Sterile Product Preparations 6 Sterile Product Preparations

IV Bags Most common sterile product Contain base solutions + medication Medication must be diluted before administration

IV Bags (cont’d) Two types Intravenous piggybacks Continuous preparations Large-volume IVs Drips

IV Bags (cont’d) IV Piggybacks (IVPB) Also known as small-volume parenterals (SVP) Administered over short time at specific intervals Consist of base fluid (D5W or NS) & medication Range in volume from 25 to 250 mL

IV Bags (cont’d) Used when Patient cannot take another method Medication needs to act quickly Typically are antibiotic, antifungal, antiviral, mineral replacement, or maintenance medicine Add-A-Vial/Advantage systems

IV Piggyback FIGURE 6-2 Intravenous piggyback

IV Bags (cont’d) Continuous Preparations Large-volume IVs (LVIV) Also known as large-volume parenteral (LVP) Infused on a continuous rate For hydration & electrolyte/vitamin replacement 500 mL or greater (most common = 1 liter) Many consist of just base solution, no additive Also for continuous antibiotic infusions (infections)

IV Bags (cont’d) Continuous Preparations Drips Infused at very slow rate For nitroglycerin, insulin, amiodarone, lidocaine, nitroprusside, heparin, narcotics 500 mL or less Ordered by amount of drug to be infused over given timeframe (mg/kg/min or mcg/hr)

Syringes Used for IV push (IVP) Undiluted IVP medications Skin tests Vaccinations Colony-stimulating factors Diluted IVP medications Personal controlled analgesia (PCA) Pediatric & neonatal antibiotics

Multi-Dose Vials (MDVS) Can be used multiple times, for multiple doses Can retain sterility after >1 needle puncture Usually contain preservatives Remainder in vial must be Stored properly Used before expiration date

Multi-Dose Vials (MDVS) (cont’d) Tech must label date/time opened, initials on vial Expiration date is 28 days, if not specified

Patient-Controlled Analgesia An IV pain medication Patient controls delivery of drug When patient has pain, he/she pushes button Administered via various IV pumps & devices Devices are calibrated to prevent overdose

Patient-Controlled Analgesia (cont’d) FIGURE 6-7 Patient-controlled anesthesia

Epidurals Inserted intrathecally For pain control in surgery or obstetrics Consist of anesthetic, alone or with a narcotic Common anesthetics: bupivacaine, ropivacaine All medication must be preservative-free Preservatives in epidurals can cause paralysis

Neonates and Pediatric Patients Typically require dilutions Dilutions Make substances less concentrated Used when dose is too small to be measured accurately Example: 5 unit insulin dose diluted to 0.5 mL Are less taxing on developing liver & kidneys Common dilution medications: antibiotics, antifungals, antivirals, narcotics, insulin

Irrigations Used in surgery to irrigate open surgical sites Must be sterile, though not administered by IV Most common irrigations Surgical antibiotic solution (SAS) Gentamicin irrigation solution

Irrigations (cont’d) Sterile water & normal saline used for irrigations must be labeled “for irrigation only” Do not meet requirements for IV use

Cytotoxic Agents Chemotherapy drugs Always compounded in biological safety cabinet Vertical airflow of BSC prevents aerosols from being blown toward technician Come in various forms Syringes IVPBs Continuous infusions

Total Parenteral Nutrition (TPN) For patients unable to receive adequate nutrition via other means Provide all dietary requirements to sustain life Contain protein, fat, sugar, water, minerals, electrolytes, & vitamins Compounded daily, every 24 hours

Total Parenteral Nutrition (TPN) (cont’d) Specific to patient’s needs & size IV bag size ranges from 500 to 3000 mL

Albumin A sterile solution for a single-dose administration Contains 25% human albumin Used to treat Hypovolemic shock (with exchange transfusion) Neonatal hyperbilirubinemia

Albumin (cont’d) May be a floor stock item in critical-care areas Don’t use if turbid or if sediment is in bottle Begin administration within 4 hr after puncturing bottle

Plasma Protein Fraction (Ppf) A sterile solution for single-dose IV admin. Contains 5% plasma proteins Used to prevent & treat hypovolemic shock Also used to treat severe hypoproteinuria Don’t use if turbid or if sediment is in bottle Begin administration within 4 hours after puncturing bottle

Immunoglobulin (Gammar-P, IgG) A sterile, lyophilized, single-dose preparation of immune globulin Indicated for patients with Primary defective or suppressed immune systems Greater risk for infection Wear chemo gloves when preparing

Immunoglobulin (Gammar-P, IgG) (cont’d) Must be reconstituted before admininstration Short stability time, expensive Use within 24 hr of reconstitution

Factor VIII (Alphanate) A sterile, lyophilized, single-dose concentrate of antihemophilic factor (AHF) Used to prevent & control bleeding For patients with Factor VIII deficiency Wear gloves when preparing Refrigerated; must be warmed to room temp Must be administered within 8 hours

Factor IX (Konyne) A sterile, lyophilized, single-dose concentrate of AHF For IV admin. to treat Factor IX deficiency Reconstitution, handling, & delivery same as for Factor VIII

Ophthalmics Must be prepared using aseptic technique Most preparations are available from manufacturer Special strengths/formulations must be compounded by pharmacy Sterilized by filtration before being packaged in dropper bottle