Before you start, you'll need:
- 3ml syringe with 21 gauge 1 inch needle
- 1ml syringe with 27 gauge 1/2 inch needle
- 2 alcohol wipes
- 1 cotton ball
- 1 vial of Betaseron (green vial)
- 1 2ml vial of saline (white vial)
- Sharps container
- Autoject 2
- Clean work area
- Working with needles on syringes:
- Twist and pull to remove needle
- Use a straight pull to remove just the safety cap
- Wash your hands with a disinfectant soap
- Warm vials in hands (warm solution reconstitutes the Betaseron better than cold). Alternative: leave the vials out for approximately 20 minutes.
- Remove caps from vials
- Wipe each vial with an alcohol prep
- Discard the prep
- Snap/Flick each vial (like a salt shaker) to remove excess alcohol
- Allow the alcohol to evaporate
- With the cap still on the needle of your 3ml syringe, pull the syringe plunger back to the 1ml mark (more over-pressurizes the vial and causes leakage when the needle is removed).
- Remove the needle cap and insert the needle into the saline vial (white vial) approximately two-thirds of its length for the vial-down position and one third of its length for the vial-up position.
- Inject the air from the syringe into the air space inside the vial (good practice for working with the Betaseron where we do not want any bubbling). During this portion of the procedure, remember to keep your thumb on the plunger to keep the air from pushing back into the syringe.
- If necessary, invert the vial/syringe combination to have the vial above the syringe.
- With the syringe in upright position, adjust the needle so it is near the bottom of the liquid and slowly pull back about 0.5ml of liquid (you'll also pull air in the syringe).
- Point the vial/syringe combination vertical and flick the syringe at the location of any bubbles to force them to the top of the syringe.
- Adjust the needle into the air space and push the plunger to expel the air from the syringe.
- Adjust the needle so it is near the bottom of the liquid and slowly pull back about 1.2ml of liquid.
- Re-check for any bubbles and repeat if necessary.
- Remove the syringe and needle from the vial.
- Insert the needle approximately one-third of its length into vial of Betaseron (green vial).
- Keep un-beveled side of needle towards side of vial and slowly press the syringe plunger to force the saline into the vial.
- With the syringe in the upright position and in the air space of the vial, pull back about 0.5ml of air and flick the syringe to drop any remaining saline to the bottom of the syringe.
- Push the remaining saline into the vial.
- Pull back 1.0ml of air from the vial into the syringe and remove the syringe from the vial.
- Cap the syringe.
- Remove the needle from the 3ml syringe, saving the needle and disposing of the syringe.
- "Swirl" vial-Let stand giving time to settle.
- Get a 1ml syringe and open the package an inch or so.
- Leaving the capped needle in the package, remove the 1ml syringe.
- Take the needle from the 3ml syringe (same one) and put on the 1ml syringe.
- Leaving the cap on, draw up 1ml of air into the syringe
- Set up Autoject 2- The yellow dot on back will show it’s loaded.
- Locate a cotton ball (these last two steps allow time for the medication to reconstitute.
- Insert needle into vial and (air to air) push the plunger all the way down.
- Lower needle into the slot space (look for slot in gray area of vial) and pull back on plunger to .5ml.
- Flick the syringe to loosen any air bubbles, then push plunger gently forward, getting rid of any bubbles.
- Pull back down to past 1ml and re-check for air bubbles. Push back to 1ml.
- Cap the needle, remove it from the syringe, and dispose of it.
- Insert syringe into the waiting needle in the 1ml syringe package
- Leaving the cap in the package, pull the needle from the cap.
- Carefully place the filled syringe into Autoject 2.
- Keep 1 "circle" diameter away from previous injection sites.
- Do not pinch the skin into a 'tent'.
- Wipe area to inject with alcohol pad; allow to dry.
- Have cotton ball ready. Line up Autoject 2 with thumb and finger to adjust for "no pressure."; the Autoject rests gently on the skin.
- Face Autoject 2 towards face to watch for yellow sign that solution has been injected.
- Pull down slightly on Autoject 2 to release safety and push the blue button. Wait 5 seconds or look for yellow in window before removing the needle from the skin.
- Remove the Autoject, remembering there is a needle exposed on the end and press the cotton ball on the injection site.
- After any bleeding or medication seepage has stopped, remove the syringe from the Autoject and dispose of it.
- Put Autoject 2 in holder, clean up and pack the kit away.
- Restock supplies when necessary