Children’s Services : How to give emergency hydrocortisone injections to patients with Duchenne Muscular Dystrophy (DMD) receiving long term steroid therapy

Who is this leaflet for?

This leaflet gives advice for parents or guardians of children with Duchenne Muscular Dystrophy (DMD) receiving long term steroid therapy and includes instructions for the use of Solu-Cortef vials.

Introduction

It may be necessary in certain situations to give your child an emergency injection of hydrocortisone. These situations include if your child your young person:

• Is unable to take tablets or fluids by mouth (e.g. due to continued vomiting).
• Has severe diarrhoea
• Feels sleepy, drowsy and is difficult to wake up
• Has been taking sickness dose of steroids my mouth but suddenly gets worse, more lethargic and drowsy. Has been involved in a major accident

Dosage

The dose of the injection depends on the age of your child:

• Age 1-5 years give 50mg (0.5ml of the 100mg/ml solution)
• Age 6 years and above give 100mg (1ml of the 100mg/ml solution)

Equipment Needed

Clinell wipe

2ml syringe

Blue needle

Red filter needle

Hydrocortisone vial

Water for Injection ampule

1. Preparing the syringe and needle

1.1 Remove the syringe from the sterile packet without touching the nozzle of the syringe.

1.2 Carefully remove the red ‘fill’ needle from the sterile packet and attach it to the nozzle end of the syringe.

2. Drawing up the water for injection

Place the water for injection on a flat surface and draw up 1ml using the syringe and needle.

3. Mixing Solu-Cortef (Hydrocortisone sodium succinate)

3.1 Remove the cap and insert the needle into the bung of the Solu-Cortef 100 mg vial. Push the water in to produce 100mg/ml solution.

3.2 Leave the needle and syringe in the vial whilst waiting for the powder to dissolve. Do not shake the vial.

4. Loading the syringe Part 1

4.1 Once dissolved, carefully draw up the contents of the vial into the syringe.

4.2 Remove the needle from the vial.

5. Loading the syringe Part 2

5.1 Remove the red ‘fill’ needle from the syringe and attach a new blue (or orange) ‘giving’ needle.

5.2 Turn the syringe so that the needle is pointing upwards.

5.3 Tap the syringe to ensure any air bubbles rise to the top.

5.4 Gently push up the plunger so that any air is expelled from the syringe.

5.5 Gently push up the plunger to expel any excess hydrocortisone so that you have the correct dose for the child.

6. Giving the injection

6.1 Your child should be lying down in a safe position.

6.2 The injection should be given into the upper outer thigh or the upper outer aspect of the bottom depending on where you have been shown to give it.

6.3 Clean the skin with the small alcohol wipe.

6.4 Place one hand on the surrounding skin.

6.5 Smoothly insert the needle through the skin to a depth of about half the length of the needle.

6.6 Smoothly push down the plunger until the syringe is empty.

6.7 Remove the needle and syringe from the skin and dispose of the needle in a sharps bin if you have one. (If a sharps bin is not available, put the needle in an empty sandwich box or other suitable container and take it with you to hospital where it can be disposed of safely.)

6.8 Take your child to your nearest hospital with an Emergency Department immediately.

Contacts

Please contact the Neuromuscular Specialist Nurses on 01223 348882 if you need any further advice.