Especially special

Let me tell you about an exciting little drug called AT-III.

Actually, it's technically not a drug, it's a component of a human clotting factor called antithrombin III.

And I got to give it last night for the very first time.

Mmmm.

I was checking on a patient, doing my evening assessment and making the first morphine rounds, when a pharmacy tech came up to me and said, "Becky?"

"Yes..."
"Here."
"Here what?"

At this point, she held out a gallon zip-lock bag with seven smallish boxes in it.

"What's this?"
"AT-III."
"Oh really?"
"Yeah. For the patient next door."
"Oh lovely."
"Where do you want it? I have to hand it off to you."
"Uh, ok. I'll just...put it on my cart and take it with me."
"Ok. What's your last name?"

While looking at the boxes, I had a vague memory of watching somebody else struggle with double-sided needles and a painfully slow, precise mixing process that involved doing everything possible to avoid creating bubbles or foam, because they never went away once formed.

With growing dread, I approached the pharmacist who was still in the nurse's station, who looked at it and said, "Oh, I have no idea how to mix that. We don't do that. Oh no. Never. Did you know you're holding about $6000 in your hand?"

I was incredibly tempted to call up the infomercial people who were trying to say that printer ink was the most expensive liquid on the planet on a price-per-volume-unit basis.

After reading through the instructions with the pharmacist, my worse fears were confirmed. A few hours later, I finally was able to make the time to mix and administer the stuff.

First, insert short end of double-ended needle into 10mL vial of sterile water. Remove cap from other end of needle and insert at 45 degree angle into vial of powdered AT-III, ensuring that the stream of water flows down the side of the vial and not directly into the powder. If directed at powder, foam will form.

Then, after removing empty vial and needle, slowly swirl in 4" diameter circle to mix any remaining particles. If large chunks remain, vial may be turned horizontally and rotated.

Once all vials to complete dose have been mixed, attach filter needle to syringe, clean top of vial, insert needle, carefully invert container, and slowly withdraw reconstituted AT-III. Ensure that no bubbles or foam form.

Administer entire dose over 10 - 20 minutes.

Riiiiight.

Seven vials, twelve call lights of people asking for pain meds or coffee with 5 sugars, 1 cream, 3 ice cubes, and a straw, and an hour and a half later, it was drawn up, sitting on the counter, ready to administer.

Just so you know, an hour plus is a lot of time to spend on one medication for one patient whose heparin is working just fine and will be discharged in the morning anyway. And it takes a lot of effort and concentration to hold your hand still and not create bubbles.

Why don't I get a cut of that $6000?