the 250ml bag. Each manipulation you do increases the chance of bacterial contamination. There are NO preservatives in these bags. I'd stop this process immediately.

On 4/10/2019 at 5:43 AM, IVRUS said:

I don't understand why in the world you are doing this. If you are giving a drug and you want it diluted in a diluent, and you have a 250 bag, why draw out 50?? Use the 250ml bag. Each manipulation you do increases the chance of bacterial contamination. There are NO preservatives in these bags. I'd stop this process immediately.

This post was only a scenario for nurses to discuss. I noticed a few nurses do it in this way. You are the first person to share the experience. It is great.

The post was specifically produced according to the following example.

----------------------

https://allnurses.com/normal-saline-shortage-t663124/

"In our larger hospital we are doing a TON of IV push meds that used to be in bags. They are also using larger bags of fluids, pulling out the extra fluid and mixing appropriately (using a 1,000ml bag, pulling out the extra 500ml). Supposedly there is another country where the NS bags can be made, but it'll be 6+weeks before we can start importing them".

----------------------

If you don't have a normal saline bag with the required volume, would you like to stop the medication and wait for a few days in order to get a specific normal saline bag?

Certainly you can use a large bag to replace a smaller bag . Sometimes if there is no stock, what else can you do?

Meanwhile, if you need to make a specific drug concentration in a normal saline bag with a specific volume, none of regular normal saline bags can meet the requirement, what can you do?

Please share your experience.

To IVRUS:

You have 32 years experience and works as a Clinical Infusion Specialist. You must have something to share with others, regarding making a specific drug concentration in a normal saline bag with a specific volume which is not available in regular normal saline bags.

That is the real question that the original post aims to discuss with others.

There is one article from a specialized pharmacy journal - Hospital Pharmacy.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3971104/

Understanding and Managing Intravenous Container Overfill; Potential Dose Confusion.

Some details are as follows:

2. Withdrawal prior to admixture (drug volume). A volume of the base solution equal to the volume of the medication to be added to the container is withdrawn from the manufacturer’s container, without concern about overfill. The medication is then added to the remaining volume in the container. This method is typically used when the volume of medication to be added is large relative to the size of the base solution container. For example, before adding 150 mL of sodium bicarbonate from a syringe or vial to a 1,000 mL bag of dextrose 5%, a volume of 150 mL of the base solution is withdrawn from the bag and discarded.

3. Withdrawal prior to admixture (drug volume and overfill volume). A volume of the base solution equal to the sum of the volume of the medication to be added to the container and the estimated volume of overfill is withdrawn from the manufacturer’s container. The medication is then added to the remaining volume in the container. This method is typically used when the volume of medication to be added is large relative to the size of the base solution container.

With the first 3 practitioner-based methods ...

Did the "practitioner-based methods" such as "Withdrawal prior to admixture" increase the chance of bacterial contamination as IVRUS said?

If "practitioner-based methods"can increase the chance of bacterial contamination, what else can you do regarding making a specific drug concentration in a normal saline bag with a specific volume which is not available in regular normal saline bags?

So, Are you a pharmacist and are doing these preparations for nursing staff under a Laminar Flow Hood in a Compounding Room? I am sorry, but I was under the impression that you were a nurse doing this on the floor, or at bedside.

On 4/11/2019 at 8:15 AM, IVRUS said:

So, Are you a pharmacist and are doing these preparations for nursing staff under a Laminar Flow Hood in a Compounding Room? I am sorry, but I was under the impression that you were a nurse doing this on the floor, or at bedside.

I never withdraw extra fluid from a normal saline bag. The original post was produced for discussion according to what I observed on the allnurses website.

You didn't answer my question regarding making a specific drug concentration in a normal saline bag with a specific volume which is not available in regular normal saline bags

IV infusion (via CVC):
Use dopamine 200 mg/5 mL ampoules to prepare infusion.
Withdraw 10 mL from a 100 mL sodium chloride 0.9% minibag.
Dopamine 400 mg (10 mL from TWO ampoules) added to remaining 90 mL sodium chloride 0.9% in the minibag.
Total Volume: 100 mL.
Final concentration: 4 mg/mL (4000 microgram/mL).

------------------

Can anyone working at this hospital to provide recommendations whether "Withdraw 10 mL from a 100 mL sodium chloride 0.9% minibag" can increase the chance of bacterial contamination as IVRUS said?

Can anyone also provide recommendations whether "Withdraw 10 mL from a 100 mL sodium chloride 0.9% minibag" should be done under a Laminar Flow Hood in a Compounding Room as IVRUS said?

Maintenance dose set up

> NB: To avoid mixing up the infusion bags, do not draw up the maintenance dose until after the loading dose infusion has been commenced

> Draw up 20 g (40 mL) magnesium sulphate

> Withdraw 40 mL from a 100 mL bag of sodium chloride 0.9 % and discard.

> Add the 40 mL magnesium sulphate (20 g) to the remaining 60 mL bag of sodium chloride 0.9 % to make 100 mL

> Using medication added label write “magnesium sulphate 20 g (40 mL) in sodium chloride 0.9 % to a total volume of 100 mL” and attach label to bag.

Can anyone working at this health organization to provide recommendations whether "Withdraw 40 mL from a 100 mL bag of sodium chloride 0.9 %" can increase the chance of bacterial contamination as IVRUS said?

Can anyone also provide recommendations whether "Withdraw 40 mL from a 100 mL bag of sodium chloride 0.9 %" should be done under a Laminar Flow Hood in a Compounding Room as IVRUS said?

I never withdraw extra fluid from a normal saline bag before and I didn't make a specific drug concentration by myself before. I always got specific drug concentration from pharmacy.

In my opinion, withdrawing or not depends on hospital policy.

I didn't work at above health organizations before. It will be great if somebody working at these two health organisations can provide recommendations.

You would get better replies to this question if you post it on an Australian nurses forum. Withdrawing fluid from bags is not common in the USA. It is also very uncommon for nurses in the USA to mix or concentrate their own infusions. It has been the policy of most hospitals I have worked at in the USA that infusions must be prepared by the pharmacy.

Is this homework?

30 minutes ago, AnnieNP said:

Is this homework?

Check homework here.

Would you like to try the above homework?