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Tips on Mixing Desferal and Doing the Pump

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Offline nice friend

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Tips on Mixing Desferal and Doing the Pump
« on: November 17, 2008, 07:16:52 PM »
Quote
http://74.6.239.67/search/cache?ei=UTF-8&p=why.stop.desferal.fever&fr=b2ie7&u=www.thalassemia.com/perspectives.805.pdf&w=why+stop+desferal+fever&d=SsEimkLURrs4&icp=1&.intl=us

Note : its a little piece of the article , to read full article , click on the link above ....

1. When you get your delivery of Desferal forthe week or month, sort everything out,
and make individual bags for each night of
the week. For example, put everything you
need to mix Desferal (Desferal, sterile
water, syringe, etc.) in a Ziploc bag, and
then when you are ready to mix, you have
everything ready to go.

2. Mix a few nights worth of Desferal all atonce—it saves time! Note that once mixed
with sterile water, Desferal lasts for up to
seven days.

3. Wash your hands with warm water and anti-bacterial soap before mixing Desferal.

4. When you pop off the tops of the Desferaland sterile water vials, clean the vials with
an alcohol wipe.

5. Always point the syringe and needle awayfrom your body so you do not poke yourself
by accident.

6. When mixing Desferal with sterile water,DO NOT shake the vials. To dissolve the
Desferal, roll the vials in the palm of your
hand, or place the vials in your sock or the
waistband of your pants. Your body heat
will dissolve the Desferal in a few minutes.

7. Put all needles in a sharps container.

8. Wash your hands and clean the site withalcohol before inserting the needle into
your subcutaneous tissue.

9. Rotate the needle sites so that the tissuehas time to heal before you use the same
site a second time.

10. If inserting the needle is painful, take a fewdeep breaths and try to relax before trying
again.

11. [bgcolor=#ffff00]f you have a fever above 101ºF, do nottake Desferal.[/bgcolor]

12. Emla cream, a topical anesthetic, some-times helps lessen the pain of the needle
stick. Emla should be applied at least 30
minutes before needle insertion.

13. If you experience redness and itching atthe infusion site, you may want to add
hydrocortisone to your Desferal routine.
Hydrocortisone cream, applied to the skin
when the infusion is finished, may reduce
itching, as well. Adding more sterile water
to Desferal or running your pump for a
longer period of time may also help
reduce lumps and itching.

14. It is vital to use Desferal to prevent ironoverload and to live a healthier life!
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Sometimes , He breaks our heart to make us whole.
Sometimes , He sends us pain so we can be stronger.
Sometimes , He sends us failure so we can be humble.
Sometimes , He sends us illness so we can take better care of our selves.
Sometimes , He takes everything away from us so we can learn the value of everything we have.
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Offline Zaini

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Re: Tips on Mixing Desferal and Doing the Pump
« Reply #1 on: November 18, 2008, 03:04:38 AM »
Quote
2. Mix a few nights worth of Desferal all atonce—it saves time! Note that once mixed
with sterile water, Desferal lasts for up to
seven days.

Never heard that before,is that really correct,because sometimes it happens that when our daughter wakes up,her desferal isn't finished,and it's school time so we have to remove the pump,when i asked doctor about this left desferal,that if we can use it gain once she is back from school,but he said no  ??? .

Zaini.
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Offline nice friend

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Re: Tips on Mixing Desferal and Doing the Pump
« Reply #2 on: November 18, 2008, 05:04:49 AM »
AOA Zaini ,
you're pretty right on it ,doctors  said like wat you mentioned but thing is that why do we need to store mixed desferal for a whole week ??? .. and why to store desferal ?? .. you may make and start chelation at same time as u r doing,,
about this inofrmation/quote ,
i quoted this piece of information from a well knowned sites PDF document , yes its Childrens Hospital & REsearch Center , Oakland , where The Dr.Vichniisky is professor , so anyone have doubt abt his research ??. no one ... it couldn't be wrong .. but we dont need to left mixed desferal on shelf .. i red somewhere in Sharmin's ost that they get's pre-mixed desferal , if they get pre-mixed then they definately didn't use all in same time and same day ... soo , i think that information is correct becouse its come from a good place . i m send the link of that PDF so you can download the complete document , its a newsletter .... oh yeah wait for others to reply and have their opinion as well . Temprature and storage also effect's the shelf life of desferal , so it vary on the storage and temprature as well.... its my opinion , please wait for others as well ....

PERSPECTIVE
Newsletter of the Northern California Thalassemia Center - fall in September 2005 ...
www.thalassemia.com/perspectives.805.pdf

Take Care
Umair
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Sometimes , God breaks our spirit to save our soul.
Sometimes , He breaks our heart to make us whole.
Sometimes , He sends us pain so we can be stronger.
Sometimes , He sends us failure so we can be humble.
Sometimes , He sends us illness so we can take better care of our selves.
Sometimes , He takes everything away from us so we can learn the value of everything we have.
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Umair
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Offline Sharmin

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Re: Tips on Mixing Desferal and Doing the Pump
« Reply #3 on: November 18, 2008, 05:24:16 AM »
Zaini,

We receive desferal premixed and we use it for up to 7 days.  We pick up the premixed bag every Wednesday that we attach to his pump.  The expiration date on the bag is always 7 days from the date that it was mixed.  We were also told in Oakland that desferal is good for 7days once mixed. 

And yes, I have also been told that one should avoid desferal during a fever and when a urinary infection is present because desferal can prolong urinary tract infections. 

Sharmin
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Offline Zaini

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Re: Tips on Mixing Desferal and Doing the Pump
« Reply #4 on: November 18, 2008, 11:28:18 AM »
So is it okay to use left over desferal in the syringe? after changing the butterfly needle?

Zaini.
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Offline nice friend

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Re: Tips on Mixing Desferal and Doing the Pump
« Reply #5 on: November 18, 2008, 11:34:45 AM »
Hi Zaini ,
My opinion is , Yes , don't knw abt others ..  i think that you can use remaindered desferal in syring , but try to not store mixed desferal .. better is to make and use , dont store needlessly/unnecessory ..... Good Luck Sis ....

Best regards
Take Care
Umair
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Sometimes , God breaks our spirit to save our soul.
Sometimes , He breaks our heart to make us whole.
Sometimes , He sends us pain so we can be stronger.
Sometimes , He sends us failure so we can be humble.
Sometimes , He sends us illness so we can take better care of our selves.
Sometimes , He takes everything away from us so we can learn the value of everything we have.
===========
Umair
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Offline Canadian_Family

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Re: Tips on Mixing Desferal and Doing the Pump
« Reply #6 on: November 18, 2008, 02:48:28 PM »
Hi Zaini,

In your case you are preparing the desferal. My wife prepared the desferal in the morning and store it in the fridge to be used at night but we never used it after. I think the instructions were to refrigerate the desferal after mixing and use it, however, once used overnight, refrigerating and using again, I am not aware of such instructions. I would not take the risk until I confirm it with doctor or Novartis. I can try emailing Novartis or calling the pharmacy to confirm that for you. Please wait.

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Offline nice friend

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Re: Tips on Mixing Desferal and Doing the Pump
« Reply #7 on: November 18, 2008, 08:37:15 PM »
Quote
http://emc.medicines.org.uk/emc/assets/c/html/displaydoc.asp?DocumentID=2666

Vial: Store below 25°C.

Reconstituted solution : Single use only.

From a microbiological point of view, the product should be used immediately after reconstitution (commencement of treatment within 3 hours). When the reconstitution is carried out under validated aseptic conditions the reconstituted solution may be stored for a maximum of 24 hours at room temperature (25°C or below) before administration. If not used immediately, in-use storage times and conditions prior to administration are the responsibility of the user. Unused solution should be discarded.

Quote
http://www-klinik.uni-mainz.de/Zentrallabor/Lab-Web/Literatur/Desferaltest.pdf
How to store Desferal
Store the vials containing the dry active substance below 25°C.
One vial is for single use only. Once the solution has been made up (reconstitution), the
product should be used immediately thereafter (i.e., start of treatment within 3 hours). When
the solution has been made up under recognised sterile conditions it may be stored for a
maximum period of 24 hours at room temperature before start of treatment.

its pretty much confusing but i believe that Dr.Vichinisky's  research and study is good to believe on . but again i want to say that , we dont need to store mixed desferal to its full storage life ... it will b good as soon as possible u use the desferal after mixing that up ... i will try to find out more links abt wat i mentioned in  my first post ...      i think none of us have any doubt on the  professors Vichinsky's research ... but we have to investigate and confirm every possible way , before doing anything new .... Nice Zaini , you raise the point to think on ... i realy appreciate that ...

Take Care
Umair
« Last Edit: November 18, 2008, 08:51:13 PM by nice friend »
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Sometimes , God breaks our spirit to save our soul.
Sometimes , He breaks our heart to make us whole.
Sometimes , He sends us pain so we can be stronger.
Sometimes , He sends us failure so we can be humble.
Sometimes , He sends us illness so we can take better care of our selves.
Sometimes , He takes everything away from us so we can learn the value of everything we have.
===========
Umair
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Offline Canadian_Family

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Re: Tips on Mixing Desferal and Doing the Pump
« Reply #8 on: November 19, 2008, 02:10:03 AM »
The pharmacy confirmed not to use the leftover. Once mixed and stored in the fridge (it can stay for 12 hours to be used), at room temperatures (during administration) it can stay for 8-10 hours, discard the leftover as it is no good in the syringe anymore.
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Offline Zaini

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Re: Tips on Mixing Desferal and Doing the Pump
« Reply #9 on: November 19, 2008, 03:31:43 AM »
Thanks Canadian Family,

You cleared a big confusion,our pump is not very accurate,so i remember that sometimes,and i am talking about a long time ago,it happened that half the syringe use to be still full after she woke up in the morning,so we used to discard it ,so i thought we might use it again,but now you cleared it for us.Thanks a lot again.

Zaini.
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Offline Andy Battaglia

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Re: Tips on Mixing Desferal and Doing the Pump
« Reply #10 on: November 19, 2008, 04:59:48 AM »
There is conflicting information about how long desferal can be kept once mixed. Some people mix a week supply at once and use it through the week. This is supported by the Merck Manual.  http://www.merck.com/mmpe/lexicomp/deferoxamine.html

Quote
Storage

Prior to reconstitution, do not store above 25?C (77?F). Following reconstitution, may be stored at room temperature for 7 days; protect from light. Do not refrigerate reconstituted solution.

However, because of the possibility of bacterial contamination, it is also commonly recommended that once mixed, it must be used within 24 hours.
http://emc.medicines.org.uk/emc/assets/c/html/DisplayDoc.asp?DocumentID=2666#STORAGE

Quote
   

Vial: Store below 25°C.

Reconstituted solution : Single use only.

From a microbiological point of view, the product should be used immediately after reconstitution (commencement of treatment within 3 hours). When the reconstitution is carried out under validated aseptic conditions the reconstituted solution may be stored for a maximum of 24 hours at room temperature (25°C or below) before administration. If not used immediately, in-use storage times and conditions prior to administration are the responsibility of the user. Unused solution should be discarded.

That is a disclaimer so if there is any problem of bacterial contamination after more than 24 hours from when the desferal was mixed, the company has some protection against liability. When mixing desferal everything must be kept as sterile as possible. Real life practice has caused the recommendation to be shortened because in many cases the strict adherence to staying sterile has not been followed, so the 24 recommendation has become more standard. If you have been successfully storing mixed desferal for up to 7 days with no problems with bacterial infections, I don't think there is any cause for concern, as long as sterile standards are followed.
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