Patient Instructions: FSH

Procedures for using Fertinex, Follistim and Gonal-F (75 IU & 37.5 IU)

OPENING THE MEDICATION

1. Use a new sterile syringe and needle each time you inject.
2. Carefully open the ampule or flip the lid of the vial off. If you are using Fertinex or Gonal-F use this procedure to open glass ampules.
• Hold the ampule in one hand between your thumb and index finger. The dot should be facing towards you. Tap the ampule if any powder is in the ampule head.
• With your other hand, grasp the top of the ampule between your index finger and thumb. Place your thumb on the dot.
• Snap the neck of the ampule firmly by pushing your thumbs away from you.
• Open as many ampules as needed for that dosage including the ampules of diluent. Tap any drops of diluent fluid to the bottom before opening diluent.
• Dispose tops in sharps container.


3. Carefully twist the needle cover (clockwise to tighten needle on the syringe) off of the syringe. Be sure not to touch the needle. If you do touch the needle, replace it, because it is no longer sterile. To do this, carefully recap the needle, untwist the needle from the syringe and twist on a new needle. Remove cover.

RECONSTITUTING (MIXING) THE MEDICATION

1. Making sure the needle is on the syringe tightly, draw the diluent (saline or water) into the syringe using the following method.
• For ampules: Draw up the diluent into the syringe by holding the ampule in one hand and putting the needle into the liquid in the ampule with the plunger pushed in. Next, pull back the plunger to the proper dose amount. It may be necessary to tilt the ampule - it should not spill due to the design of the ampule. Withdraw 1cc of diluent. (saline or water)
• For vials: Wipe the top of the vial with alcohol swab. Do not touch the top after wiping with anything other than the needle. Draw air into the syringe by pulling the plunger back until the 1cc mark. Insert the needle into the vial. Push the plunger incompletely. Turn vial upside down without removing the needle. Withdraw 1cc making sure the tip of the needle remains in the solution. Withdraw the needle from the vial.
2. Slowly empty the syringe of diluent into the ampule or vial containing the powdered medication. Aim the needle at the side of the ampule or vial and not directly on the powder.
3. You can gently rotate the ampule or vial between your fingers to dissolve the powder, but DO NOT SHAKE IT. If bubbles form, allow the mixture to rest, they will mostly dissipate.
4. If your dose requires MORE THAN ONE AMPULE OR VIAL of medication, withdraw the solution in the same way you withdrew the diluent and add it to the next ampule or vial of mediation. Make sure the tip of the needle remains within the liquid when withdrawing. Repeat this process until your recommended dose is in one ampule or vial. The TOTAL DILUENT (sterile water or saline) will be 1cc. 1cc-1ml.
5. Withdraw all the medication from the ampule or vial making sure the tip of the needle is within the medication.

If you are changing needles to a different gauge, carefully recap the needle, twist off and dispose in a sharps container. Change from a 22G needle to a 27G needle if injecting subcutaneously Next, attach the new needle and remove cap. Do not touch the needle. If you do, replace it with a new one.

6. Tap the syringe with the needle pointed up to cause any air bubbles to rise.
7. You are now ready to administer the injection.
8. Do not mix the solution in advance. It must be used immediately after reconstitution.

INJECTING THE MEDICATION

Subcutaneous Injections

1. Choose an injection site (abdomen, thigh, or upper arm) as shown in picture, and swab the area with alcohol. Allow to air dry.
2. Pinch a fold of skin with one hand and insert the syringe with the other hand.
3. Inject the entire solution by gently pushing the plunger all the way in until all the medication is injected.
4. Discard syringe and needle in your sharps container. If any bleeding occurs, apply gentle pressure.
5. Choose a different site each time you inject. Good sites for subcutaneous injections are the upper arm, the outer thigh, the hips and abdomen.

CLEAN UP

1. Discard used needles, syringes, ampules and vials in to your sharps container.
2. Your sharps container is classified as medical waste and must be disposed of properly. Ask your health care provider (doctor, nurse or pharmacist) about disposal when it is full.
3. Your injection material must be sterile and cannot be reused.
4. Never leave needles lying around where others can pick them up.
5. Never reuse a needle. Not only does a needle need to be sterile each time you use it, but today's needles are thinner and more delicate for greater comfort so reusing a needle can damage the tip and cause injury and greater pain.