Screw up Kcentra reconstitution? Yea, I do it too.
Kcentra, our beloved four-factor prothrombin complex concentrate comes packaged as a lyophilized powder from the manufacturer. When needed, it is reconstituted with its accompanying diluent and handy-dandy transfer device. Then, the transfer device becomes a port to withdraw the now reconstituted drug from and either into an empty bag, or syringe for administration.
In real life, that process can sometimes go awry. Or you could just be me, and flip the system once connected like I would to if it were Alteplase. If that happens, the vacuum is lost in the lyophilized powder vial and the diluent will not drain. Then you have a very expensive problem: get a new vial or try to remove the transfer device and use a needle and syringe (not recommended).
My solution is to use the EM pharmacists’ best friend: the three-way stopcock.
Step 1: Shame
Step 2: Unscrew the vials from each other and attach it to the three-way stopcock. The male connections of the device will connect to the drug vial (white top), and the syringe (20mL to 60 mL recommended). The female port will connect to the diluent (blue top) vial.
Step 3: With the “off” pointing towards the drug vial (white top), drawback the diluent into the syringe.
Step 4: Flip the “off” to the diluent vial and push the diluent into the drug vial (white top).
That’s it! Problem solved. The drug is now safely (and still a closed system) in a syringe that can be added to the remaining dose and subsequently administered to the patient.
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