How to administer your medication using Mini-bag^™ Plus gravity infusion with a rate flow device

Hi, I'm Helen and I'm going to walk you through how to administer your medication using a mini bag Plus and the gravity method with a rate flow device. With this method, you'll use an IV pole, a mini bag plus medicine bag, and tubing with rate flow control to administer your medication. You'll set the dial on the rate flow regulator to make sure you get the right amount of medication at the rate ordered by your doctor. 

There are 7 steps you'll need to follow, and you can jump to anyone at any time using the chapters below. 

Step 1: Getting started 

Let's start by making sure you're using a clean area at home. You can wash the surface with soap and water or a disinfectant wipe. You can use your SASH preparation mat as a clean work surface. Use soap and water or disinfectant wipes after each use to keep your SASH mat clean. 

Now go ahead and wash your hands really well for at least 20 seconds. Apply enough liquid soap to cover the entire surface of your hands. Use a nail brush to clean under your nails if needed. 

Rinse your hands thoroughly and dry them with a paper towel or clean unused hand towel and use that same towel to turn off the faucet. If you don't have access to soap and water, use an alcohol based hand sanitizer. 

Making sure you have a clean area and clean hands during every step is really important to help prevent infection. Next, make sure you've got all your supplies ready to go on your SASH mat or other clean work surface. Mini bag plus medication bag at room temperature, IV pole, IV tubing with rate flow control, sterile protective cap if infusing more than once a day, 2 prefilled saline syringes, 1 prefilled heparin syringe if ordered alcohol pads. You'll want to check your medication and label for the correct patient name, correct medication, correct dose, and that it's not expired. And the solution should be clear, consistent in color, and free of any visible particles. If it's not, call us right away. You will also want to remove any air from your saline and heparin syringes. Hold the saline syringe with the tip pointing up and press firmly on the plunger while the tip cap is still on until you feel a click or see the plunger move. Then loosen the tip cap and gently push the plunger to remove any air. Retighten the cap before placing it back down. Hold the heparin syringe with the tip pointing up and press firmly on the plunger while the tip cap is still on until you feel a click or see the plunger move. Then loosen the tip cap and gently push the plunger to remove any air. Retighten the cap before placing it back down. 

Once all of your supplies are ready, wash your hands again for at least 20 seconds. If you touch something other than your supplies after washing your hands, you need to re wash your hands or you can use an alcohol based hand sanitizer. 

Step 2: Preparing your medication 

If your medication was refrigerated, you need to let it warm to room temperature before you move on. And no shortcuts here. It's not safe to ever use hot water or a microwave to warm your medication. 

OK, let's get your medication ready. Pick up the Mini bag Plus and bend the connection between the bag and the vial adapter by moving it back and forth until the seal breaks. Holding the bag with the medication vial hanging down, squeeze the bag until the vial is half full of solution. Shake it gently to dissolve the medication into the fluid. Now holding the bag with the vial upside down, squeeze and release the bag a few times to force air into the vial and allow all the medication to flow into the bag. 

You might need to do this again if there's still powder in the vial. When the vial is empty, take the IV tubing out of the package and untwist it to its full length. Close the clamp on the tubing and turn the dial to the off position. Now, without touching the end of the medication bag port with your fingers, remove the tab. 

Then take the clear cover off the spike end of the IV tubing and push the spike into the port of the medication bag, twisting it as you push it so it reaches the ridge. 

Hang the medication bag from the IV pole, making sure it is fully extended so that the medication is above your catheter line. Then, gently squeeze the clear drip chamber of the IV tubing until it's filled, halfway. Open the clamp on the IV tubing and turn the rate flow dial until you see medication dripping into the drip chamber. You'll want to watch the medication as it moves through the tubing. 

When you see a drop of fluid at the end of the tubing, quickly close the clamp to stop the medication from dripping. Now you can set the dial to your prescribed infusion rate, so go ahead and do that. 

If your label doesn't show the rate milliliters per hour, your nurse will tell you what it should be. 

Your tubing is now primed and ready to use. It's likely you've heard us talk about SASH or S-A-S-H to help you remember several of the steps for infusion, and we're going to use SASH again today. 

Step 3: Saline flush 

The first part of SASH is the saline, which you'll use to flush your catheter. If you have a double lumen catheter flush as directed by your nurse or pharmacist. Use an alcohol pad to clean the injection cap for 15 seconds and let it air dry for five seconds. Be careful not to touch the top of the injection cap with your fingers. Go ahead and open the clamp on your IV catheter or extension set. Remove the tip cap from the saline syringe, then push the saline syringe onto the injection cap and twist it clockwise until it's secure. The tip of the syringe is sterile, so do not touch it or lay it down on any surface while the cap is removed. If it does come in contact with something, throw it away and get a new one. Push the plunger and slowly to flush the catheter with as much saline as instructed. If you don't know how much to use, call us and we'll confirm. Administer your saline flush as instructed by your nurse. This can be done slow and steady or by the pulse method. To use the pulse method, push the plunger, then stop for a second and then push the plunger again. When you have flushed all of the saline into the catheter, remove the syringe from the injection cap and discard the syringe as instructed by your nurse. 

One note, if it's hard to push in the plunger during any flush, check to make sure all the clamps are open. And if you have pain, burning, or swelling when flushing, stop right away and call us. 

Step 4: Administering your medication 

Now you're ready to administer your medication. The second part of SASH. Scrub the catheter injection cap again with a new alcohol pad for 15 seconds and let it air dry for five seconds. Be careful not to touch the top of the injection cap with your fingers. Take the protective cap off the end of the rate flow tubing, being careful not to touch the sterile end with your fingers. 

Connect the end of the tubing to the catheter injection cap by pushing it in and turning it clockwise until it's secure. Recheck that the dial is set to your prescribed infusion rate and then unclamp the tubing. Medication should start to drip into the clear chamber. Now, find a comfortable place to sit while your medication is being administered. 

Take a deep breath, you're doing great. 

You want to stop the flow right when the bag is empty but still includes a little fluid in the drip chamber. Then clamp the tubing and turn the dial to off. Disconnect the tubing from the injection cap. 

If you're infusing more than once a day, put a sterile cap on the end of the tubing to keep it sterile until it's ready for the next use. 

To keep the spike sterile, you can leave it in the empty bag hanging from the IV pole until it's time for your next dose. You should only use your tubing for 24 hours, and then throw it away. For example, if you need to infuse a new dose every 12 hours, you can use the same tubing 2 times before discarding it. 

When it's time for your next dose, take the spike out of the empty bag, being careful not to touch the spike to anything before using it to spike a new medication bag. 

You will not need to reprime the tubing. 

Step 5: Second saline flush 

Now you do another saline flush, the third part of SASH and you'll follow the same steps as earlier. Use a new alcohol pad to clean the injection cap for 15 seconds and let it air dry for five seconds. Be careful not to touch the top of the injection cap with your fingers. Remove the tip cap from the saline syringe, then push the saline syringe onto the injection cap and twist it clockwise until it's secure. The tip of the syringe is sterile, so don't touch it or lay it down on any surface while the cap is removed. 

If it does come in contact with something, throw it away and get a new one.  

Push the plunger in slowly or use the pulse method to flush the catheter with as much saline as instructed. If you don't know how much to use, call us and we'll confirm. 

If you were given heparin and told to use it to flush your catheter, continue with these next steps. Otherwise, you can jump right to the final step, which is clean up. 

Step 6: Heparin flush, if ordered 

The heparin flush is the last part of SASH. Use a new alcohol pad to clean the injection cap for 15 seconds and let it air dry for 5 seconds. Be careful not to touch the top of the injection cap with your fingers. 

Remove the tip cap from the heparin syringe, then push the heparin syringe onto the injection cap and twist it clockwise until it's secure. The tip of the syringe is sterile, so don't touch it or lay it down on any surface while the cap is removed. If it does come in contact with something, throw it away and get a new one.  

Push the plunger in slowly or use the pulse method to flush the catheter with as much heparin as instructed. If you don't know how much to use, call us and we'll confirm. 

When you're done, take the syringe off the injection cap and clamp the catheter or extension set. 

Step 7: Cleanup and disposal 

Now your final step is clean up. Go ahead and throw away the used alcohol pads into your trash. You can also throw your used flushed syringes into your trash unless your nurse has told you to dispose of them in your sharps container. If you don't need to use your tubing again for another dose within 24 hours, you can discard your empty medication bag and the tubing in the trash, clean your SASH mat, and put it away for next time. This may all seem a bit overwhelming at first, but once you do this a few times, you'll feel more comfortable. 

And remember, as a Coram patient, our team is here for you 24 hours a day, seven days a week. 

Thank you for watching.