Introduction to IV Admixture and Aseptic Technique

1
Introduction to IV Admixture and Aseptic Technique

• Pharmacy 721
• January 23-27, 2006

2
Objectives

• Background and Definitions
• Equipment
• USP 797
• Technique

3
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

4
Definitions

• LVP-large volume parenteral (gt100 ml)
• piggy back smaller volume (may be up to 250
  ml)
• D5W (5 dextrose in water)
• NS (normal saline) 0.9NaCl
• Compounded Sterile Preparation (CSP)
• Continuous infusion vs. intermittent dosing

5
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 µm per cubic
  foot

6
Hood types

• Horizontal Laminar Airflow Workbench

7
Hood Types

• Vertical Laminar Airflow Workbench (Biosafety)

8
Hood Types

• Barrier Isolator

9
USP 797 Risk Levels

• High (3)
• Nonsterile ingredients
• ltISO class 5
• 24 hours rt, 3 days cold
• Medium (2)
• Multiple doses
• Complex manipulations
• 30 hours rt, 7 days cold
• Low (1)
• Sterile components
• ISO Class 5
• lt3 sterile products
• See Tables 32.1 and 32.2 in Thompson

10
Clean room

• Video

11
Syringes and Needles

• Parts of syringe (32.12)
• Barrel
• Plunger
• Tip
• Parts of needle (32.12)
• Bevel
• Shaft
• Hub

12
Injection technique

• Critical sites
• Swabbing
• Bevel up, angle
• Equalize pressure

13
IV Preparation

• Preparation
• Calculations
• Assembly
• Cleaning
• Inspection
• Expiration dates
• Quality
• Manipulation
• Inspection
• Quality

14
References and Resources

• USP, Proposed Revisions to USP Chapter lt797gt
  http//www.usp.org/healthcareInfo/pharmInfo/revisi
  ons797.html
• ASHP Self Assessment Tool for Compounding Sterile
  Preparations http//www.ashpbestpracticessat.com/P
  rint_Version_ASHP_797_Assessment.pdf
• Ockerman AV, U.S. Pharmacist, Compounded Sterile
  Preparations An Overview of the New Standards
  USP lt797gt http//www.uspharmacist.com/index.asp?sh
  owarticlepage8_1252.htm
• ASHP Guidelines on Quality Assurance for
  Pharmacy-Prepared Sterile Products, Am J
  Health-Syst Pharm, 2000571150-69