|
FERTILITY CENTER OF LAS VEGAS
Guide for Preparing and Administering Injectable Fertility Medications
Edited December, 2006 – Main text courtesy of Freedom MedTEACH
Index
Preparation Basics
Preparing Medication Vials and Drawing Up Medication
Administering Subcutaneous Injection
Administering Intramuscular Injection
Using the Gonal-f RFF Pen
Using the Follistim Pen
Preparation Basics
STEP 1
When your shipment of medication arrives, open it and check to see that you have all the medications and supplies that you need. Please follow instructions regarding storage at either room temperature or in the refrigerator. Review your instructions for preparation and administration of your medications. If you have any questions, please call our office at 702-254-1777 or toll-free at 800-509-7174 for help. If it is after-hours, the answering service should connect you to the provider on-call.
STEP 2
Designate a clean surface area where you can organize your supplies and prepare your medications. Many people choose their bathroom or kitchen countertop or a bedroom bureau, dresser or vanity table.
STEP 3
Review the instructions for preparing your prescribed medications.
STEP 4
Clean the surface of your work area with soap and water or another appropriate cleaner.
STEP 5
Wash your hands with soap and water for at least 15 seconds and dry well.
STEP 6
Assemble the supplies you need for your injection including:
- Medication (the vials of powder and vials of diluent/liquid) to be prepared. Set out the number of powder vials needed for your prescribed dose.
- Syringe.
- Mixing needle (this is usually larger and longer than the needle you will use to inject the medication).
- Injection needle.
- Alcohol preparation pad or bottle of alcohol and cotton balls.
(Different preparation steps apply for the Gonal-f RFF Pen, the Follistim Pen and Follistim AQ Cartridge.)
Preparing Medication Vials and Drawing Up Medication
Always mix your medications just before you use them. If you are using a “multidose vial” it may come as powder and diluent/liquid that you only mix once or it may come premixed.
STEP 1
Carefully remove the needle(s) and syringe from the sterile packages. You will use a new syringe and needle for each injection. To avoid contaminating these supplies, DO NOT touch the end of the syringe that attaches to the needle or the end of the needle that attaches to the syringe. DO NOT remove the cap from the needle until it is securely attached to the syringe.
STEP 2
Twist the mixing needle onto the syringe and set aside.
STEP 3
Lift the plastic cap off the top of each vial to be used.
STEP 4
Wipe the top of each vial with an alcohol preparation pad, but do NOT touch the top of the vial with your hands.
STEP 5
Carefully take the top off the needle, taking care NOT to touch the needle itself.
STEP 6
Insert the needle into the middle of the rubber stopper on top of the vial liquid/diluent.
STEP 7
With the needle still inside the vial, turn the vial so the stopper side is pointing down.
STEP 8
With the needle below the fluid line, slowly pull back on the plunger to withdraw the amount of diluent instructed by your doctor or nurse. This is generally 1 cc or ml. Remember, both “cc” and “ml” are the same unit of measurement.
STEP 9
Remove the needle from the vial.
STEP 10
Insert the needle into the vial of medication (powder), and push the plunger of the syringe to add the liquid/diluent to the powder WITHOUT shaking the vial. The powder will dissolve quickly.
STEP 11
With the needle still inside the vial, turn the vial so the stopper side is pointing down, and with the needle below the fluid line, slowly pull back on the plunger to withdraw all of the medication in the vial. When using a “multidose vial” withdraw the amount of medication instructed.
STEP 12
If more than one vial of medication has been prescribed, squirt the above mixture into the next powder using the same steps as above. Repeat these steps, as necessary, to incorporate the dosage prescribed by your physician.
STEP 13
Carefully remove the mixing needle from the syringe, discard it in your sharps container and replace with the injection needle. Be sure that the injection needle is securely fastened.
STEP 14
Discard all of the used vials in the trash. If you are using a “multidose vial” store as directed.
Administering Subcutaneous Injection
STEP 1
Select the site to inject, and gently wipe with an alcohol pad or cotton ball dipped in alcohol. Securely hold the medication-filled syringe in one hand and remove the cap from the needle with the other hand. Do not touch the needle with your hand or it to allow it to touch any surface.
STEP 2
Holding the syringe with the needle pointing up, gently tap the barrel of the syringe to move any air bubbles to the top. Once you have the air at the top of the syringe, slowly push the plunger upward to dispel the air. Stop when the air is gone. You may see a tiny droplet of medication at the needle tip.
STEP 3
Hold the syringe in your dominant hand like a pen or pencil. Gently grasp a small fold of skin between your thumb and index finger at the selected injection site
STEP 4
Insert the needle into the fold of skin in a quick, dart-like motion up to the needle’s hub. Slowly release the pinch of skin and depress the plunger to inject all of the medication in the syringe. Once the injection is complete, remove the needle.
STEP 5
Place the needle and syringe in a sharps container.
STEP 6
You may see a small drop of blood or medication at the injection site. Simply apply gentle pressure with a dry cotton ball or tissue for a few seconds.
Congratulations! You have successfully received your subcutaneous injection.
Administering Intramuscular Injection
STEP 1
If at all possible, it may be more comfortable to have someone else administer your IM injection for you, even if you have been doing your own SC injections. You can reduce discomfort by relaxing the muscle chosen for the injection site and by shifting your body weight to the leg on the opposite side from the hip to be injected. Either stand or lean against a countertop with your knee on the side of the injection bent and relaxed, or lie down on the side that you will not be getting the injection on. Select the injection site and gently wipe it with an alcohol pad or cotton ball with alcohol on it. Securely hold the medication-filled syringe in one hand, and remove the cap from the needle with the other hand, taking care not to touch the needle with you hand allowing it to touch any surface.
STEP 2
Holding the syringe with the needle pointing up, gently tap the barrel of the syringe to move any air bubbles to the top. Once you have the air at the top of the syringe, slowly push the plunger upward to dispel the air. Stop when the air is gone. You may see a tiny droplet of medication at the needle tip.
STEP 3
Hold the syringe in your dominant hand like a pen or pencil. Use the thumb and index finger of your hand to gently spread the skin at the injection site. This will flatten the skin. Try to relax the muscle where the injection will be given to minimize discomfort.
STEP 4
Insert the needle in a quick, dart-like motion up to the hub (plastic connector). Now hold the barrel of the syringe with your non-dominant hand and very gently pull back just a bit on the plunger to check for blood. Do not pull back forcefully on the plunger. If you see blood in the syringe, first pull the needle tip out just slightly and check again. If no new blood enters syringe, inject medication. If blood continues to enter remove the needle, change it and start again at a different injection site. This does not happen very often and is not a reason for concern. If there is no blood, slowly push the plunger all the way to administer the medication.
STEP 5
Once the injection has been completed, withdraw the needle from the injection site. Dispose of the needle and syringe in your Sharps container. If you see a drop of medication or a drop of blood at the injection site, gently apply pressure with a dry cotton ball or tissue for a minute. If bleeding continues, apply a bandage and gentle pressure for another minute.
Congratulations! You have now successfully received your intramuscular injection.
Using the Gonal-f RFF Pen
STEP 1
ATTACH NEEDLE: Remove pen cap and wipe threaded tip with alcohol wipe. Remove peel tab from outer needle cap. Press threaded needle tip of the pen into the open end of outer needle cap. Twist pen clockwise until the needle is securely attached. Remove outer needle cap.
STEP 2
SET THE DOSE: Turn the dosage dial so your prescribed dosage dial is lined up with the black dose arrow. Recheck that correct dose on the dosage dial is lined up with back dose arrow before proceeding. If the dialed dose is too high or too low, reset before pulling the injection button.
STEP 3
LOAD AND CONFIRM: Load the dose by pulling out the injection button as far as it will go. Find the last fully visible flat red arrow on the injection button. It confirms the dose that is loaded and ready to be injected. If the does showing on the end of pen is less than your does is supposed to be then there is not enough drug to complete dose. Use a new Gonal-f RFF Pen to complete dose.
STEP 4
INJECT: Clean recommended injection site with alcohol swab and let air dry. Remove inner needle cap. Do not touch needle or allow it to touch any surface. Inject needle into skin at a 90 degree angle and push injection button until it stops clicking. After the last click, keep the needle in he skin for at least 5 seconds. Remove the needle and apply pressure as needed with gauze pad.
Using the Follistim Pen
Your doctor will decide on the dose of Follistim AQ Cartridge to be given. The Follistim Pen dosage can be set from 50 IU to 450 IU, in marked increments of 25 IU. The pen’s Dosage Scale has easy-to-read numbers and audible clicks to help you set the correct dose. Incorrect settings can easily be adjusted without losing any drug.
WHAT YOU WILL NEED
+ Follistim Pen, Follistim AQ Cartridge, the BD Micro-Fine Pen Needle provided with the cartridge.
+ Alcohol, cotton balls or alcohol pads/swabs, sterile gauze, antibacterial soap and a special safety container to discard used needles, cartridges or other supplies.
STEP 1
USING THE FOLLISTIM PEN: Hold the pen firmly with one hand, and pull off the Protective Cap with your other hand. Place the cap on a clean, dry surface. Unscrew the entire Pen Body from the Cartridge Holder, and place the Cartridge Holder and Pen Body on a clean, dry surface.
STEP 2
LOADING THE FOLLISTIM PEN: Take the Follistim AQ Cartridge out of its package but don’t use it if the medicine inside contains particles or is not clear. Make sure the medicine is at room temperature before using. Clean the Rubber Stopper on the cartridge with an alcohol pad, then pick up the Cartridge Holder and place the cartridge inside by inserting the Metal Rimmed Cap end first. Taking the Pen Body, lower it into the Cartridge Holder, ensuring that the black rod presses against the Rubber Piston on the cartridge. Screw the Pen Body fully onto the Cartridge Holder, making sure there is no gap between the two. The arrow (^) on the Cartridge Holder should point to the middle of the yellow alignment mark ([]) on the blue Pen Body.
STEP 3
ATTACHING THE BD MICRO-FINE PEN NEEDLE: You must use a new BD Micro-Fine Pen Needle with each injection. Attach a fresh BD Micro-Fine Pen Needle after you ensure there is a Follistim AQ Cartridge in the Cartridge Holder. Clean the open end of the Cartridge Holder with an alcohol pad. Pick up your BD Micro-Fine Pen Needle held in an Outer Needle Shield. Peel off the protective paper seal, but don’t touch the needle or place it on any surface. Hold the Outer Needle Shield firmly in one hand while holding the Cartridge Holder firmly in the other hand. Push the end of the Cartridge Holder in to the Outer Needle Shield, and screw them tightly together.
STEP 4
PREPARING THE INJECTION SITE: The best place for the subcutaneous injection is the abdomen—the stomach area below the belly button or the upper leg. Your health care provider can show you other places where you can inject Follistim AQ Cartridge. You should change your injection site with each injection to lower the chance of skin reactions. Taking a swab moistened with alcohol, clean about two inches around the injection site where the needle will be inserted. Let the alcohol dry on your skin for at least one minute before injecting.
STEP 5
CHECKING THE FLOW OF FOLLISTIM AQ CARTRIDGE: Pull the Outer Needle Shield gently, leaving the Inner Needle Shield in place, covering the needle. Do not discard the Outer Needle Shield. It will be needed for disposing the needle later. Carefully remove the Inner Needle Shield and discard it, ensuring you do not touch or allow the now exposed needle to come in contact with any surface. While holding the Follistim Pen with the needle pointing upward, tap the Cartridge Holder gently with your finger to push the air bubbles to the top of the needle. Look for a droplet forming at the tip of the needle. If you can’t see a droplet, dial the Dosage Knob until you hear one click, and with the needle pointing upward, push in the Injection Button. If you still do not see a droplet, repeat this step until you do.
IMPORTANT: Do not touch the needle or leave it uncapped without Inner Needle Shield so it remains sterile.
Use a new, sterile BD Micro-Fine Pen Needle for each injection. Only use the BD Micro-Fine 0.33 mm x 12.7 mm (29G) Pen needles as supplied with the Follistim AQ Cartridge.
STEP 6
DIALING THE PRESCIBED DOSE: Your Follistim AQ Cartridge contains either 300 IU, 600 IU or 900 IU of Follistim AQ solution. Record the amount in your Follistim Pen Treatment Diary. For doses between 50 IU and 450 IU, turn the Dosage Knob until the dot beside the correct number on the Dosage Scale is displayed in the middle of the dosage window. If you dial pass the correct number, do not turn the Dosage Knob backward. Continue to turn in the same direction past the 450 IU mark, as far as it will turn. The Dosage Scale must move freely. Push the Injection Button in all the way, and then dial again starting from the “0” upward. By following these directions, you will not lose any medication from your Follistim AQ Cartridge.
IMPORTANT: If you do turn the Dosage Knob backward to correct the mistake, you will not hurt the Pen, but you will lose some drops of Follistim AQ Cartridge from the tip of the needle.
Never dial your dose or try to correct a dialing mistake when the needle is still in your skin, as this may result in your receiving an incorrect dose.
STEP 7
GIVING YOURSELF AN INJECTION: Once the correct dose has been selected, you are ready for injection. Pinch the already swabbed area of the skin between two fingers, and with your other hand, insert the entire BD Micro-Fine Pen Needle straight into the skin. Press the injection button all the way in, then wait for 5 seconds before pulling the needle out. The middle of the Dosage Window should display a dot next to the “0”. If the Injection Button does not push in all the way and the number in the Dosage Window does not read “0”, it means there’s not enough medication left in the cartridge. In this event, you should write down the number displayed in the Dosage Window. This will be the number you dial for completion of your dose. Start over with a new Follistim AQ Cartridge, a fresh needle, and follow all the instructions up to this step. Choose a different injection site.
IMPORTANT: If the dot next to the “0” is not in the middle of the Dosage Window and you cannot push the Injection Button all the way in, do not try to force down to the button. Your Follistim AQ Cartridge is probably empty. This means you have not received your full dose. Do not adjust the setting on the Dosage Scale. Follow the instructions in this step.
STEP 8
REMOVING AND DISPOSING OF THE MICRO-FINE PEN NEEDLE: Once you’ve injected your correct dose, pull out the BD Micro-Fine Needle and firmly press down on the injection site with an alcohol swab. Use the needle for one injection only. Place the Outer Needle Shield on a flat surface with the opening pointing up. Without holding the Outer Needle Shield, carefully insert the needle into the Outer Needle Shield opening, and push the Pen down firmly. The Outer Needle Shield should now be attached to the Cartridge Holder and cover the needle.
Grip the Outer Needle Shield and use it to unscrew the needle from the Cartridge Holder. Do not discard the needle in a trash can. Your healthcare provider can advise about obtaining a special container for proper needle disposal. If more medicine remains for future injections, place the Pen Cap back on the Pen Body, and store in a safe place at room temperature or in the refrigerator.
IMPORTANT: Use the BD Micro-Fine Pen Needle for one injection only. Dispose of the used needle inside the Outer Needle Shield immediately in a properly secured container as instructed by your healthcare provider.
Always unscrew the needle before you put the Follistim Pen away.
Never store the Follistim Pen with needle attached. If you store the Follistim Pen with the needle attached, the drug could leak out, and there is risk for contamination.
Never leave needles where others can pick them up.
STEP 9
REMOVING THE CARTRIDGE: Before you remove the Follistim AQ Cartridge from the Follistim Pen, unscrew the needle by following the previous instructions. Unscrew the Follistim AQ Cartridge from the Cartridge Holder. Safely dispose of the empty cartridge in the same container you used for needle disposal. Do not discard the cartridge in the trash can.
Now you can put the Follistim Pen back together without the cartridge, and store for your next injection, OR insert a new cartridge into the Cartridge Holder, put the pen back together and store at room temperature or the refrigerator.
FINAL SUMMARY: Based on your individual, prescribed dosage, there will be a certain number of doses per cartridge in the Follistim Pen. Don’t use the cartridge beyond the advised number of doses, or there may not be enough volume of drug for your prescribed dosage.
Starting with your initial injection, you should begin using your Follistim Pen Treatment Diary by recording the Follistim AQ Cartridge content (either 300 or 600 IU), recording the daily dose you have been prescribed, and subtracting your Day 1 dose from the cartridge content (300 or 600 IU). This will give you the remaining content.
If you realize before you inject that you don’t have enough drug remaining in your Follistim AQ Cartridge for your complete dose, remove the old cartridge, and insert a new cartridge into the Follistim Pen OR dial your dose and inject the remaining content in the cartridge. The Dosage Knob Injection Button will not push all the way, and the Dosage Window will not read “0”, but will display the number of units you’ll need to complete your prescribed dose. Remove the needle, and dispose of it properly. Write the number down that appears in the Dosage Window. Then, using the Dosage Knob, reset the Dial Window to “0” by turning it to past the 450 IU mark as far as it will turn, and push the Injection Button in all the way. Insert a new cartridge into the pen, and attach a fresh needle. Dial to the number of units you’ve written down to complete your prescribed dose. Make sure you use a different injection site.
IMPORTANT: Always remove the needle from the Follistim Pen after you have completed your injection. If you store the Pen with the Needle attached, the drug could leak out, and there is risk of contamination. Dispose of the used needle in a properly secured container as instructed by your healthcare provider.
If you have any questions regarding this information, please call our office at
702-254-1777 or 800-509-7174.
|
