1. Compounding

2. Compounding Considerations
Handling, preparation, and administration of antineoplastic agents are of special concern because of their mutagenic and suspected carcinogenic effects.

3. Personnel
All personnel must receive special training to work with antineoplastic agents.
Number of personnel involved in working with these agents should be kept to a minimum.
Technicians should be observed regularly by supervisory personnel to ensure compliance.
Maintain a permanent registry of all employees who handle antineoplastic drugs.

4. Class II Biological Safety Cabinets (Vertical Airflow)
Special aseptic techniques and precautions are necessary because of the downward flow of filtered air.
No admixtures other than antineoplastic medications should be compounded in the designated vertical flow hood.

5. Class II Biological Safety Cabinets (Vertical Airflow)
Should be certified at least annually or any time the cabinet is moved.
Should be operated with the blower on at all times.
Admixture compounding should only take place with the front window down, leaving an opening just high enough to allow the preparer to work comfortably.

6. Protective Coverings Disposable gloves (double gloving is recommended)
Protective barrier gown or other garment with a closed front, long sleeves, and tight fitting cuffs.
Potentially contaminated garments or gloves must not be worn outside of the work area and should be disposed of properly.
Wash hands after removing and disposing of gloves.

7. Compounding Techniques
Remember that airflow is downward and it is important not to block the airflow by moving hands or objects over the top of the product being compounded and equipment being used.
Syringes and IV sets with Luer-lock fittings should be used whenever possible.
Vials should not be pressurized by injecting air into them.

8. Compounding Techniques
If a vial is over pressurized, a spray or spill may occur when removing the needle.
Devices are available, which fit onto vials, and allow air to be injected into the vial without fear of aerosolization of the drug.
When removing a needle from a vial, wrap the needle and injection site of the vial or bag with an alcohol swab to prevent spilling droplets or release of aerosolized drug.

9. Disposal
All disposable items that have potentially come into contact with antineoplastic drugs during preparation or administration must be disposed of in containers designated with the biohazard symbol.
Hazardous waste containers should be removed from the work area by appropriate personnel and destroyed according to work site policy and procedure.