1. Sterile Product Preparations6
Sterile Product Preparations

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

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

4. 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

5. 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

6. IV Piggyback
FIGURE 6-2 Intravenous piggyback

7. 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)

8. 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)

9. 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

10. 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

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

12. 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

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

14. 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

15. 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

16. 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

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

18. 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

19. 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

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

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

22. 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

23. 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

24. 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

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

26. 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

27. 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

28. 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