Today we're talking about medication reconstitution. When you're working with
medications that come in a vial as either a liquid or a powder we sometimes
need to dilute this in order to administer it safely. So we're going to
look at that right after this. Welcome back my name is Tammy and this is Nurseminder
and on this channel we do everything nursing so if you're new here
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Let's begin with an example of Ondansetron 0.15 milligrams per kilogram
IV one hour prior chemo and our patient weighs 65 kilograms. We need to begin
with our parenteral monograph. Looking at the guidelines here I do see that
(states 1.5, should state 0.15 mg
milligrams per kilo is a good dose - it's safe dose. So we're gonna go
back now and calculate how many milligrams of this medication will I
need to draw up. Quickly doing the math 0.15 milligrams per kilogram
is my order and have a patient of 65 kilograms I now know that I have to draw
up 9.75 milligrams of medication. Going back to the monograph I
see that there's a max dose of 16 milligrams of which this is a safe dose.
Looking at the medication and how it's available I see that it comes in a 20 ml
multi dose file at two milligrams per ml. So I need to continue on with my
math now determine how many mls do I need to draw up. I know that it is
available as one ml equals two milligrams and I need 9.75
milligram for a dose. Again using dimensional analysis, cross off your
milligrams, and we're into this calculation, and I quickly learn that
what I need is 4.875 mls. Now don't forget you're
rounding rules. Rounding rules mean if it's greater than 0.5 you round up so
we're going to need 4.9 mls. So we're not quite done our math yet I
see I need to dilute this dose into 50 to 100 mls of diluent but I need a
max concentration of one milligram per ml. So I need to make sure that if I
pick a 50 ml bag or a 100 ml bag I have the correct concentration. So we'll do
the math here for a 50 ml bag first. I want to know milligrams/ml
Completing this calculation I see that I actually have a 0.195
milligrams /ml which is well within my safe dose. Say you didn't have a 50 ml
bag available you only had a 100 ml, quickly calculate that dosage out as
well to make sure you was in the safe range and you find that you have 0.097
milligrams per ml. So now we're ready to select our tools to draw up our
medication. Looking at the supplies I have here, I see that I have both a blunt
fill needle and a blunt fill needle with a filter. Now the filter is the one with
the purple cap here and why we use a filter is we don't want to get shards of
glass into our patients medication so we have to use the filter when we're
working with ampules. Now because I'm working with a vial it's got a rubber
stopper - I don't need to have the filter on there I'm just going to use the blunt
end. So I've selected my needle now I need to select my syringe I have a three
ml and a 10 ml syringe available to me ideally a 5 ml would be better but I
don't have one in my facility today and I need to get my medication so we're
gonna take a look at both of these. First let's look at the 10 ml. When I look at
the breakdown of Units here I can see I've got 1 ml, 2 ml, and 3 ml and then
I've got these black lines in between. Now each one of those black lines
represents 0.2 ml. So if I needed 4.9 I could
accurately get 4.2, 4.4, 4.6, 4.8 and 4.9
comes somewhere between this black line and the five ml so it's
going to be hard to get an accurate dose with this 10 ml so I'm not going to
choose to use this one. Now I know with a 3 ml I'm looking to draw up 4.9 ml
so I'm gonna have to use two of these to get the dose that I need.
So just to look at the syringe first. When I'm looking at the 3 ml
syringe I can see that I've got my one ml and I have a half a mll which means that
each line in between is a tenth of a ml. So this would be from one half to
0.6, 0.7, 0.8, 0.9 to 1 ml.
So if I draw up three ,for example in this syringe, I would need to
still draw up 1.9 ml in my other syringe and I can accurately get to one
point nine with this equipment so I'm gonna choose to use two 3 mls. Okay
so don't forget to do your 30-second scrub on the top. We'll check that
medication one more time. Ondansetron two milligrams per ml and I want 4.9 ml.
I've got my air in my syringe and I'm going to draw up a full three in
this vial. Again it's okay to go past it. I always like to make sure I get my air
out and I'm exactly at the three ml.
There. I'm gonna recap this one and label it
Now I've just got that one non filter so I'm just gonna snap on here the second
filter, clean again in between, draw up my air and I want to pull up to 1.9 ml now.
So I always like to go past and get rid of the air bubbles.
Now to administer this medication we need to add this medication into a
solution that is stable and you find this information off your parental
manual. So for this one I have a 50 ml bag of normal saline and I check the
expiry date and it says December of 2018 and I'm using the 50 ml bag because
that's the calculation I decided to go with. We're going to access this through
the rubber stopper, we're going to clean - cleanse it with our alcohol swab and
we're going to insert the needle of our blunt fill into that rubber stopper so
you can see the needle here is inside and we're going to insert the medication.
We will complete this with our second vial of medications for that total dose of
4.9 ml or 9.75 milligrams and then we'll be ready
to administer this to our patient. Again go to your print to a manual for further
instruction on how to administer. So that was an example of using a medication
that's already in a fluid state. So next we're going to look at medication that
comes as a powder because we need to dilute this medication and then decide
how much of the diluted medication we're drawing up to administer. So let's look
at another example. So let's start with this order of 600 milligrams of an
antibiotic. When I look at the vial I see that there are several different
strengths in which I can dilute my medication. So I do have a desired dose
of 600 milligrams and I have several options for an
available dose. Let's take a look at our vial again. If I want a concentration of
300 milligrams per ml, I need to add 9.6 mls of diluent and I will have a
total volume of 10 mls. At a concentration of 300 milligrams per ml
I still don't have my desired dose so I need to figure out how many mls I would
use if I were to reconstitute with 9.6 mls.
So using dimensional analysis I will solve for this equation and I can see
that I would need 2 mls of the medication at this concentration. Now I
also have the option of doing a 400 milligrams per ml concentration or a
500 milligram per ml concentration so let's look at those two next. So a 400
milligram per ml concentration, it indicated I would need 7.1 mls of
diluent for a total volume of 7.5 mls. You'll notice as the total volume
decreases the concentration increases. Using dimensional analysis at this
concentration, I would only need 1.5 mls of medication. Similarly for
the 500 milligram per ml concentration the recipe required 5.6 mls of diluent.
I would have a total volume of 6 mls. Using dimensional analysis again I
discover I would a lead 1.2 ml of the medication to achieve the desired dose.
So after looking at my equipment I have a 3 ml syring, I've decided to use the
300 milligrams per ml concentration because I can accurately draw up 2 mls.
So going to my vial I now know I need 9.6 mis of a diluent. So I have my day
diluent. You still need to clean the top before
accessing. I've grabbed a 10 cc syringe, put my air in and now I'm going to drop
9.6 mls of saline. Be sure to get rid of your air.
9.6. Again you want to clean this and now I'm going to insert. So this
is the powder and as I insert it will start to diffuse and mix. I'm getting a
lot of resistance now so I'm gonna pull my needle out of the fluid and let the
air come out. I just let go the depressor in it naturally - and make sure I insert
the rest of that fluid. Now it's important that when you're mixing this
you just roll it in your hands gently
and then we inspect to see if it's all mixed.
Once you inspect that there is no more particle we can go ahead and draw up the
required dose. So remember we now have 300 milligrams per ml and there's 10 mls
in this vial. We're gonna clean again and now I'm going to drop my 2 mls.
Get rid of those air bubbles
We're ready to go. Well there you have it now you are able to reconstitute your
drugs using the information in your facility so that you can administer your
medication to your patient safely. Until next time make it a great day!