Parenterals E1_basics of sterile compounding

90 degree

angle of an IM injections

45 degree

angle of a subcutaneous injections

35-45 degree

angle of an intravenous injection

10-15 degree

angle of an intradermal injection

5 ml

max volume of an IM injection

small volume that she did not specify

max volume of a subcutaneous injection

unlimited

max volume of an IV injection

0.02-0.5 ml

max volume of an intradermal injection

around the dura mater

where is an epidural injected

into the spine/spinal cord

where is an intrathecal injection injected

steroids

medication that is usually intra-articularly injected

intra-articular

injection into the joints

1. retinopathy

2. glaucoma

3. macular edema

diseases that are typically treated with intra-ocular injections

1. avastin

2. steroids

what are some meds that can be given through intra-ocular administration

intraperitoneal

injection into the peritoneal cavity

peritoneum

membrane that lines the inside of your abdomen and pelvis

1. dialysis

2. chemo

3. antibiotics

medication typically given through intraperitoneal administration

intravenous

most common type of parenteral administration

has 100% bioavailability

need for access

disadvantage of intravenous administration

1. continuous infusion

2. intermittent infusion

3. IV push or bolus

types of intravenous adminstration

a. dextrose 5% and 0.45% sodium chloride 1000 ml infusion IV at 100 ml/hr

which of the following orders is an example of a continuous infusion

a. dextrose 5% and 0.45% sodium chloride 1000 ml infusion IV at 100 ml/hr

b. ceftriaxone 2 g in dextrose 5% 50 ml IV q12 hours

c. promethazine 12.5 mg in sodium chlorid 0.9% 10 ml q6h as needed

d. lasix 40 mg IV once over 1-2 minutes

1. provision of drugs/nutrition in patients unable to tolerate PO

2. bypass GI tract=circumvents absorption

3. quick onset of action

4. localized delivery

5. extended duration of effect

advantages of IV administration

1. difficulty/impossibility of drug removal or reversal

2. risk of infection

3. risk of emboli

4. risk of infusion related reactions

5. higher cost

disadvantages of IV administration

aluminum or stainless steel

what are needles made of

length

part of needle

hub to tip

guage

size of needle

gauge

diameter of a needle lumen

as its value increase, the diameter of the needle lumen decreases

1 ml, 3 ml, 5 ml

syringe size of a 20 gauge 1 in needle

10 ml, 20 ml, 30 ml, 60 ml

syringe sizes for a 18 gauge 1 ½ in needle

1. double ended needles and transfer sets

2. filter needle and filter straws

3. vented needles

types of needles

1. needle must be at least 6 in the hood

2. do not block air flow

3. tilt needle hub towards the back of the hood

4. pull packaging from the hub towards you

5. discard the packaging into the waste container beside the work station

6. do no move needle outside of the hood

7. do not touch the hub of the needle or the needle itself

step by step how to open a needle

1. luer lock/slip tip

2. oral

3. prefilled

4. glass/plastic

types of syringes

luer lock

type of syringe that has threads to hold the needle on

slip tip

type of syringe that uses friction to hold the needle on

collar

part of a syringe

red blocked out portion

barrel

part of a syringe

red blocked out portion

calibrations

part of a syringe

red blocked out portion

tip

part of a syringe

red blocked out portion

plunger

part of a syringe

red blocked out portion

flange

part of a syringe

red blocked out portion

ribs

part of a syringe

red blocked out portion

piston

part of a syringe

red blocked out portion

lowest amount that can be measured= calibration/2

calibration is the marks on a syringe

how to determine the accuracy/lowest amount that can be measured by a syringe

0.01 ml

calibration of a 1 ml syringe

0.1 ml

calibration of a 3 ml syringe

0.2 ml

calibration of a 5 ml syringe

0.2 ml

calibration of a 10 ml syringe

1 ml

calibration of a 20 ml syringe

1 ml

calibration of a 30 ml syringe

2 ml

calibration of a 60 ml syringe

draw no less than 20% or no more than 80% of the syringe

rule for amount of fluid pulled in a syringe

oral syringe

type of syringe

the tip will not accommodate attachment of a needle

“for oral use only”

should be marked on all oral syringes

1. improved accuracy of safety

2. added convenience

3. efficiency

4. ease of use

pros of prefilled syringes

1. complexity

2. potential for needle sticks with those that come with a needle attached

3. problems with malfunction

4. breaking or clogging of glass syringes

cons of prefilled syringes

safety syringes

type of syringe

the plunger is inactivated once the plunger is fully depressed

1. remove package from syringe at least 6 inches inside the hood

2. do not block airflow

3. pull packaging down from top

4. discard wrapper in waste container

steps of opening a syringe

ampule

glass container

broken prior to use

single use only

open system

once an ampule is broken it is considered a ___

filter needle

must be used when drawing from an ampule

1. tip

2. neck

3. body

parts of an ampule

1. swirl contents into body of ampule

2. clean neck with alcohol swab

3. leave swab around neck when opening

4. hold head of ampule between thumb and index finger of one hand and body with the thumb and index finger of other; exert pressure on both thumbs, pushing outward and away from HEPA filter

steps of opening an ampule

it is an open system. do NOT inject air

important point of withdrawing from an ampule

option 1: tilt the ampule and place the bevel of the needle in the corner space near the opening. pull the syringe plunger back to withdraw the solution

option 2: keeping ampule in vertical position with opening up, place needle bevel in the corner space at the bottom of the ampule. pull plunger back to withdraw solution

option 3: turn ampule over, ending up with the opening at the bottom. pull plunger back to withdraw solution

options for withdrawing from an ampule

plastic or glass

what can vials be made of

vials

closed system containers

contain medications that contain preservatives or are prepared with bacteriostatic water for injection

must never be used for epidural or intrathecal administration

1. remove flip-top cap

2. swab vial top with alcohol swab

3. let alcohol dry

4. insert needle with bevel up into rubber closure

steps of piercing a vial

adaptable systems

systems that facilitate direct attachment of a vial to a bag of diluent

aka ready mix systems

1. add-vantage

2. vial-mate

3. add-ease

4. minibag plus

types of adaptable systems

add-vantage

what type of adaptable system is this

viral-mate

what type of adaptable system is this

add-ease

what type of adaptable system is this

minibag plus

what type of adaptable system is this

1. faster preparation time

2. accuracy

3. reduction in drug wastage

4. longer expiration dates

5. added convenience

6. improved efficiency

advantages of adaptable systems

1. higher costs

2. need to store additional inventory that are specific to the system

disadvantages of adapatable systems

1. decreased chemical interactions between container and contents

2. ability to sterilize

advantages of glass cotnainers

1. vacuum

2. breakability

3. max volume of 1 L

disadvantages of glass containers

1. easy storage, including freezing

2. flexibility of container

3. disposability

4. easily hung for IV administration

advantages of plastic containers

1. chemical incompatibilities

2. easily punctured

disadvantages of plastic containers

1. eyehole

2. medication port

3. set port

4. medication port/belly button

parts of a plastic bag

1. sterile water

2. dextrose

3. saline

4. lactated ringers

5. various electrolyte solutions

what are the types of diluents

1. W

2. SWI

3. SWFI

abbreviations for sterile water

1. D5W

2. D5NS

3. D10W

4. D10NS

abbreviations for dextrose

1. NaCL

2. NS

3. ½ NS

4. D51/2NS

5. ¼ NS

6. D10 ¼ NS

abbreviations of saline

1. LR

2. D5LR

abbreviations of lactated ringers

1. normosol

2. isolyte

3. plasmalyte

abbreviations/name of various electrolyte solutions

</=100 ml

what is considered a small parenteral volume

>100 ml

what is considered a large parenteral volume

1. aseptic technique

2. disinfection of critical area

3. PPE

4. label and quality inspect CSPs

responsibilities of compounding personnel

1. medication

2. dose

3. time

4. route

5. patient

what are the five rights