• Chapter 5: Aseptic Technique and Compounding Manipulations

DO THIS IN THE LABB!!! DO NOT NEED TO KNOW EVERYTHING IN SAME EXACT DETAIL!!

Staging & Disinfection of Supplies

• Bring all needed supplies into the buffer room; wipe everything with sterile 70% IPA on lint-free wipes before placing in hood.

• Place all needed items in hood before starting.

Swabbing Protocol (before use, every entry)

• Vials: pop cap → swab stopper 3 times toward you; let dry.

• Ampules: swab neck where you’ll break; let dry.

• IV bag port: remove cap → swab.

Syringe & Needle Assembly

• Open syringe → wrapper = trash.

• For the needle, peel wrapper back to expose the hub; attach syringe while the needle stays mostly in the wrapper (don’t push it out).

Entering Vials (prevent coring)

• Bevel up, ~45° to make a tiny puncture; slight bend/pressure, then straighten to go straight in.

• Two techniques for the turn:

• Two-handed (one hand on vial, one on syringe).

• One-hand “C-path” (preferred if you can):

What to do right before you will inject needle in vial and withdraw?

• draw air into syringe = volume you plan to remove from vial

Explain withdrawing technique

• invert vial 

• withdrawing technique is called milking

• inject same air into vial to neutralize pressure/ let fluid come back

• usually ~2 pushes.

Why bubbles are not good

• Reason: bubbles displace volume → dose error.

• Tiny microbubbles may be acceptable; your preceptor will say when.

 

How to remove bubbles

• Aim to pull slightly over volume (e.g., 9 mL if you need 8).

• Flick to dislodge bubbles; push them back into vial, then set the plunger to the exact final volume.

difference between positive pressure and negative pressure

• Positive pressure 

  • easier to withdraw, risk of spraying if not neutralized.

    • After all diluent goes in (INJECTING), allow plunger to rebound to starting point → restores neutral pressure.

• Negative pressure

  • slower, but safer becuae you inject less air

  • used for hazardous drugs

During reconstitution, when injecting the diluent into the powder vial, what to do after

• allow pressure equilibration.

• Shake if allowed (⚠ Do NOT shake immune globulin → foaming).

Ampules (open systems)

• No pressure issues (unlike vials).

• Break away from HEPA filter (toward side wall). If it resists, rotate to find the weak spot.

• Always use a filter needle/straw to withdraw (to remove glass).
  Then switch to a regular needle before injecting drug/diluent elsewhere.

Injecting into IV Bags (ports & posture)

• Keep injection port facing the HEPA filter (gets first air).

• Inject with bag on deck or hung from hook—never block air to the port.

What are the final checks?

• Shake (gently): really a gentle invert/rock—mix thoroughly (don’t foam).

• See: hold to light; bubbles rise, particulates sink. Look for incompatibilities or cored rubber.

• Squeeze: with ports down, squeeze bag to check for leaks (stream from a damaged port).

Needle Safety

• Do not recap; place syringe + needle directly into sharps.

• If you must recap, use the one-hand “scoop” technique (lay cap on deck

How you send syringes sent to the floor for administration:

remove needle and place a luer cap; nurses attach needles if required at bedside—never ship with a needle attached.

Workflow in the Hood

left → right

JUST READ THE NOTES ON CHAT GPT!! THIS IS PRACTICAL LAB STUFF

Reconstitution steps:

1. Remove tab → swab top with 70% isopropyl alcohol.

2. Determine correct diluent volume (per package insert).

3. Inject equal volume of air into vial before withdrawing liquid (to prevent vacuum).

4. Invert vial → withdraw solution.

5. Inject diluent into powder vial → allow pressure equilibration.

6. Shake if allowed (⚠ Do NOT shake immune globulin → foaming).

7. Withdraw drug solution, remove air bubbles, measure accurately.