NURSING PATIENT CARE POLICY & PROCEDURE
October 27, 2017
Nursing Manual (Red)
Policy #: 1.10AP
Title: Reconstitution/Administration of Factor
VIII or Factor IX Concentrate for Patients with
Hemophilia A or B or Von Willebrand Disease
(Adult & Pediatric)
To safely reconstitute and administer factor VIII or IX or Antihemophilic Factor VIII/von
Willebrand Factor Complex concentrates.
1. Patients may not use their own factor supply when inpatient.
B. Outpatient & Emergency Department (ED):
1. If an outpatient procedure is planned (with no inpatient admission) or when
presenting to the ED, patients who are followed by the UW Health
Comprehensive Program for Bleeding Disorders (CPBD) are encouraged to bring
their factor from home in order to expedite care and avoid unnecessary pharmacy
costs. These products may be reconstituted and administered by nursing personnel
according to the following procedure. The person reconstituting the product
for the patient will verify the product’s integrity by verifying how the
product was stored and reviewing the expiration date of the vial. Refer to
UWHC Administrative Policy 8.17, Administration of Medications.
2. Patients undergoing a scheduled surgery and not being admitted (outpatient only)
will provide their own factor concentrate. For patients who are formally admitted,
factor must be supplied from Central Pharmacy.
NOTE: In the event that the patient does not bring factor from home, Pharmacy will be
responsible for processing orders for Factor VIII, IX, and Antihemophilic Factor VIII/von
Willebrand Factor Complex, factor reconstitution, and distribution. The factor concentrates
will then be administered by nursing personnel following Nursing Patient Care Policy 10.19,
Medication Administration. The Blood Bank does not stock factor concentrate. Factor
concentrate needed for home use by patients followed in the UW Health CPBD may be
obtained by calling (608) 890-9493, M-F 8am-4:30pm.
A. Factor concentrate (each box includes the product insert, a vial of dried product, diluent,
double-ended transfer device and filter device or a single mixing device that has both the
transfer device and filter device as one)
B. Butterfly needle (or other IV access)
C. Normal saline (or flush appropriate for vascular access device)
D. One to two (1-2) sterile plastic syringes, size determined by the diluent volume
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E. Non-sterile gloves
F. Alcohol sponges
Refer to Clinical Practice Guidelines: Flushing/Locking of Venous Access Devices –
Pediatric/Adult – Inpatient/Ambulatory (found on U-Connect).
The form of factor concentrate the patient uses must be determined. For most patients
followed in the CPBD, information related to the product and dosing is located in the
electronic medical record under problem list and under medications.
A. Many patients (and/or their families) are quite knowledgeable about hemophilia and are
experienced with reconstitution and administration of factor concentrates. Personnel are
encouraged to utilize this expertise.
1. Patient requires patent IV access.
2. The package insert describes how to reconstitute and administer factor
3. Check factor concentrate against physician's orders.
a. Physician orders include type of product, dosage (in units), and frequency
b. Dosage of factor replacement required for normal hemostasis is dependent
on the patient's degree of factor deficiency, the desired factor level (which
is determined by the severity and/or locus of bleed), and the patient's
weight. The number of units needed for treatment is rarely an even
number of bottles. The dosage does not have to be exact and should be
written as a range. To avoid wasting factor the dosage may be rounded up
to 125% of the recommended dose to accommodate available vial sizes.
4. Factor concentrate should be brought to room temperature prior to reconstitution.
Check expiration date on vial and number of units per vial. Must be administered
within three (3) hours of reconstitution. Do not refrigerate.
a. Factor concentrate may be kept under refrigeration and can be used until
expiration date on the vial. Some types of factor concentrate are stable at
room temperature, but will expire sooner than box indicates without
refrigeration (check package insert).
b. Vials may be warmed by gently rolling between hands.
5. Perform hand hygiene according to UW Health Clinical Policy 4.1.13, Hand
Hygiene, assemble supplies, and set up clean work area. Don gloves according to
UW Health Clinical Policy 4.1.8, Standard Precautions and Isolation.
a. Factor concentrate made from donor plasma has been screened and treated
to destroy the HIV and hepatitis virus. Nonetheless, standard precautions
in the reconstitution and administration of plasma derived factor
concentrate are required as is true for the administration of all blood
products and in the care of all patients.
b. Recombinant factor VIII does not come from human blood although some
products do contain human albumin as a stabilizing agent. Recombinant
factor IX (Benefix) does not contain human blood products.
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6. Remove caps from factor concentrate vial of dried product and diluent to expose
7. Cleanse stoppers with alcohol swab and let dry.
8. Refer to package insert for detailed reconstitution instructions.
9. If a patient is to receive more than one bottle of concentrate, the contents of two
(2) bottles may be drawn into the same syringe. If using a plasma derived product
with a double needle filter system, each bottle must be drawn using a different
10. Identify patient
11. Inject factor concentrate intravenously at rate ordered by provider or described in
12. Monitor subjective symptoms of tolerance. Observe for fever, chills, hives and
dyspnea. Although rare, allergic reactions may occur and are more likely to
happen during first several exposures.
13. Discard all needles in sharps disposal unit.
14. Document the following in medication administration record (MAR):
a. Type of factor
b. Units given
c. Lot number of vial(s)
d. Expiration date
VI. UW HEALTH CROSS REFERENCES
A. Clinical Practice Guidelines: Flushing/Locking of Venous Access Devices –
Pediatric/Adult – Inpatient/Ambulatory (found on U-Connect)
B. UWHC Administrative Policy 8.17, Administration of Medications
C. UW Health Clinical Policy 4.1.13, Hand Hygiene
D. UW Health Clinical Policy 4.1.8, Standard Precautions and Isolation
E. Nursing Patient Care Policy 10.19, Medication Administration Using Barcode Scanning
VII. REVIEWED BY
Nurse Practitioner, UW Health Comprehensive Program for Bleeding Disorders
Program Coordinator, UW Health Comprehensive Program for Bleeding Disorders
Nursing Patient Care Policy and Procedure Committee, October 2017
Beth Houlahan, DNP, RN, CENP
Senior Vice President, Chief Nurse Executive