How to reconstitute cytotoxic drugs

Calculation: First of all, Perform all necessary calculation before entering the chemo safety hood.

And follow proper garbing procedure ( Proper PPE) and ensure proper aseptic technique is performed for the preparation of chemotherapy.

Set Up: All required material including like isopropyl alcohol swab, the needle, the drug vial, the re constituent medium (WFI) and the sealing materials set up right to left to minimise air flow disturbance.

Disinfecting: Remove the plastic cap of the desired cytotoxic drugs vial and disinfect the stopper bypass with the alcohol swabs as well as the recontituent medium (WFI)'s top ,you may keep the alcohol swab on the top of saline bags although it's not necessary.

Assembly : Unwrap the syringe and hold the syringe barrel  with one hand keeping in mind not to block air  in the Luer-Lock.Then unwrap the needle with the other hand and assemble hub of  the needle with Luer –lock  by twisting either needle or syringe with it .Now remove the cap by pulling the cap and barrel in the opposite direction.

Air : Take the volume of air into the syringe because the cytotoxic drugs vial is a close system container .To correctly read a syringe  the edge of   plunger must be lined up with the calibration barrel.

The non coring method of needle insertation : The bevel should be  placed on the stopper at the 40-degree angel  when  the bavel lines up with the stopper , pierces the stopper with bevel tip first and press downward as the needle is inserted .

Holding the system : Use Your index and middle finger to hold the vial and two other fingers on the syringe barrel, when you are done flip the assemble system clockwise.After that inject air slowly by pushing on the plunger ,it can be done at once ,if the volume the volume is smaller.

Removing the air bubble :Firmly tap the barrel with finger or knuckles so the air bubbles clinging to the side are freed and float to the top of the syringe or expel all the air in the syringe by slowly pushing up the plunger until the solution fully primed the attached needle.Then flip the assembly counterclockwise downward and place it on the surface while still holding it and remove the needle.

Drug powder reconstitution: Perform the non-coring technique of needle insertion to avoid pouring fragment out of rubber stopper.While the drug vial sat down to inject the reconstitute fluid slowly and then shake the vial gently  until you get a homogenous mixture .

Drawing up the reconstient drug dose: Frist of all ,draw air into the syringe to the desired volume of reconstituted drug to be administered for one dose and inject air into the drug vial and adjust the dose by watching the reading of the barrel of the syringe  .Now remove the needle from the vial and push it into the saline bag and mix drug with the normal saline or DA by pushing the plunger slowly  .Now recap the syringe using Sccop method and dispose all needles and syringe in the cytotoxic waste bins (yellow color bin) when you are done .The proper disposal of cytotoxic waste is very important.

Now inspect the saline bag very well for any drug particle inside it . If found any shake gently until it come into homogenous form .