Your nurse will teach you how to mix and inject hydrocortisone. Review these steps every few months so that you will feel more confident in case you need to do an injection. The nurses are also happy to review the steps with you if questions come up during your child's follow-up visits to the clinic.
Reminder: The medicine must be injected if:
Your child cannot take hydrocortisone by mouth or vomits more than once.
Your child is weak, unconscious, or cannot wake up.
If your child is severely injured, appears very ill, or shows signs of adrenal insufficiency.
In these situations, please give the injection of medicine FIRST and then call.
Emergency Number 911
Dosage: If your child is over 3 years old, most often all of the medicine, 2 mL (100mg) is given. If the child is less than 3 years old, most often 1 mL (50mg) is given.
Storage and Replacement
Store all your supplies in a small clean container. Crucial supplies include:
Vial(s) of hydrocortisone
Syringes and needles
Unused vials: Store in a dark, dry area at room temperature (not warmer than 86ºF).
Opened vials: After the hydrocortisone powder is mixed, label the vial with the date and time. Once mixed, the hydrocortisone solution is good for only 3 days. Keep it at room temperature.
Expiration dates: Vials of hydrocortisone powder and bacteriostatic water have expiration dates. Check these dates from time to time. Call for a new prescription if the expiration date is near.
For more information on hydrocortisone and cortisol dependency, see the handout, “Guidelines for the Child Who Is Cortisol or Steroid Dependent” HFFY #4424.
How to Mix If Powder and Water Come in One Vial (for example, Act-O-Vial)
1 vial of hydrocortisone powder and water
3mL syringe and inch needle
Wash hands. Press down hard on the plastic cap (Rubber divider will fall into lower section).
Gently shake vial until all powder is dissolved.
Remove the plastic tab covering the center of the stopper. Wipe top of rubber stopper with an alcohol wipe.
Connect the needle and syringe as instructed. To draw air into syringe, pull the plunger of the syringe down to the ____mL mark. Remove the needle cap and insert the needle squarely through the center of the stopper until you see the needle tip. Inject air into the vial. Do not remove the needle.
Turn the vial and syringe upside down. Keeping the tip of the needle below the medicine line, draw up ____mL of medicine into the syringe.
Remove the needle and syringe from the vial. If you notice any large air spaces, point needle upright and carefully press on plunger until the air space is gone. Be sure you have the proper volume in the syringe before removing the needle. You are now ready to inject the hydrocortisone.
How to Mix If Powder and Water Are in Separate Vials
1 vial bacteriostatic water
1 vial hydrocortisone powder
3mL syringe and inch needle
Wash hands. Remove plastic caps from both vials. Clean rubber stoppers with an alcohol wipe.
After connecting the needle and syringe, pull the plunger of the syringe out to the ____mL mark (to draw air into syringe). Remove the needle cap and insert needle squarely through the top of vial of water. Inject air into the vial.
Turn the water vial and syringe upside down. Make sure needle tip is in the water. Then pull the plunger out to the ____mL mark (to draw water into syringe).
Remove the filled syringe and insert needle squarely through the center of the stopper into the vial of powder. Inject the water without removing the needle. Gently shake vial until all powder is dissolved.
Turn the hydrocortisone vial and syringe upside down. Keeping the tip of the needle below the medicine line, pull the plunger out to the ____mL mark (to draw up the medicine).
Remove needle and syringe from the vial. If you notice any large air spaces, point needle upright and carefully press on plunger until the air space is gone. Be sure you have the proper volume in the syringe before removing the needle. You are now ready to inject the hydrocortisone.
How to Inject
Select an injection site in the thigh (see diagram). Clean the site with an alcohol wipe.
Hold the syringe like a dart at a 90º angle to the site.
With the other hand, hold the muscle firmly at the site.
Insert the needle straight into the skin with a quick firm motion.
Slowly push down on the plunger until the syringe is empty.
Remove the needle quickly (at the same angle it was inserted). Apply gentle pressure to the site with an alcohol wipe, cotton ball or gauze. The site may bleed a bit.
Throw out the needle and syringe in a puncture proof container (like a coffee can or sharps container).