Self-administration of ertapenem

This leaflet is for patients who have been advised to take an antibiotic called ertapenem to treat their infection and have chosen to self-administer this medication with the support of the outpatient parenteral antibiotic team (OPAT).

What is ertapenem?

Ertapenem is an antibiotic of the beta-lactam group. It is a medicine which is used in a wide range of bacterial infections. Ertapenem will always be administered intravenously (into a vein) and must not be taken by mouth.

Are there any side effects?

The most common (more than one in 100 patients and less than one in 10 patients) side effects are:

• headache
• diarrhoea, nausea, vomiting
• rash, itching

If you experience any of the above side effects or any others please inform one of the OPAT team. You will have regular blood tests in clinic while being treated with ertapenem to check for any problems.

How do I administer it?

The OPAT nurse and ward nursing team will ensure you are happy and safe to administer ertapenem following the procedure below.

Equipment per dose

• One: 10ml syringes
• One: red blunt needle
• One: 100ml bag of normal saline solution 0.9% (sodium chloride)
• Two: small Clinell wipes
• One: 10ml ampoule of ‘water for injection’.
• Two: 10ml syringes of normal saline 0.9% (sodium chloride)
• One: intravenous giving set
• One: disinfectant spray
• One: sharps bin
• One : vial of ertapenem in powder form (1gram(g) strength)

Actions

Always remember to check the dose and expiry date of ertapenem, ‘water for injection’ and normal saline (sodium chloride).

1. Wash your hands and clean the preparation surface with disinfectant spray and assemble the necessary equipment. Your preparation surface should be a non-porous surface which is clear of clutter (eg a kitchen top or work desk).
2. Prepare saline flushes
3. Prepare medication

• Clean the top of the ‘water for injection’ ampoule and allow 20 seconds to dry before opening it.
• Draw up the ‘water for injection’ into a 10ml syringe using a red needle.
• Slowly inject the water into the vial of ertapenem powder and agitate this vial until the powder is fully dissolved. Keep the needle and syringe attached to the vial.
• Withdraw the mixed solution into the syringe – tilt the vial to the side if necessary.
• Slowly inject the mixed solution of ertapenem into the bag of 100ml of normal saline through the administration port.
• Invert the bag of saline with the ertapenem in it several times to ensure adequate mixing of the drug.
• Dispose the needle and syringe into the sharps bin.

4. Preparing administration set

• Open the intravenous administration giving set and roll down the roller clamp.
• Snap off the plastic cap on the 100ml bag of normal saline with the ertapenem mixed in to it and then insert the giving set. Squeeze the drip chamber until it is half full with fluid.
• Hang the bag up somewhere high. If it is very high the fluid will run through quickly and if it is lower the fluid will run through slowly. You may find a coat hanger helpful to hang it up.
• Slowly open the roller clamp on the giving set and allow fluid to flow to the end of the line.
• Close the roller clamp.

5. Administering medication

• Clean the bio-connector on the PICC line with a small Cinell wipe and allow 20 seconds to dry.
• Flush the line with 10 ml of normal saline using the pulse (push-pause) technique as demonstrated by the ward nurses and OPAT team.
• Attach the giving set to the bio-connecter.
• Open the roller clamp and adjust it to a speed of roughly 50 drops a minute, so that the drug takes 30 minutes to be administered. One way to get this rate is to try to get one drop per second and then slow it down a fraction.

6. End of administration

• Close the clamp and disconnect the giving set from the PICC line.
• Flush the PICC line with 10ml of normal saline using the pulse technique.

Potential problems

You should let the OPAT team know if any of the following happen;

• You feel unwell after administering the antibiotic.
• The antibiotic or the flush cannot be administered easily through the PICC line.
• You may have injected a large amount of air.
• If the PICC line feels sore/uncomfortable, or a discharge is coming from the PICC entry site.