HCG Mixing Needle, Sterility, discard after 1 month?

[MarkLA]

Hi,

I just started HCG. I have been on T-Cyp for years.

The kit came with an 18G needle for mixing the water into the powder. This is a big needle and made a big hole in the rubber stopper. Maybe even bigger as I was pointing the water at the side of the vial.

Today I did my second injection. I had the vial inverted, pulled about .5ml into the insulin syringe, then pushed the syringe plunger back to get my dose. Normal so far. When I pulled the syringe out of the vial, I got a squirt from the big hole until I turned the vial upright. That makes me concerned about sterility over the life of the vial.

Questions...

1. I didn't pressurize the vial with air so I'm not sure why I got the squirt. I'm used to injecting oil so maybe this is OK for a water based med. Any ideas?

2. Since mixing is only water, it would seem possible to put a much smaller needle on the 10ml syringe and not make such a big hole. My current syringe vendor has 30G luer lock needles. Does anyone use or recommend anything that small?

3. Per the instructions from the compounder, the HCG is good for 28 days, although at my dose I would have enough for 40 days. If I adjust my dose then it would last even longher. I'm concerned with the sterility from the issues above, but on my next vial if I didn't have those concerns is it OK to use it for 40 days? for 60 days? HCG is cheap and I can get more, so if there's a concern that it's not sterile or no longer effective, I could run 28 days and toss the rest.

Thanks,

Mark

 

[Vince Carter]

The vial is pressurized, it's nothing you did. When I reconstitute my vials, after adding the water, I draw out two 5ml syringes worth of air and expel it. This will cure the pressure and the squirt you're getting when withdrawing the syringe. There should be no sterility issues and the rubber top is self-sealing. HCG has been proven to last, refrigerated, much beyond the 28 days they claim.

 

[Re-Ride]

Mark, I keep my hCG vial inside a plastic pill vial with an alcohol wipe as an extra layer of protection. For reconstitution a 21 G or finer stubby might be a better choice but you can use the 18 G. No I would not worry about sterility from what you describe. You likely introduced air pressure accidentally. Try letting the water drip in by gravity. It can drip on the powder. You may wish to halve the water then halve the volume of the injection.

You can use a 30 G for reconstitution but you may find it unnecessarily tedious.

 

[ERO]

Agree with Vince and Re-Ride. Also, the water is bacteriostatic water so nothing bad is going to grow in it.

 

[Vince]

Mark, this also happens to me. When I questioned Defy Medical about it. They told everything was good, I was good to go.

 

[MarkLA]

Thanks, Gents!

What's a safe reasonable time to keep an open vial going?

 

[Fireproof]

Another question while discussing HCG mixing.

My new vial apparently had quite a vacuum because as soon as I stuck the needle of bacteriostatic water into the vial with the HCG - it sucked all the water in pretty fast. Before I knew it and could stop it.

I know they typically recommend squirting slowly on the glass, not directly on the HCG powder disk itself.

Any chance the above harmed it? It's my first time using HCG...

 

[ERO]

You are fine. If you had some sort of ultra sensitive way to test the potency your HCG may be a bit lower in strength now because of this but I would not worry too much about it.

 

[torrential]

I've seen experienced members comment on being comfortable with 60 days in the fridge. I use a vial 35-40 days and am comfortable with that timing.

Another option is to fill all of the syringes right after mixing then freeze them. Thawing is fast and freshness / potency is preserved.

Speaking of ways to store the vial, I put a cotton ball in the bottom of the little jar I use as a cushion to ease contact. I started this AFTER letting the thing slip once and cracking a nearly new vial. Proud moment!

Also: keep your dry hcg cold too. Fridge, not freezer.

 

[Re-Ride]

A lyophilized powder can be packaged in an inert gas OR a vacuum. In the latter there is neither pressure nor vacuum in the vial. To reconstitute the powder the packaged gas must escape during addition of the bac water. If the technician fails to allow for this he will pressurize the vial. This results in:
a) reconstitute spaying out past the needle
b) pressure which might damage delicate compounds

Many techs will withdraw the inert gas to create a slight vacuum before reconstitution. The following method saves this step and reduces puncture damage to the vial stopper:

Seat vial on sturdy flat surface. Wipe stopper with alcohol and let dry. A 21G stubby and 10 ml syringe allows gas in the vial to slowly bubble up through the bac water filled syringe as it is displaced by water accumulating in the vial. Other gauges work too. A long 30 G obviously will not work well.

Left alone the water will gently drip on the hCG. Slight movement of the plunger might assist the process. If the flow stops pull back on the plunger to remove gas from the vial which will bubble up through the bac water in the syringe. Repeat but at no time pressurize the vial by forcing the plunger and bac water in to the vial.

This prevents pressure from building inside the vial as water displaces gas. When done pull back to remove as much gas as possible which remains in the vial over the reconstitute before withdrawing the 10 ml syringe.
---
Where hCG is packaged in a slight vacuum instead of an inert gas such as Novarel ( I believe), I have found the following:

I use the same method as above except at first the flow is greater than might be ideal. Tilt the needle and let the flow hit the wall of the vial. This initial vacuum will dissipate before 10 ml of water can enter the vial. At this point the situation will be as above. There will be some gas in the vial that needs to escape so more water can enter without a resultant pressure building in the vial. That will happen on it's own or you may press the plunger down to inject a ml or two of water then pull back and watch the gas bubble back up through the syringe.

The point of this simple technique is that at no time are you pressurizing the vial by forcing water in to it. the last step removes gas and leaves your reconstitute under slight vacuum.

Next you will be withdrawing your dose with the smaller injection syringe. Each time you prepare to dose inject the same amount of air in ml volume in to the alcohol swabbed vial as you intend to withdraw. At no time will you ever pressurize your vial or have difficulty withdrawing an aliqot.

The short stubby 21G to 25G needles can safely be reused for reconstitution if necessary IF stored in a vial with a little alcohol. Nothing has been in contact with them but bac water assuming good technique. Just make sure they are air dried before use. Mounting them to the 10 ml with the plunger already withdrawn effectively forces any alcohol out and drys the needle. In health care it has become the practice never to reuse a syringe or needle even for reconstitution. Not to debate the wisdom of this but good technique makes it unnecessary. Nice to know should you ever find yourself short of supplies.

 

[Jackie Treehorn]

The short stubby 21G to 25G needles can safely be reused for reconstitution if necessary IF stored in a vial with a little alcohol. Nothing has been in contact with them but bac water assuming good technique. Just make sure they are air dried before use. Mounting them to the 10 ml with the plunger already withdrawn effectively forces any alcohol out and drys the needle. In health care it has become the practice never to reuse a syringe or needle even for reconstitution. Not to debate the wisdom of this but good technique makes it unnecessary. Nice to know should you ever find yourself short of supplies.

With the cost of syringes/needles so cheap, I can't think of one good reason why you would re-use either. Why risk the chance of using something that isn't sterile? I don't see the advantage.

 

[Re-Ride]

... keep your dry hcg cold too. Fridge, not freezer.

The allowable storage temperature and excursions permitted are printed on the insert for both Novarel and APP. Novarel is certified to retain potency for two years when stored at allowable ambient with occasional excursions. . In past threads I have posted links to the on-line facsimile. Refrigeration -not- allowed.

Nor is leaving it in the cupboard at 100F weeks on end. Please store in your wine or root cellar for maximum life and potency. If it's full or your s.o. won't give you the key then you may be faced with a tough decision. Repetitive fluctuations might be more harmful than constant temperature below what is allowable per the insert.

 

[MarkLA]

Where hCG is packaged in a slight vacuum instead of an inert gas such as Novarel ( I believe), I have found the following:

I use the same method as above except at first the flow is greater than might be ideal. Tilt the needle and let the flow hit the wall of the vial. This initial vacuum will dissipate before 10 ml of water can enter the vial. At this point the situation will be as above. There will be some gas in the vial that needs to escape so more water can enter without a resultant pressure building in the vial. That will happen on it's own or you may press the plunger down to inject a ml or two of water then pull back and watch the gas bubble back up through the syringe.

The point of this simple technique is that at no time are you pressurizing the vial by forcing water in to it. the last step removes gas and leaves your reconstitute under slight vacuum.

Thanks, this makes sense. I think my vial had a vacuum, but then I pressurized it when adding the 5.5ml of water. I'll use your methods next time.

Thanks again!

 

[Re-Ride]

With the cost of syringes/needles so cheap, I can't think of one good reason why you would re-use either. Why risk the chance of using something that isn't sterile? I don't see the advantage.

I wrote " IF you should find yourself short of supplies" Jackie. There is risk in everything. Our task playing lab tech is to quantify risk rationally. We are required to learn a little basic microbiology to make decisions grounded in science not fear. Let's think about what we are doing instead of blindly relying on dogma. Confidence in safety is actually higher when the tech performs the sanitation personally.

BTW... it doesn't matter how cheap they are. My script for 30 G was all the pharmacist had last week. You think she was going to allow me to have a 21 G? Not on your life! AB-1743 (2013-2014), commonly known as NPSS or the "non-prescription syringe sale law" completely deregulated needle and syringe sale in CA on Jan 1 2015.

Needles and syringes are an over-the-counter-item no longer requiring an Rx. Good luck trying to find a pharmacist who knows the law. I love those crazy conspiracy theories that attribute the epidemic of irrational thought and dumbing down of America to stuff raining down on us from jets. The Surgeon General needs to investigate this as a national health crisis. I know for a fact that the contrails forming a tight checkerboard over the Carson Valley at 5 am I saw when camping last summer were just commercial pilots who were temporarily confused or lost.

 

[Jackie Treehorn]

I wrote " IF you should find yourself short of supplies" Jackie. There is risk in everything. Our task playing lab tech is to quantify risk rationally. We are required to learn a little basic microbiology to make decisions grounded in science not fear. Let's think about what we are doing instead of blindly relying on dogma. Confidence in safety is actually higher when the tech performs the sanitation personally.

There's no gear to sanitize using a sterile, single use, individually packaged syringe/needle. That alone pretty much eliminates any quantifiable risk of infection. Sorry, but I don't follow your reasoning. If I run short of supplies, I'll buy some more before I re-use a pin.

BTW... it doesn't matter how cheap they are. My script for 30 G was all the pharmacist had last week. You think she was going to allow me to have a 21 G? Not on your life! AB-1743 (2013-2014), commonly known as NPSS or the "non-prescription syringe sale law" completely deregulated needle and syringe sale in CA on Jan 1 2015.

That's why I buy all of my medical supplies online. Never a problem getting everything I need, delivered to my front door quickly.

Needles and syringes are an over-the-counter-item no longer requiring an Rx. Good luck trying to find a pharmacist who knows the law. I love those crazy conspiracy theories that attribute the epidemic of irrational thought and dumbing down of America to stuff raining down on us from jets. The Surgeon General needs to investigate this as a national health crisis. I know for a fact that the contrails forming a tight checkerboard over the Carson Valley at 5 am I saw when camping last summer were just commercial pilots who were temporarily confused or lost.

Ok, you lost me again.

 

[Re-Ride]

Jackie, OP's questions have been answered. A better place for the topic of aseptic technique is a new thread. "Sterility" has a definition. Alcohol alone can not achieve sterility although it tends to preserve it if the technician is very careful.

The moment the syringe package is opened it risks loosing sterility. If a single microorganism lands on the needle then by definition it is no longer sterile. That doesn't make it unsafe. The injection techniques we are taught attempt to reduce introduction of viable organisms and spore in to out bloodstream. Bacteriostatic water is used in reconstitution because it is understood that maintaining absolute sterility is nearly impossible in a clinic setting.

The handling that I described is unlikely to introduce a significant contamination load i.e. enough organisms to cause infection.

I agree that the safest practice is to always use a fresh needle. It's clear that this is not always done. For instance, transferring two aliquots, 5ml each of bac water to reconstitute hCG is often mentioned here.