Step 7: Mix diluent and factor powder using the double-ended needle or the needle-less transfer device

This is the step that varies the most between brands of factor concentrate.  Some brands use a needle-less transfer device to connect the vial of factor and the vial of diluent.  Others use a syringe that is pre-filled with diluent.  Be sure to follow the steps provided with the factor you are using.

This is the traditional vacuum method and is shown in the first illustration.

A. Remove metal or plastic caps from the bottles.

B. Clean the rubber bottle stoppers with alcohol pads and allow them to dry.

C. Remove the cap from the small end of the double-ended needle.

D. Stick the small end of the double-ended needle through the stopper of the diluent bottle.

E. Remove the cap from the long end of the double-ended needle.

F. Turn the diluent bottle upside down.

G. Stick the long end of the double-ended needle through the rubber stopper of the factor bottle.  The diluent should flow through the needle into the factor bottle.

H. Remove the diluent bottle with the needle when it is empty and discard safely.  Be sure to use all of the diluent that is sent with the factor.

Guidelines:

• When mixing, hold bottles with both hands.
• Use only one brand of factor for each infusion.
• If the vacuum does not draw the diluent into the factor bottle, use the syringe method (Alternate Step 7).
• If you touch the tip of the needle, use a new one.

Figure 4-11  Mixing with a double-ended needle.

Alternate Step 7: Mix diluent and factor powder using the syringe method.

[To be used if the vacuum method with the double-ended needle (Step 7) does not work.]

A. Remove the metal or plastic caps from the bottles.

B. Clean the bottle stoppers with alcohol pads and allow them to dry.

C. Remove the cap from the tip of a plastic syringe.

D. Attach a sterile #18 or #20 needle to the syringe.

E. Remove the cap from the needle.

F. Pull back on the syringe plunger to fill the syringe with air.

G. Stick the needle through the diluent bottle stopper.

H. Push the plunger to inject the air from the syringe into the diluent bottle.

I. Turn the diluent bottle upside down.

J. Pull back on the syringe plunger to fill the syringe with diluent.

K. Remove the needle and syringe from the diluent bottle.

L. Stick the needle through the rubber stopper of the factor bottle.

M. Push the syringe plunger to inject diluent into the factor bottle.

N. Remove the needle and syringe from the factor bottle.

O. Discard the needle and syringe properly.

Guidelines:

• When filling the syringe with air, pull back on the plunger to draw in about the same amount of air as the amount of liquid in the diluent bottle.
• When filling the syringe with diluent, hold both the syringe and the bottle upright.  Keep the end of the needle in the diluent when pulling back the plunger to keep air from filling the syringe.

Caution: When injecting diluent into the factor bottle, point the needle so that the water flows down the side of the bottle.  This will prevent bubbles.

• If it is hard to pull back the plunger when drawing up the diluent, remove the needle and syringe from the bottle.  Add more air to the syringe by pulling back the plunger.  Insert the needle into the bottle and push the air into the bottle.  Draw the diluent into the syringe.