reconstitute antibiotics

ktwlpn, LPN · Jan 25, 2004

Originally posted by rmn
Can anyone advise me? When reconstituting cephelexin ( or any powder antibiotic) using WATER, does it mean ordinary tap water, sterilised or what? I'm a first year student getting real grief for just asking the staff nurse on my current placement! Please help!! :imbar

Most facilities have lots of educational material in the med room-did you try to look this up on your own? Know where the policy and procedure info is-did you look this up in the PDR or your 2004 med book? It helps to look this stuff up on your own-you are more likely to remember it after you have made that effort...I am NOT saying to you that you should NOT ask questions-you certainly should...after you have made every effort to find the answer on your own...and almost always those answers are on the nursing unit somewhere-you just have to learn where...You can always call the pharmacy...and your instructor...Now-if you are reconstituting this med for IV or IM administration ask yourself this question-"How would I get the tap water into the vial in a safe and sterile manner?" Look around in the med room and see what kind of supplies they have in there...I bet they have those little piggyback bags of normal saline and glucose and plain water-see how the little bottle that the antibiotic powder is in fits into the end of the piggy? There is your answer...I bet there is a big poster on the med room wall with instructions on reconstituting the common meds...Start honing those critical thinking skills NOW...good luck...

rmn · Jan 25, 2004

This was for oral suspension. The bottles in the stock cupboards all just say water. Obviously I would have gathered that IM water was the sterile water in ampuoles for injections. It was out of hours for pharmacy otherwise I would have called them as my first line of defence! So does anyone know if I should be using sterile or tap water?

ktwlpn, LPN · Jan 25, 2004

OK-let's continue to try to work the problem....The vials must at least tell you how many cc's to use--what is the best way to draw up that exact amount? When you look in the med room at the available supplies you should find cases and cases of vials of sterile water....I think it is safe to bet that you are not going to use tap water....Go back and read the keflex vial again-it really should tell you what to use...I have not seen any drug vials without expicit intructions on them..ever...really...right down to the 10's of cc's....

rmn · Jan 25, 2004

Thanks...I'll take that as 'sterile water is used to reconstitute 'bottles' of Cephelexin. And No the bottle 'just' says reconstitute using 60mls of water. What is the problem with you qualified staff? Can't give a straight answer to a straight and obvious question? It doesn't specify 'Sterile water' on the bottle. And no this is a psychy ward and there are not vials of sterile water stacked up any where...I would have noticed them. There are no procedure files that cover this problem! I thought it was obvious to ask rather than to make an error. I wonder how many errors have been made because senior nurses were too power mad to give obvious information, that needs to be shared, rather than boost thier own power base by with holding!

flashpoint · Jan 25, 2004

To answer your question simply...here we use sterile water. We have a bottle of it hanging in the med room with a syringe attached for accurate measuring. It's quick and simple and since they didn't put a sink in our med room, it works. The hospital I trained in used plain old tap water...they measured it into a graduated cylinder and poured it into the med bottle. It's a lot cheaper than the sterile water and it usually tastes better too because it doesn't get that funny stale taste or absorb the taste from the rubber stopper in the sterile water bottle. You don't need sterile water to mix PO meds...unless your facility policy dictates otherwise.

Edited because I cannot type today! :)

Karen30 · Jan 25, 2004

You really need to ring the pharmacy and check with them. I'm assuming your working in an NHS hospital and as such each trusts drug policy will be different. At our hospital we have bottles of 1 litre sterile water which we use, to reconstitue powder medication.

Although it sounds like your mentor isn't being very helpful, we are trying to help and sometimes, you do need to work through a problem, that's nursing, everybody won't know the answer and that is when you need to think how best to use the resources available to you to find the answers.

Sometimes qualified staff may seem to be being horrible and nasty not giving you an answer to a straight and obvious question but sometimes it is because we want you to work the answer out yourself rather than spoonfeed you everything. That way you are more likely to remember and learn and in the process do some problem solving.

Speculating · Jan 25, 2004

Originally posted by rmn
This was for oral suspension. The bottles in the stock cupboards all just say water. Obviously I would have gathered that IM water was the sterile water in ampuoles for injections. It was out of hours for pharmacy otherwise I would have called them as my first line of defence! So does anyone know if I should be using sterile or tap water?

There's no reason at all you can't use tap water. It is going to end up in the stomach. There's nothing sterile about the gut. I don't think you would have to worry to much about the tap water being to much of a medium either since it's now an antibiotic. Sterile water isn't cheap either so I wouldn't waste it unless you absolutely had to use it. I would certainly refrigerate the keflex after mixing it though.

Speculating · Jan 25, 2004

Originally posted by rmn
This was for oral suspension. The bottles in the stock cupboards all just say water. Obviously I would have gathered that IM water was the sterile water in ampuoles for injections. It was out of hours for pharmacy otherwise I would have called them as my first line of defence! So does anyone know if I should be using sterile or tap water?

rmn don't limit yourself. For something like an oral suspension question or just about anything else a pharmacist is a pharmacist and if you have nobody else to bounce it off of there is always a 24 hour Walgreen's open somewhere in town.

rmn · Jan 25, 2004

Thanks for all your help and sound advice. It confirms what I thought was correct but I will be checking with pharmacy as this Trust has no policy covering reconstitution. I also doesn't have a policy for the safe disposal of medication that has been dispensed but not used. I'll let you know what other short comings I find.

gwenith, BSN, RN · Jan 25, 2004

Just a small word of caution here since we are speaking of two different countries please make sure you are all talking about the same thing. I know that we here seem to do things somewhat differently than in the States.

Now as to your question - the only time I would reconsitute an ORAL antibiotic with sterile water was if it was to go down either a jejunostomy tube or an NG if the patient was on a h2 receptor antagonist. Why - in both of those cases the body's main defence against bacterial invasion - a low gastric ph has been disrupted and we may actually cause diahorrhea with tap water.

IamRN · Jan 26, 2004

Originally posted by ktwlpn
Go back and read the keflex vial again-it really should tell you what to use...I have not seen any drug vials without expicit intructions on them..ever...really...right down to the 10's of cc's....

I guess purgatory is a better place to work than my unit then LOL! :eek: :roll

I had never worked in a place where we would IVPush antibiotics. I ran across quite a few of them that needed reconstitution for IVP when working w/my preceptor and either though her or reading the vial I worked out what was needed; sterile water v. normal saline. However, just last week I ran into a bottle that advised to read the insert for reconstitution instructions...of course said isnert was not included! The pharmacist was glad to help though! Never say never!:)