Reconstituon of Powdered Drugs (Mixing Powders)

Reconstitution of Powdered Drugs For meds available in powdered form in a vial. Must be reconstituted with a liquid (diluent). Add the diluent that will give you an injectable amount in the final concentration.

Reconstitution Technique of adding a diluent to a powdered solution Type and amount of diluent to use provided by manufacturer: On vial label Package insert Pharmacist

Also may be an “Act-O-Vial” system.

1. Steps for mixing Powders 1. Look at order. What is the dosage to be given? 2. Read label on powder bottle or insert How much diluent do you instill? What do you instill (NS or SDW)? Resulting concentration - the ONLY part you need for figuring amount to draw out.

Read the entire label Is it for IM or IV administration? What are the differences in dilutions? Do you need more than one vial? Always figure on paper before mixing. Why? Must double check your figures with another RN if Ped or IV. Check the 5 rights.

Several Options? If instructions on label give several options for reconstitution, choose the correct option based on: Should get ordered dose in 1 injection. Site of injection and type of injection IM - 3 cc. SubQ - 1.5 cc. IV - no limit (usually <5cc)

Example #1 Instructions on label: Order: Kefzol 0.5 Gm IM qd Available in powder/vial: Kefzol 1 Gm Instructions on label: “Add 4 cc of SDW to provide a concentration of 1 Gm per 4.4 cc.” Figure problem on paper first.

Figure amount to be given per dose: Step l: 1 Gm. 0.5 Gm 4.4 cc = x cc 1 x = 4.4 (0.5) x = 2.2 cc Step 2: Add 4cc SDW to bottle. What size syringe do you need to add the 4 cc? 5cc syringe

What size syringe do you need to withdraw and give the injection? 3 cc syringe Can you give 2.2 cc in an IM injection? yes

Example # 2 Order: 400,000 units Penicillin IM Available: 500,000 u/ bottle- powdered How many bottles do you need? 1

Directions on the bottle: Use SNS for diluent Add diluent: Concentration a. 9.8 cc 50,000 u/ cc b. 4.8 cc 100,000 u/cc c. 1.8 cc 250,000 u/cc

Order: 400,000 units Available: 50,000 units / mL

Order: 400,000 units Available: 100,000 units / mL

Order: 400,000 units Available: 250,000 units / mL

Figure which amount of solution to add: Option # 1 50,000 u = 400,000 u 1 cc X cc 50,000 x = 400,000. x = 8 cc Is this under 3 cc? No, too much for one injection!

Option # 2 100,000 u = 400,000 u 1 cc X cc 400,000 = 100,000 x x = 4 cc Can you give this amount? No, still too much.

Option # 3 250,000 u = 400,000 u 1 cc X cc -400,000 = 250,000x - x = 1.6 cc Can you give this amount? Yes!!

Which option do you choose? How much can you give in one IM injection Can you give the ordered dose in 1 injection How much diluent will you add: 1.8 cc How much will you withdraw into syringe for the injection? 1.6 cc Preferred option is # 3

Order: Cefzolin 0.3 Gm IM Supply: 500 mg powder in a Vial Read label How much diluent: 2 mL SDW Concentration will be: 225 mg/mL How much will you give? 0.3 Gm = 300 mg 225 mg = 300 mg 1 mL X mL 225 X = 300 X = 1.3 mL

Penicillin G 1,000,000 u IM Supply: PenG 5,000,000 u powder Read Label Which dilution will you choose? 5 million unit vial 4 options 2 answers are correct 500,000 u/mL 100,000 u/mL (Give 1 cc) or 500,000 u = 1,000,000 u 1 mL x mL X = 2 cc

Order: Omnipen (ampicillin sodium) 250 mg IM q 6h Supply: 500-mg vial of powder Read label Which dilution will you choose? 1.8 mL Concentration will be: 250 mg/mL How much will you give? 250 mg = 250 mg 1 mL X mL 250 x = 250 X = 1.0 mL

Order: Ancef (cefazolin sodium) 225 mg IM q6h Supply: three vials – 250 mg, 500 mg, 1 g Read label Which powder will you choose? 500 mg How much diluent will you add? 2 mL SW Concentration will be: 225 mg/mL How much will you give? 1 mL

Practice makes perfect !!