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Acetylcysteine Administration

Views: 8264 - Comments: 12

Rachel Kinney, CVT, VTS(ECC), demonstrates the procedure for administering acetlycysteine to a patient. Appropriate drug dilution and IV administration protocol are covered.

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Rachel Kinney's picture
Rachel Kinney


Enrolled: 08/2011

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Stephanie  Cowan 's picture

How many times do you re-use the filter? Hemonate filters are typically effective for filtering up to 50mls. That looks like a 0.2 micron filter, so just wondering if it can appropriately filter that large a volume? Do you (gas) sterilize them between uses? Our protocol dictates that all filters are single use; I am curious to know what your research indicates.

Megan Brashear's picture

Stephanie, that is a micropore filter that we are using, they are for filtering bacteria (same on we would use for an epidural for example). The hemonate filters are not small enough for bacteria. We do not re-use them, we will charge the client for each use. When Rachel mentions 'using it multiple times' she is referring to the same bottle of preservative free acetylcysteine that we will use multiple times on the same patient.

Becky Stine's picture

I have been "strongly encouraged" not to flush lines or dilute (most) medications with sterile water unless it's required, and rather use sterile saline. Is this overly cautious or am I missing something?

Megan Brashear's picture

Caroline, D5W is 5% Dextrose in Water. The easy equation for diluting percentages is: C1*V1 = C2*V2 where C is your concentration, and V is your volume. In this video, Rachel draws up 4ml of D5W for every 1ml of acetylcysteine (20/5 = 4). The actual math: 20*1.52 = 5*x ; 30.4/5=6.08
You would draw up 1.52ml of acetylcysteine and 6.1 (rounding up) ml of D5W and that gives you a 5% solution.

Megan Brashear's picture

Becky, you have been told correctly. Sterile water is hypotonic and is painful to inject alone. Large quantities can cause hemolysis. Take a look at the hyponatremia tiny talk where I explain it in more detail, but unless specifically ordered, normal saline should be used to flush IV lines and drugs. D5W, while in sterile water, is isotonic with the addition of the dextrose.

Rebecca Marcus's picture

I have also been told that it is inappropriate to use sterile water in IV injections, unless it has been made isotonic prior. Given that in the comments Megan Brashear agrees, perhaps this video should be remade with the exclusion of sterile water as an appropriate IV line flush. It is very misleading as it stands.

Megan Brashear's picture

Hey all, I did a little digging just to make sure, and the package insert (and human pharmacy sites) do list sterile water as an approved diluent for acetlysteine along with D5W and 0.9% NaCl. I recommend discussing a protocol with your veterinarian and training your team as to which diluent you will use (we use exclusively D5W unless the patient happens to be diabetic or something crazy like that)and just make sure everyone is on the same page. I would have to do some more research, but perhaps the acetylcysteine changes the tonicity of the sterile water enough that it isn't a problem? If anyone has a great answer for that let me know! Otherwise I'll put my chemistry hat on...

Alexandra  Bodan's picture

Why do we stop the fluids while giving acetylcysteine? Does it percipitate in the line with most crystalloids?

Jessica Waters-Miller's picture

Hi Alexandra,
While Acetylcysteine is compatible with crystalloids, it is incompatible with multiple commonly used medications and residual drug may remain in the fluid line. So it is best practice to discontinue their fluids while giving Acetylcysteine. This is also why we flush before and after. Hope this helps!

Jessica Waters-Miller's picture

I apologize, we also stop the fluids because the volume we dilute Acetylcysteine in is a large amount and we do not want to fluid over load the patient.

Denali Halsey's picture

I'm a little confused about the final math, when using the dilution formula do you use V2 as the total amount of solution or only as the amount of the diluent? In this example would it be V2 + V1 (the calculated ml dose of 20% Acetylcysteine plus the D5W) or V2 - V1? I'm also confused because the tech in the video says something different that a technicians math's in the comments section.

In the video the tech says she is pulling up just over 4.5 ml of D5W and then adding the 1.5 ml of Acetylcysteine to that amount, that would be a total volume of around 6mls. In the comments another tech uses the dilution formula C1V1 = C2V2 and says that it would be 6.2mls D5W plus 1.5ml of Acetylcysteine, that would be a total volume of 7.7ml. If you do that math backwards, i.e the total mg of Acetylcysteine (305mg) divided by the total volume of liquid you should be able to get the correct percentage either 20% or 5%, right?

For example - 305mg/1.5ml(of the 20% Acetylcysteine) = 203mg/ml or a 20.3% Acetylcysteine solution.
Using the total volume suggested by the video - 305mg/6ml = 50.8 mg/ml or a 5% Acetylcysteine solution.
Using the techs math from the comments - 305mg/7.7ml = 39.6mg/ml or a 3.9% Acetylcysteine solution.