Self-administration of tigecycline infusion

This leaflet is for patients who have been advised to take an antibiotic called tigecycline to treat their infection and have chosen to self-administer this medication with the support of the outpatient parenteral antibiotic therapy (OPAT) team. Family and/or carers may also find the information useful.

What is tigecycline?

Tigecycline belongs to a group of antibiotics called glycylcyclines. It is a medicine that can be used to treat a wide range of bacterial infections. Tigecycline will always be administered intravenously (into a vein) and must not be taken by mouth.

Are there any side effects?

The most common side effects experienced by more than one in 100 patients and fewer than one in 10 patients are:

• headache, dizziness
• 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 tigecycline to check for any problems.

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

Equipment per dose

• One: 10ml syringes
• One: red blunt needles
• Two: small Clinell wipes
• One: spray disinfectant
• One: sharps bin
• One: intravenous giving set
• One: 10ml ampoule of sodium chloride 0.9% (normal saline) solution
• Two:10ml prefilled 0.9% sodium chloride syringes
• One: vial of tigecycline in powder form [50 milligram (mg) strength]
• One: 100ml bag of sodium chloride 0.9%

Actions

Before you start always remember to check the dose and expiry date of the tigecycline vial and the normal saline (sodium chloride) ampoules.

1. Wash your hands thoroughly and clean the preparation surface with disinfectant spray and then assemble the necessary equipment. Your preparation surface should be a non-porous surface which is clear of clutter ( for example, a kitchen top or work desk) and, if possible, large enough to spread out the equipment for easy use.
2. Prepare saline flushes
3. Prepare medication

• Clean the top of the saline ampoule and stopper of tigecycline vial with a small Clinell wipe and allow 20 seconds to dry before opening it.
• Draw up 5.3ml of normal saline into a 10ml syringe using the red needle, and slowly inject into the vial of tigecycline 50mg powder. Agitate this vial until the powder is fully dissolved. Keep the needle and syringe attached to the vial.
• Withdraw 5ml of the mixed solution into the syringe – tilt the vial to the side if necessary.
• Slowly inject the mixed solution of tigecycline into the bag of 100ml of normal saline through the administration port. Invert the bag of sodium chloride 0.9% several times to ensure adequate mixing of the drug.
• Dispose of the needle and syringe into the sharps bin.

4. Preparing intravenous administration set

• Open the intravenous administration giving set and roll down the roller clamp.
• Snap off the plastic cap on the 100ml bag of sodium chloride 0.9% with the tigecycline mixed in to it and 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 too quickly and if it is very low, the fluid will run through too 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 Clinell wipe and allow 20 seconds to dry.
• Flush the line with 10 ml saline solution 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.