Administration of ACTH
Your child’s prescribed dosage of ACTH is _______________units. This equals ___________ mLs of medicine.
1. Wash your hands.
2. Wipe the top of the medicine vial with an alcohol wipe.
3. Pull back the plunger of the syringe to _________mLs of air. (This equals the amount of medicine to be given).
4. Inject the air into the vial.
5. Pull back _________mLs of medicine into the syringe.
6. Expel all the air bubbles out of the syringe by tapping on the syringe.
7. Remove needle from vial and recap, using one-hand method.
Note: ACTH must be refrigerated between uses; the gel is much easier to inject when it is closer to room temperature, so take it out of the refrigerator one hour before giving it.
Preparing Injection Site
The vastus lateralis is the major muscle of the quadricep femoris, the largest muscle group in the upper thigh. The vastus lateralis is located on the outer aspect of the thigh away from major nerves and vessels.
1. Place the child on his back.
2. Locate the outer half of the upper thigh by placing your thumb down the middle of the thigh and wrapping your fingers around the outside of the thigh.
Note: If you have a helper, tell your helper to hold the leg still with one hand at the top of the thigh while the other hand keeps the knee joint from moving.
3. Bunch up the muscle mass with your fingers. This will help stabilize the child’s leg and concentrate the muscle mass to receive the medicine.
4. Clean the site with an alcohol swab.
The Injection
1. Grasp the syringe close to the uncapped needle and direct the needle into the muscle at a 90º angle using a quick dart-like motion. Leave 1/8 inch of the needle showing.
2. Pull back on the plunger to check for blood return in the needle (to make sure the needle is not in a blood vessel).
3. If blood appears: remove needle. Throw away the entire syringe and draw up a new dose.
4. Inject medicine slowly holding the syringe at a steady 90° angle. Note: ACTH is a gel and pushes hard!
5. Remove the needle from the muscle
6. Apply pressure at injection site and gently rub the site. (This prevents medicine from leaking out of the muscle and increases the rate at which the medicine is absorbed into the blood stream).
7. Rotate injection sites, alternating legs each day. It may help you to remember by keeping a chart of injection sites and dates.
General Information
1. Keep all the equipment out of reach of children.
2. Keep the needles and syringes in wrappers to ensure sterility.
3. Note: If you poke yourself with a used needle, call your doctor.
About Steroids
1. Steroids may increase the risk of infection.
- Instruct all people coming in contact with child to wash their hands thoroughly.
- Do not immunize your child during the course of ACTH therapy.
- Avoid contact with measles or chicken pox.
2. Steroids may cause weight gain and increase in appetite.
- Offer water or diluted fruit juice between meals.
3. Steroids may cause your child to retain sodium and lose potassium. This can lead to weight gain.
- Keep salt intake low. Increase potassium in the diet, e.g. orange juice, bananas.
- Have your child’s blood pressure checked for any increase by your primary doctor or Home Health nurse twice a week. When the ACTH dose or frequency of injections is decreased, blood pressure can be checked once a week.
- Watch for signs of extra fluid or swelling in the legs, arms, and body, tell your child's primary doctor.
4. Steroids may cause a delay in healing.
- Use good safety habits to avoid injuries.
- Let the doctor know if a wound is not healing.
5. Steroids may cause high glucose level in blood and urine.
- Dipstick urine for glucose once each day throughout ACTH treatment. To obtain a ruine sample from your infant, place cotton balls in the front of your child's diaper. After your child urinates, squeeze urine from the cotton balls onto the dipstick to test it.
6. Steroids may cause an increase in secretion of stomach acid.
- Encourage milk or milk products.
- Check stools for blood once a week.
- Note any blood in vomit.
- Give Ranitidine as prescribed.
7. Steroids may alter behavior patterns.
- Watch for seizures and changes in seizure activity.
- Watch for increased excitability.
- Watch any unusual behavior.
8. Steroids may affect the child’s ability to respond to stress.
- Avoid temperature extremes.
- Avoid exposure to infection.
- If your child is seriously hurt, tell the doctor about your child’s steroid therapy.
- Carry an ID card with the same information.
Side Effects
Acceptable/Expected Side Effects
1. Facial “mooning” (Cushing’s Syndrome). This appears as very full cheeks.
2. Fluid retention/weight gain.
- Offer water or diluted juice between meals.
- Avoid foods high in sodium, salt, and salty snacks
3. Increased thirst and urinary frequency.
4. Skin changes: thin fragile skin, increased sweating, acne.
- Follow daily hygiene routine, change diapers frequently and apply ointment to avoid diaper rash.
- Use sunscreen for outdoor activities.
5. Changes in behavior or neurological status.
- Irritability or euphoria.
- Sleeplessness.
Unacceptable/Undesirable Side Effects: If these occur, call your child's primary doctor and neurologist.
1. Allergic reaction - rash, hives, breathing difficulty.
2. Cardiovascular system effects.
- Hypertension/high blood pressure (usually seen at week 2 or 3 of treatment).
- Call your child's primary care doctor and your neurology nurse weekly with blood pressure readings.
3. Gastrointestinal complication.
- Gastroenteritis (nausea and vomiting). Persistent gastroenteritis (vomiting and/or diarrhea) may require IV rehydration.
- Abdominal pain.
- Blood in stools.
4. Seizure activity.
Discharge Needs
Supplies:
1. Medicine
2. Alcohol swabs
3. 23 gauge 1" needles
4. 3 mL syringes
5. Needle disposal box
6. Urine dipsticks
7. Occult (iFOB) vials (obtained during hospitalization or from UWHC
Outpatient Lab)
8. Seizure flow calendar
Discharge Orders
Medicine Schedule
ACTH
Dose ___________ Date _________ to _________
Dose ___________ Date _________ to _________
Dose ___________ Date _________ to _________
Ranitidine: Dose ___________ Date __________ to __________
Seizure Medicines
______________________________________________ Dose ___________
______________________________________________ Dose ___________
Schedule for lab work and blood pressure
- Have electrolytes, BUN, creatinine, and glucose drawn weekly by your child’s primary doctor. Have results faxed to your neurologist at (608) 265-1753.
- Stool occult blood done twice a week. Take a stool sample vial to your child’s primary care doctor or bring them to the visit with the neurologist.
- Urine dipstick for glucose once each day. If the result is greater than 100 (on the dipstick), contact your child’s primary care doctor to have labs drawn.
- Blood pressure done twice a week. Call your child’s primary care doctor and neurology nurse every week with blood pressure readings.
Phone Numbers
Pediatric Neurologist: (608) 890-6500
UWH Clinic for Appointments: (608) 890-6500
UWH Clinic Nurse: (608) 890-6500
After hours, weekends or holiday call (608) 262-0486. This is the paging operator. Ask for the Neurology Resident on call. Leave your name, your child’s name, and your phone number with the area code. The doctor will call you back.
If you live out of the area, please call 1-800-323-8942.
Appointment at UWHC with Dr. _________________________________
Date ___________________________
Time ___________________________
EEG (if ordered) _______________________
Location of appointments ________________________
Call the clinic for an appointment if you do not have one when you leave the hospital.
The information provided should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed physician should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Any duplication or distribution of the information contained herein is strictly prohibited.
Last Updated: 12/27/2011
Copyright © 12/27/2011 University of Wisconsin Hospitals and Clinics Authority. All rights reserved. Produced by the Department of Nursing. HF#5066
Print Health Fact For You