Surfactant Administration, drawing up the medication

[rachels.rn]

I have a question. When I drew up surfactant for the first time I made a huge mistake. Like all medication you draw up from a vial, I injected air equal to the amount of med to be given into the vial of surfactant. That made all sorts of bubbles which is not good and when I tried to draw it up with an 18 g syringe the surfactant kind of went everywhere because of the pressure. So, the second time with a new vial I did not inject air and was able to pull up the medication slowly with a lot of tension.

What is the exact steps of drawing up surfactant without having this happen? Please break it down in idiot proof steps. :-)

Thank you.

[TiffyRN, BSN, PhD]

I don't usually administer surfactant as I tend to take more the level 2 type kids; however. . . I'm thinking to inject air into your vial, but not through liquid. Inject it before turning the bottle upside down pressurizing the bottle without creating all the bubbles.

But it would be great to hear from the many nurses on here that do this procedure regularly.

[NicuGal, MSN, RN]

We warm it in our hands and don't shake it. Our RT's just draw it up, they don't inject air into it.

[rachels.rn]

Thank you for replies. I know about the not shaking and warming up in hands. I've been told by someone also to hold the bottle upside down and inject air with the bevel above the fluid not into the fluid. I have never got to try it though so I don't know if it works. I just want to know a fool proof way so when I have to do it again I don't make such a mess and waste resources and time.

[Love_2_Learn]

I have better luck not instilling any air into the vial. The last thing you want is to have a bunch of bubbles in the surfactant because it works incredibly better that way. As you said, never shake the vial and use the largest gauge needle you can find to avoid any bubbles forming.