title: Improving Crotalidae polyvalent immune Fab reconstitution times.
abstract: BACKGROUND
  Crotalidae polyvalent immune Fab (CroFab) is used to treat rattlesnake envenomations in the United States. Time to infusion may be a critical factor in the treatment of these bites. Per manufacturer's instructions, 10 mL of sterile water for injection (SWI) and hand swirling are recommended for reconstitution. We wondered whether completely filling vials with 25 mL of SWI would result in shorter reconstitution times than using 10-mL volumes and how hand mixing compared to mechanical agitation of vials or leaving vials undisturbed.
  
  
  METHODS
  Six sets of 5 vials were filled with either 10 mL or 25 mL. Three mixing techniques were used as follows: undisturbed; agitation with a mechanical agitator; and continuous hand rolling and inverting of vials. Dissolution was determined by observation and time to complete dissolution for each vial. Nonparametric 2-tailed P values were calculated.
  
  
  RESULTS
  Filling vials completely with 25 mL resulted in quicker dissolution than using 10-mL volumes, regardless of mixing method (2-tailed P = .024). Mixing by hand was shorter than other methods (P < .001). Reconstitution with 25 mL and hand mixing resulted in the shortest dissolution times (median, 1.1 minutes; range, 0.9-1.3 minutes). This appeared clinically important because dissolution times using 10 mL and mechanical rocking of vials (median, 26.4 minutes) or leaving vials undisturbed (median, 33.6 minutes) was several-fold longer.
  
  
  CONCLUSIONS
  Hand mixing after filling vials completely with 25 mL results in shorter dissolution times than using 10 mL or other methods of mixing and is recommended, especially when preparing initial doses of CroFab.
authors.affiliation: Department of Pharmacy, Banner Good Samaritan Medical Center, Phoenix, AZ 85006, USA.
authors.forename: Asia N
authors.initials: AN
authors.lastname: Quan
authors.forename: Dan
authors.initials: D
authors.lastname: Quan
authors.forename: Steven C
authors.initials: SC
authors.lastname: Curry
mesh_terms: D000997:Antivenins / Q000008:administration & dosage* / Q000627:therapeutic use; D006801:Humans; D007140:Immunoglobulin Fab Fragments; D007128:Immunoglobulin Fragments / Q000008:administration & dosage* / Q000627:therapeutic use; D012909:Snake Bites / Q000628:therapy; D013997:Time Factors
chemical_list: D000997:Antivenins; C431183:Crotalidae Polyvalent immune Fab; D007140:Immunoglobulin Fab Fragments; D007128:Immunoglobulin Fragments