Introduction to IV Admixture and Aseptic Technique

Pharmacy 721 January 23-27, 2006

Objectives

Background and Definitions Equipment USP 797 Technique

Background

Parenteral: injected through skin or other external boundary tissue, alongside of small intestine Uses:

NPO nothing by mouth Unstable in GI, 1st pass metabolism Immediate action needed Delivery to specific site Depot form

Definitions

LVP-large volume parenteral (>100 ml) piggy back smaller volume (may be up to 250 ml) D5W (5% dextrose in water) NS (normal saline) 0.9%NaCl Compounded Sterile Preparation (CSP) Continuous infusion vs. intermittent dosing

Definitions

HEPA filter- High Efficiency Particulate Air

0.3 micron, 99.97%

ISO: International Organization for Standardization

ISO 5: Clean room standards based on particles for cubic meter by particle size Class 100: number of particles 5 m per cubic foot

Hood types

Horizontal Laminar Airflow Workbench

Hood Types

Vertical Laminar Airflow Workbench (Biosafety)

Hood Types

Barrier Isolator

USP 797 Risk Levels

High (3)

Medium (2)

Nonsterile ingredients <ISO class 5 24 hours rt, 3 days cold Multiple doses Complex manipulations 30 hours rt, 7 days cold Sterile components ISO Class 5 <3 sterile products

Low (1)

See Tables 32.1 and 32.2 in Thompson

Clean room

Video

Syringes and Needles

Parts of syringe (32.12)

Barrel Plunger Tip Bevel Shaft Hub

Parts of needle (32.12)

Injection technique

Critical sites Swabbing Bevel up, angle Equalize pressure

IV Preparation

Preparation

Cleaning Inspection

Calculations Assembly

Manipulation Inspection

Expiration dates Quality

Quality

References and Resources

USP, Proposed Revisions to USP Chapter <797> http://www.usp.org/healthcareInfo/pharmInfo/revisions797.html ASHP Self Assessment Tool for Compounding Sterile Preparations http://www.ashpbestpracticessat.com/Print_Version_ASHP_797_Ass essment.pdf Ockerman AV, U.S. Pharmacist, Compounded Sterile Preparations: An Overview of the New Standards USP <797> http://www.uspharmacist.com/index.asp?show=article&page=8_12 52.htm ASHP Guidelines on Quality Assurance for Pharmacy-Prepared Sterile Products, Am J Health-Syst Pharm, 2000;57:1150-69