- Prepare 4 syringes, each containing approximately 100 mg amphotericin B powder, as follows: Take 4 vials of base - each contains 15.2 ml of Suppocire C which has already been sterilised. Put these into the waterbath at about 60°C to melt.
- Put the 8 vials of amphotericin, into the isolator, together with scissors, 2ml syringes, 2 sterile towels, green needles, 4 cream needles, 4.20ml Luer lock syringes, 4 red stoppers for syringes & metal device for removing caps from vials.
- Remove the melted Suppocire C vial - work on one at a time as they start to solidify - from waterbath, spray, and put in isolator.
- Place one of the towels over the surface of the isolator, and use the paper side of the wrap to keep as a funnel. Take 2 vials of amphotericin and shake very hard to disperse the plug of powder, then open the vial using device and carefully tip the contents onto the paper wrap.
- Remove the seal and lid from the Suppocire vial - keeping the rubber stopper on one side - and carefully tip the amphotericin into the vial, using the paper as a funnel. The amphotericin is very light and a small quantity does fly onto the towel.
- Replace the stopper on the vial, shake gently, and take out of the isolator and place back in the waterbath - MAKING SURE THE WATER LEVEL DOES NOT REACH FURTHER THAN TWO THIRDS UP THE SIDE OF THE VIAL.
- Repeat procedure for the other 3 vials.
- Remove the vials one at a time from the waterbath, put in isolator and shake gently to ensure even dispersion of the amphotericin throughout the mixture. Remove the stopper and using Luer lock syringe and cream needle, withdraw the contents of the vial into the syringe. IF THE MIXTURE SOLIDIFIES DURING THIS PROCEDURE, IT WILL BE NECESSARY TO REHEAT THE VIAL - SO WORK AS QUICKLY AS POSSIBLE, AND ONLY REMOVE ONE VIAL AT A TIME FROM THE WATERBATH. The final volume is usually around 17 ml per syringe. Remove needle and firmly stop end of syringe with sterile red stopper.
- Repeat until all 4 syringes are prepared. Label syringe and place syringes in waterbath - carefully with red stoppers propped against the grill and barrel of plunger NOT in contact with water - at 50°C until ready for administration.
- Take to patient with syringes in beaker of water at about 45-50°C, and keep removing syringe from water to rotate and invert it, to ensure amphotericin is not pooling in the syringe.
North Manchester General Hospital