Drawing Up Meds. & A Diabetic Cat

[nwhitney]

I have a question about drawing up meds. But a little background is needed first.

In class we drew up injections of sodium chloride and practice giving each other injections. The assistant that was working with my group had us set the plunger (lack of a better term) to 30cc (using that as an example) then had us push that 30cc of room air into the vial then draw up 30cc of sodium chloride.

Now we move over to my cat. I have a diabetic cat and he requires 2 injections daily of insulin. When explaining the procedure the vet was very careful to explain that when mixing the insulin not to shake it but to roll it gently in between your hands so as not to induce too much air into it.

So on to my question. Is air getting mixed in a concern?

 

[usafmedic45]

When you're dealing with that fine of a syringe, even small bubbles can affect the dosage a great deal and you really want to be spot on when it comes to insulin dosages.

 

[nwhitney]

When you're dealing with that fine of a syringe, even small bubbles can affect the dosage a great deal and you really want to be spot on when it comes to insulin dosages.

I wasn't even thinking about dosage, that makes sense.

What about being taught to push room air into the vial before drawing up the med? Could introducing air that way affect dosage? Could it affect the med. itself on the molecular level? Now I'm mostly referring to meds. a medic has access to.

 

[bigbaldguy]

I think injecting air to create back pressure is different from shaking the vial in terms of how the air is distributed through the liquid.

 

[Shishkabob]

It's not the air, but the bubbles.

 

[MrBrown]

Cats get diabetes? :unsure:

 

[nwhitney]

Cats get diabetes? :unsure:

Yup and it's a pain in the arse. He got up to 23lbs at one point. He takes human insulin and takes quite a bit for a cat, 6 units twice a day.

 

[usafmedic45]

I wonder what his HgbA1C is....

 

[mycrofft]

Been there done that, cat and patients.

Fine bubbles can displace insulin, especially in tinier feline doseages. Introducing air...be conservative, you don't want the insulin jumping into the syringe, or a fine spray arising from the vial when you extract the needle. Bad form.

Hope your cat's experience is better than mine's.


ADDIT: http://baycomdiagnostics.com/index-4-canine-vs-feline.htm


"Feline Glycohemoglobin

Cat hemoglobin is particularly susceptive to oxidation and diabetic cats have increased numbers of RBCs with Heinze bodies (Heinz bodies are clumps of precipitated hemoglobin that result from oxidative damage to hemoglobin). This also leads to anemia and low phosphorous levels that precipitates a hemolytic crisis by lowering intracellular ATP levels."

IBID:
"Question: Why don't antibody based A1c tests work?


Answer: Canine and feline hemoglobin structures are just different enough from humans that the antibodies that all these tests are based on do not bind with the same affinity, giving test results for canines that can be off by 40% and even worse for felines".

 

[Frozennoodle]

He is referring to mixing the drugs together and when you shake the fluid you will introduce air bubbles into the solution. As an example take a bottle of water and shake it up and you will see air bubbles form in the water. If you draw them up you will get inaccurate dosages. I don't think he's talking about injecting air into the vacuum in order to draw mess out but the actual mixing process of the drug into a solution.

 

[18G]

I am always cautious about injecting the same volume of air into a vial that you are gonna draw out. I have had it happen to me and have seen it happen to a doctor. The top of the vial blows off and needless to say medication fly's everywhere.

The doctor time was actually kinda funny. He was doing a procedure to biopsy a vessel I believe and was using epinephrine... he went to inject the same volume of air and the top blew off the vial making a loud noise and epi sprayed everywhere...lol... this was when I was a Paramedic student observing... so yeah... be careful when drawing up meds...ha.

And a personal tip... do not instill air into a carpujet. As a student I was drawing up dilauded and instilled same volume of air that I was drawing out medication wise and my preceptor who was standing beside me got a face full of dilauded...lol... I blew the end out of the carpujet... she was very cool about it... just wanted to pass that along

Injecting the air is not a necessity it only makes getting the med into the syringe a little easier. With that said I only inject a few cc's of air (less than the volume of the vial).

But that's just me. I have also heard some teach a 1cc "air plug" in the syringe for IM injection to help push the med deeper into the muscle. Anyone practice this? Is there any info that say's there is any better absorption?

 

[mycrofft]

I always drew extra air into the insuilin syringe betwen types.

The five units of air do no harm. Also, when mixing insulins, the air draw between them allows you to see exactly how much more you have drawn.

I also always drew a couple uhiots extra insulin then ejected down to volume, then drew a few units air aferwards. Cuts down potential meniscus issues and clears all the vloume out incouding the needle and the shoulder of the syringe barrel, but you have to KNOW, KNOW the math and do it the same way every time.

Oh, try injecting the extra air into an old fashioned glass lavendar-top EDTA blood vacutainer full of blood before extracting...it repeatedly blew out the bottom.

 

[dstevens58]

Cats get diabetes? :unsure:

We have a cat with seizures, of the grand mal variety. Small cat, on maintenance dosage of 2ml phenobarbital, three times a day.