>> The Centers for Disease Control and Prevention created this video
to guide healthcare professionals on preparing
and administering antitoxin for the treatment of botulism.
>> A logo for the CDC appears featuring an abstract bird made of human faces in profile.
Preparing and administrating heptavalent antitoxin for the treatment of botulism.
Refer to the FDA package insert for complete information.
>> Botulism is a paralytic disease caused by botulinum neurotoxin.
Patients generally have symmetric, descending, flaccid paralysis of motor and autonomic nerves.
Paralysis starts in the head and moves down.
>> An illustration of a man appears.
His body changes from green to red from his head to his toes,
then an illustrated woman appears on screen.
>> People with botulism may have double vision, drooping eyelids, slurred speech,
difficulty swallowing, and dry mouth.
As paralysis progresses, the muscles needed for breathing and moving become weak.
People with botulism are usually alert and aware,
although they may not seem to be because of the paralysis.
>> An animated doctor holds a clipboard and stands at the bedside of a patient.
>> Always tell the patient when you are administering a test or treatment.
Botulism is an emergency.
The initial diagnosis is based on clinical signs and symptoms.
Do not wait for laboratory confirmation to obtain a consultation or begin treatment.
If you think a patient might have botulism,
call your state health department's emergency or after hours number.
>> The animated doctor holds a phone to her ear,
then a map of the United States appears onscreen.
After hours numbers can be found at CSTE.org/page/EpiOnCall.
>> CDC provides consultation at the request of state public health officials.
State public health officials can reach CDC 24/7 at 770-488-7100.
If the consultation supports botulism as a likely diagnosis,
the physician can request antitoxin and begin treatment as soon as it arrives.
If the patient is an infant, consult the California Department
of Public Health's Infant Botulism Treatment and Prevention Program at 510-231-7600
or visit infantbotulism.org for guidance.
Botulism antitoxin is made from the plasma of horses.
It has antibodies that neutralize the toxins.
FDA has approved the antitoxin for the treatment of botulism caused
by botulinum neurotoxins type A, B, C, D, E, F, and G in people of all ages.
>> An illustrated box appears.
The box lid is removed to reveal a bottle of botulism antitoxin.
>> The antitoxin is a clear, colorless liquid.
If it arrives frozen, you can thaw it in a water bath
at 98.6 degrees Fahrenheit, 37 degrees Celsius.
Do not shake the vial.
Inspect it closely.
If you notice any damage to the seal or vial, discard it and notify the patient care team.
The volume in the vial varies by lot number.
Vials typically contain ten to 22 milliliters.
Withdraw the entire contents of the vial to measure the volume
so you can accurately calculate the amount needed in the one to ten dilution.
>> The antitoxin bottle is submerged in a water bath and then held by a blue gloved hand.
A syringe is inserted into the bottle of antitoxin.
>> The dose for adults is one vial.
The dose for children is a percentage of one vial based on weight.
Refer to the package insert to calculate the pediatric dose.
Discard any unused antitoxin because it does not contain a preservative.
Each vial is for a single use.
>> The dose for adults 17 and older is one vial.
The pediatric dose for children less than 17 years old is 20% to 100%
of the adult dose based on weight.
>> Add the contents of the syringe
to an infusion bag containing the correct amount of 0.9% normal saline.
To make a 1:10 dilution of antitoxin to saline.
Do not use any other diluents.
Mix the antitoxin solution with the saline by gently inverting the bag
and returning it to the original position.
>> The antitoxin is inserted into the bag of normal saline with a syringe.
The bag is rotated 360 degrees.
>> Take blood, stool, and any other samples
for botulism testing before antitoxin is administered to ensure accurate test results.
Have epinephrine nearby in case of a hypersensitivity reaction.
>> An illustration of a vial of blood, a specimen cup,
and an epinephrine pen appear onscreen.
>> Patients might be at higher risk of a reaction if they are allergic to horses
or ever received a treatment derived from a horse product, have asthma, or get hay fever.
Remember that patients are typically alert and aware.
Always tell them when you are administering a test or treatment.
>> An illustrated medical professional stands at a patient's bedside and holds the IV.
The bag of saline and antitoxin hangs from the IV stand.
>> Inspect the diluted antitoxin and the IV bag before starting the infusion.
The antitoxin is a clear, colorless liquid.
Do not use if it is discolored, turbid, cloudy,
or contains more than a few small translucent particles.
Botulism antitoxin is recommended only for intravenous use.
Use an IV line with a constant infusion pump and a sterile 15 micron or smaller inline filter.
>> An illustration of an IV line inserted into the patient's arm appears on screen followed
by an IV infusion pump and an inline IV filter.
>> Do not delay antitoxin administration if a filter is not available.
Administer the diluted antitoxin solution by slow IV infusion, starting
with the recommended rate for the patient's age.
For adults age 17 and older, this is 0.5 milliliters per minute.
For children, it is 0.01 milliliters per kilogram per minute.
>> Do not exceed the adult rate.
The medical professional holds a clipboard
and pen while monitoring the patient laying in the hospital bed.
>> Throughout the infusion, observe patient for adverse reactions and monitor vital signs.
Common adverse reactions include headache, nausea, itching, and hives.
If the infusion is well tolerated, you may increase the infusion rate.
For adults, you may double the rate every 30 minutes
to a maximum of 2 milliliters per minute.
For children, you may increase the rate
by 0.01 milliliters per kilogram per minute, every 30 minutes, to a maximum
of 0.03 milliliters per kilogram per minute.
Decrease the infusion rate if the patient develops discomfort
or has an infusion-related adverse reaction.
>> Do not exceed the adult rate.
>> The infusion will take two to seven hours to finish, depending on the patient's age
and how well the fusion is tolerated.
Report any adverse reactions to the Food and Drug Administration at 1-800-332-1088
or fda.gov/medwatch or to the manufacturer at 1-800-768-2304.
>> Emergent biosolutions. Reminder.
If you suspect a patient has botulism,
call your state health department, CSTE.org/page/EpiOnCall.
If no one answers, call CDC's botulism consultation service 770-488-7100, 24/7.
cdc.gov/botulism.