Xolair administration

[T-Bird78]

Just wondering who all has experience with Xolair administration. I've been doing it for 6 years so I'm quite familiar with it, yet I had an experience the other day that's never happened before. I reconstituted it, let it settle, drew it up with the 18g and switched to the 25g 5/8" needle. I stuck the pt and was starting to push, same as I always do, and the syringe exploded--literally popped off the needle and the Xolair got all over my face and in my eyes. The needle was still in the pt's arm and the empty syringe in my hand. I immediately discarded both in the sharps container and pt asked what that loud click was. I told pt (who is also a M.D.) what happened as I was cleaning my face/neck off. Manager told me not to write up anything on it yet, we have to reorder for this pt, and asked if I needed the eyewash station. I did take my contacts out during lunch and am fine. Anyone have that happen? I'm positive I secured the 25g properly, but maybe it wasn't on as firmly as I thought; or maybe the needle wasn't patent and the stuff couldn't go through? Xolair is VERY thick, hence drawing it up in an 18g, so it's always a slow push.

[Ella26, BSN, RN]

I have been giving Xolair for about 4 years. I have personally never had that happen to me, but one of the other nurses had it happen to her. We just chalked it up to her not screwing the needle on tight enough? As far as I know it has not happened again.

[Asystole RN]

That was an expensive oops, lol.

How much pressure were you applying to the plunger? I cannot imagine the medication squirting everywhere even if the needle become disconnected with the slight pressure I usually apply when administering Xolair.

[T-Bird78]

It's usually firm pressure. I applied no more than normal. Not sure if the needle wasn't attached completely or wasn't patent. When the POP happened the needle was still in pt's arm and syringe in my hand. I'd never had that happen before either. The nurse that orders our Xolair was calling to get a replacement vial without charging the pt and kept getting transferred to other people, and every time she told the story she made sure to say, loudly, that it was "Nurse error and her name is T-Bird78 and she didn't have the needle attached right" instead of just saying it was human error. She made sure they knew who messed it up. Grr.