Sterility risks of adding air during vial reconstitution and transfers

The earlier comment was about using the same needle on a pen for several injections. There is no reason to take that chance when needles are cheap, though some still do it. I supplied a friend with a pen and extra needles and reminded him to swap each time, but after four weeks he still had several left and reported no trouble.

Nice clip. I am a big fan of my flow hood and use it for several different projects.

Did you order that hood online? I was checking out one that looked a lot like it.

Can you share the specs on the equipment? The hood itself is not visible in the clip; is there a wider shot?

I built the hood myself instead of buying one. The cost was low and I wanted to see if I could make it work. The parts came from ordinary stores and a couple of online shops. The unit is not meant for professional work but it gets the job done for what I need.

A basic laminar hood is straightforward: a filter, a couple of fans, a speed controller, and a box. I tested the clean zone in front of it and found the area about twenty to twenty-five centimeters out stays low on particles when the room is calm and there are no pets around. Everything that goes under the hood gets wiped with seventy percent isopropyl in a spray bottle because that strength evaporates at the right rate.

That is a clever home setup. I still have some leftover materials from moving. One practical question though: how do you get your hands inside the box?

You work in front of the open side rather than reaching through holes; the clean zone extends outward from the filter. A still-air box is simpler and cheaper but the flow version gives better results. Fans go on the top or side so the air is pushed through the filter evenly, and the speed control lets you tune the airflow so it stays laminar without being too strong or too weak.

You can build one for under a hundred if you want to go the DIY route.

That turned out really well. I am thinking about putting one together myself in the next few weeks; the added confidence seems worth the effort.

You are still missing the distinction. I only vent when I am transferring freshly mixed liquid into a new larger vial. I work with bigger amounts than the usual small vials, and once that new vial is filled there is no vacuum or pressure, so I add air only later when I draw individual shots from it.

With respect, that level of precaution goes beyond what nurses are taught to do even under supervision.

Hospital pharmacies prepare sterile eye drops, injectables, and chemo drugs inside ISO Class 5 clean rooms. Air that enters a vial can introduce contamination; it does not happen every time, but the chance exists. The simple steps I take at home are worth it to me because I am using these medications for a serious condition and I do not want to risk what could happen under the skin.

You are fine. My earlier reply was aimed at a different comment, so the back-and-forth was mostly a misunderstanding.

Take it easy. I was simply stating what actually happens in practice. I am a retired RN who worked as a certified infusion nurse. We routinely reconstitute and use multidose vials outside of hospital clean rooms, including in home settings.

I am not familiar with the RN title. It sounds like the rules in the US differ from those in France and the rest of Europe.

RN stands for registered nurse, as opposed to an LPN.

Exactly. I get a cosmetic treatment a couple of times a year and the nurse shows me the still-dry vial, then mixes it right there in an ordinary room while we talk. If drawing air into vials during reconstitution in normal indoor air were a real problem, outpatient clinics would face much stricter rules than they do.

The first reconstitution video I saw showed someone working with no gloves, no surface cleaning, and not even wiping the vial tops. It was surprising how casually the steps were presented without basic hygiene.

You should have seen the conditions I worked under for years as a paramedic.

I dated a paramedic for a couple of years so I have some idea what that involves.

If it was the video with the rat, the person gave reasons for skipping some steps. My son has been an RN and lieutenant for twenty years and the training he received was worth every bit of the cost.

The video I saw gave no explanation for skipping the steps, so it must have been a different one. It was just someone posting their own routine.

I have the same problem. When I try to push air in, the vacuum pulls it straight back out again. Adding the right amount of air also makes it easier to measure the dose accurately.

That is definitely something to be proud of.

LOL, I just roll over in bed in the dark around 5:30 am, grab the pre-filled syringe from the bedside drawer and jab it right into my abdomen without looking, drop it back in the drawer, roll over, fix my CPAP mask and fall asleep again.

I'm a registered nurse. That's why I replied at first after you brought up how nurses work in an earlier message. It looks like you're now saying your comment was about procedures in Europe. Sorry if my being here in the US caused any mix-up in what I wrote. I had no idea registered nurses don't exist over there. How do you refer to your roles? It was news to me that nursing lacks its own set of distinct rules in that area. Quite surprising really. Back in the early two thousands I was employed at a large drugstore company in America. Our rules came from both national and local levels covering mixing putting items into containers marking them and sending them out. Giving medicines after mixing wasn't included in what we could do though other groups who handle that have rules from governments plus professional guidelines. Where I live in Florida the habit of pushing air into a container before drawing liquid is a usual method taught to avoid getting the amount wrong.