Preparation of Ribavirin solution for Nebulisation:
6g in 100ml
The following guidelines for the safe reconstitution (in the patients
room) of ribavirin solution for nebulisation were prepared by :
Gill Shanks (Medicines Safety Manager),
Royal Hallamshire Hospital, Sheffield Teaching Hospital trust.
In conjunction with:
Sister Marie Downes (Clinical Nurse Educator)
Royal Hallamshire Hospital, Sheffield Teaching Hospital Trust.
May 2010
Preparation of Ribavirin solution for Nebulisation:
6g in 100ml
Kit Contents (supplied by pharmacy) :
• 1 x Ribavirin 6g vial
•
•
•
•
•
1x
1x
1x
2x
2x
Water for Injections 100ml
Empty Di mix EVA -parenteral bag 125ml
Baxter Control-A-Flo set (EMC5908P)
BD Plastipak Syringe luer loc 60ml
B Braun Mini-Spike Dispensing pin with
Safsite valve (DP-1500)
• 1 x Label for EVA bag
• 3 x Label for giving set line and EVA
(For Nebulisation Only)
• 1 x Instruction sheet for preparing
Ribavirin Nebuliser soln. 6g in 100ml
N.B. This kit is to prepare Ribavirin Nebuliser solution for use only with the Aiolos device for nebulisation as per protocol.
1. Take a 60ml luer loc
syringe and attach to
the dispensing pin.
2. Remove the protective
cap from the
dispensing pin and
insert via the bung
into the water for
injection vial.
3. Withdraw 50ml of water for
injections. Disconnect the
syringe from the dispensing
pin, leaving the dispensing
pin in situ.
4. Attach a second dispensing pin
to the same syringe.
Peal back the aluminium seal
from the Ribavirin vial
Safety note:
Fold metal flap back down the
side of vial neck - DO NOT
remove metal seal completely.
Keeping the aluminium ring in
tact holds the rubber bung in
place and prevents it being
pushed in to the vial or coming
out of the vial during fluid
transfer.
Remove the protective cap from
the dispensing pin and insert
the dispensing pin into the
Ribavirin vial via the bung.
5. Gently transfer the 50ml of
water in the syringe into the
Ribavirin vial.
Safety note:
When transferring the contents
of the syringe, tilt the syringe
and dispensing pin at an angle
to ensure that the fluid runs
down the side of the vial. This
reduces the chance of ribavirin
powder exiting via the vented
spike. The vented spike should
equalise the pressure
automatically.
6. Leaving the dispensing pin
and syringe in situ, shake
vial well to dissolve the
ribavirin powder.
Note:
At this stage, the ribavirin
may not totally dissolve.
7. Disconnect the syringe
from the dispensing pin in
the Ribavirin vial and
attach the same syringe to
the dispensing pin in the
water for injection vial.
Withdraw a further 25ml.
8 . Attach this syringe to the
dispensing pin in the Ribavirin
vial, gently transfer the
contents of the syringe into the
Ribavirin vial.
When transferring the contents of
the syringe, tilt the syringe and
dispensing pin at an angle to
ensure that the fluid runs down
the side of the vial.
9. Leave the dispensing pin and
syringe in situ and shake vial
well until the drug is fully
dissolved.
N.B. Ensure the solution is fully
dissolved before proceeding
to the next stage.
10. Withdraw 50ml of
solution from the
Ribavirin vial into the
attached syringe.
Disconnect the
syringe from the
dispensing pin,
leaving dispensing
pin in situ.
11. Remove the cap from the
long additive tube on the
EVA bag. Attach the
syringe containing the 50
ml Ribavirin solution to
the long tube. Transfer
the contents of the
syringe to the EVA bag.
Leave this now empty
syringe attached to the
long tube.
Safety note:
If you remove the syringe,
the ribavirin will leak from
the bag.
12. Take the second 60ml luer loc
syringe and attach to the
dispensing pin in the Ribavirin
vial and withdraw the
remaining contents of the vial.
Disconnect this syringe from
the dispensing pin.
13. Remove the empty syringe
from the long tube on the EVA
bag and attach the syringe
containing the remaining
Ribavirin solution. Transfer
the contents of the syringe
into the EVA bag. Leave this
now empty syringe attached
to the long tube.
14. Take the now empty 60ml
luer loc syringe and
attach to the dispensing
pin in the water for
injection vial. Withdraw
25ml.
Disconnect this
syringe from the
dispensing pin, then
remove the empty
syringe from the long
tube and replace with
the syringe containing
water for injections,
taking care not to let
any of the Ribavirin
solution leak from the
bag. Transfer the final
25ml water in this
syringe to the bag.
Close the
clamp on
the long
tube
15. After the clamp
is secured, remove
the syringe and fit
cap to the long tube
on the EVA bag.
Mix the contents of
the EVA bag
thoroughly.
16. The EVA bag
now contains
a solution of
Ribavirin 6g
in 100ml.
17.Take the large label
and fill in the
patient name,
ward, date, start
time and the initials
of the person
preparing the
product in the
spaces provided.
Attach this label to
the EVA bag.
18. Take the Baxter
Control-A-Flo giving
set and insert the
spike into the giving
set port of the EVA
bag. Clamp off the line
until ready to prime.
19.Take the three red print labels. Attach one label to the EVA bag and
the other two labels to the giving set line – one at the top of the line
(underneath the burette) and one at the bottom of the line (near the
luer lock connection). N.B Flag the giving set line labels so the
labels can be read easily to avoid any possible connection to an
IV line.
20. Discard all used materials (2 x 60ml
syringes, 1 x empty water for injections vial
with dispensing pin still attached, 1 x empty
Ribavirin vial with dispensing pin still
attached) in a sharps bin with purple lid
(hazardous waste).