Parenteral Products Final

Fluid volume ≤100 mL

Small volume parenterals

examples of small volume parenterals

1. bags

2. vials

3. ampules

4. bottles

5. syringes

6. ready-to-mix systems

characteristics of small volume parenterals

1. Containers of 100 mL or less

2. IV, ID, IT, SUBQ

3. Administered intermittently (on and off again)

4. One-time doses or given in intervals over a 24-hour period (antibiotics)

SVPs may be used as a ____________ to a primary line

piggyback

characteristics of IVPB

1. small volume over short period of time

2. limits multiple IV sites

3. smaller bag removed once medication is infused

4. medication must be compatible

An _______________ can be administered in addition to a primary IV fluid through the injection port in the main IV fluid line by hand or using a syringe pump

IV push (IVP)

A ___________ syringe is similar in size to an IVP

flush

purpose of a flush

flush the primary IV tubing

flushing the primary IV tubing ensures

1. all drug is administered

2. incompatible medications are not present to cause a reaction

Example IV bag sizes for SVP

25, 50, 100 mL

SVP bags are made from

1. harder plastic

2. flexible PVC material

______________ have injection ports that are not flexible

Harder plastics

Often used for direct administration through parenteral route, needle used for compounding is removed from syringe and replaced with a plastic cap to maintain closure/sterility , New sterile needle applied for patient administration

syringes prepared by compounder in sterile hood

Attach directly to access catheter (needleless) or requires needle attachment. suitable for SUBQ or IM injections

Pre-filled Syringe prepared by manufacturer

advantages of pre-filled syringes

1. Minimize medication errors

2. Lower contamination risk

3. Minimize needlesticks (needleless only)

4. Convenient & easy to use

disadvantages of pre-filled syringes

1. malfunction

2. breaking

3. clogging

advantages of ready-to-mix systems

1. significant reduction of waste

2. lower potential for medication errors

3. minimize contamination, needle sticks

disadvantages of ready-to-mix systems

1. costly

2. Potential for system to not be properly activated like receiving diluent or partial drug

Plastic tool used for joining a vial with a powdered drug and an IV solution bag

Vial-Mate®

Vial-Mate® bag has two ends of attachment

1. patient IV port

2. medication vial

Keeps the drug and diluent separate until the system is activated just prior to administration

Add-Vantage System®

components of Add-Vantage System®

1. specially designed diluent container

2. drug vial

Add-Vantage System® drugs can be prepared quickly without

needles, syringes or alcohol swabs

fluid volume is > 100 mL

Large volume parenterals

Large volume parenterals packaging

1. bags

2. bottles

uses for Large Volume Parenterals

1. Administration of medications through IV route

2. Continuous infusion

3. Administration of parenteral nutrition

4. Correction of electrolyte/fluid imbalances

5. Vehicle for administering other drug substances (admixtures)

characteristics of bottles

1. Feature plastic loop that can be peeled away from the body

2. Needs an intravenous additive seal placed over the rubber stopper before leaving an ISO5 environment

2.5% dextrose in water

D2.5W

5% dextrose in water

D5W

5% dextrose and lactated Ringer's solution

D5RL or D5LR

10% dextrose in water

D10W

5% dextrose and normal saline

D5NS

2.5% dextrose and 0.45% saline

D2.51/2NS

5% dextrose and 0.45% saline

D51/2NS

Normal saline

NS

0.45% saline

0.45%NS or 1/2NS

Lactated Ringer's solution

RL or LR

Sterile water for injection

SWFI

Once a CSP has been made and verified, it’s ready to be ______________ to the patient

administered

Specific administration ____________ are needed to deliver the medication safely and accurately

supplies

_____________ devices used to deliver IV fluids to patients

Sterile, pyrogen-free

Manual set-ups rely on ____________ for infusion (uncommon)

gravity

Rates are determined by observing the drip chamber and then ________________ the clamp to increase or decrease the rate

adjusting

Plastic tubing with two ends. One end attaches to bag or bottle, one end attaches to patient catheter

tubing

Located at end of tubing. Attaching a needle or catheter

needle adapter

Roller or slide clamp. Used to adjust flow rate or shut down flow

clamp

Plastic cylinder attached to tubing. Traps air and used to determine flow rate

drip chamber

Located at end of tubing. Pierce rubber stopper or port on IV container

spike

Located between drip chamber and clamp. Additive port used to attach secondary IV sets

Proximal Y-site

Located near needle adapter. Provides a site through which medications can be directly infused into the vein

Additive port/ Distal Y-site

Additional tubing attached to a primary infusion set to infuse a secondary IV medication or an IV piggyback (IVPB)

Secondary Sets

Adding a secondary set will interrupt the ________________ to allow a second medication to be infused

primary infusion

a secondary set is attached to the proximal Y-site of the primary set

piggyback

A piggyback allows the primary fluid (like NS) and another medication (like an antibiotic) to be infused without the need to remove the ________________________

primary infusion tubing

__________________ protect patient against particulate matter, bacteria, and air emboli from infusion

In-line filters

In-line filters are available in what sizes

1. 0.22 micron

2. 1.2 micron

use to filter crystalloid solutions

0.22 micron filter

use to filter large particles like lipids

1.2 micron filter

Certain medications (like __________) should always be given with a filter

TPN

______________________ are used to deliver fluids and medications in controlled amounts

External infusion pumps

Used with infusion sets by threading tubing through the pump so flow rates can be regulated ________________

electronically

utilize pressure under resistance to force fluid into the vein

Large Volume Pumps

Large Volume Pumps are programed to specify the __________ at which the solution should be infused (mL/hr)

rate

Large Volume Pumps can concurrently infuse __________________

multiple solutions

pre-programmed with drug libraries

Smart pump

Smart pumps specify the ________________ that a specific solution should be infused

exact rate

______________ on smart pumps will alert nurses when there is an error in infusion rate or dose

Alarm system

deliver small amounts of fluid at slow rates from medication-filled syringes

Syringe pumps

syringe pumps are good for

1. pediatrics

2. fluid-restricted patients

allows patient to self-administer medication by pressing a control button attached to the IV pump

Patient controlled analgesia (PCA) pump

When button is pressed, patient will receive a prescribed amount of medication from PCA but cannot exceed a _____________________ allowed dose

lockout or maximum

PCAs are used in

1. surgeries

2. severe injuries

characteristics of delivery methods for Continuous ambulatory drug delivery (CADD) pump

1. Continuous rate

2. Automatic dose

3. Demand dose

4. Delivery methods independent or combination

Delivery methods can be used independently or in combination, continuous rate, automatic/demand dosing

Continuous ambulatory drug delivery (CADD) pump

delivery routes for CADD pumps

1. IV

2. SQ

3. epidural

4. intrathecal

Provide continuous infusion of a local anesthetic directly into patient’s surgical site for effective, non-narcotic post operative pain relief for up to 5 days; Reduces need for narcotics, Completely portable

Elastomeric Pumps

A small device installed under the skin to administer a steady dose of drugs; Avoids need to establish IV access multiple times; more invasive; Needs refilled regularly

Implantable Pump

Devices inserted into veins for direct access to the vascular system

Catheters

characteristics of peripheral catheters

1. IV access established in peripheral vein (arms, hands)

2. Simple and inexpensive

3. Used for short-term IV therapy

4. Cannot give highly concentrated medications

5. pain, irritation, infiltration problems

characteristics of central catheters

1. IV access established in central vein or results in central delivery of medication

2. Usually requires surgical intervention

3. can give concentrated medications

4. Placed deep in vein so enters superior vena cava close to heart where blood flow is greatest

5. infection with placement problems

6. Intrajugular (IJ); subclavian; femoral; Peripherally Inserted Central Catheter (PICC)

long peripheral catheter that goes from insertion site into a deep vein

Midline catheter

fine line threaded through peripheral vein into subclavian vein (same characteristics as central line)

PICC line

insert below breast and tunnel under skin into subclavian vein. Lower point of body insertion makes catheter easier for patient to see and clean

Implantable catheters

separately administer potentially physically incompatible drugs through one, two, three or four lumens each of which exists at a different location on the catheter

Multi-lumen catheters

types of infusions

1. intermittent

2. continuous

characteristics of intermittent infusion

1.given at spaced intervals

2. small volume parenterals (bolus, IV push, piggyback)

characteristics of continuous infusion

1. given around the clock

2. large volume parenterals