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Small-Volume Parenteral Preparations


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Chapter 9

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Small-Volume Parenteral Preparations

  1. 1. Topics2 Chapter 9 Small-Volume Parenteral Preparations 2012 Paradigm Publishing
  2. 2. Topics3 Learning Objectives  Recognize the origins of small-volume parenteral preparations—in particular, antibiotics.  Understand the USP Chapter <797> procedures that must be performed prior to sterile compounding procedures.  Identify the critical sites of various small-volume parenteral preparation supply items, and describe compounding situations in which certain supply items should be used.  Discover the USP Chapter <797> procedures that must be performed during small-volume parenteral preparation.  Demonstrate effective technique in the preparation of two small-volume compounded sterile preparations. 2012 Paradigm Publishing
  3. 3. Topics4 Topics  Learning Objectives  Introduction  IVPBs  Compounding of IVPBs  Administration of IVPBs  Potential Complications of Parenteral Therapy  USP Chapter <797> Guidelines for SVPs  Understand the Resources and Supplies  Preview the Lab Procedure  Chapter Summary 2012 Paradigm Publishing In Slide Show view, click the desired topic to the left to link directly to the related slide. To return to this slide at any point in the presentation, click the Topics button below.
  4. 4. Topics55 Introduction  Small-volume parenteral (SVP) preparations—known simply as SVPs—are sterile solutions that typically have a volume of 25 mL, 50 mL, 100 mL, 150 mL, or 250 mL in general, these solutions are neutral, isotonic, and isosmotic 2012 Paradigm Publishing
  5. 5. Topics66 IVPBs  The majority of SVPs prepared by sterile compounding personnel are IV piggybacks, or IVPBs an IVPB is comprised of a small volume of a base solution and a medication the standard IV base solution may be a sterile fluid such as dextrose 5% in water (D5W), normal saline (NS), half normal saline (½ NS), or sterile water 2012 Paradigm Publishing
  6. 6. Topics77 IVPBs…/2  Unlike an LVP that is given for hydration or the continuous infusion of medication, an IVPB is used solely for the intermittent IV administration of medication according to a dosing schedule specified by a prescriber this intermittent infusion is accomplished by piggybacking the SVP through the tubing containing a patient’s primary IV solution 2012 Paradigm Publishing
  7. 7. Topics88 IVPBs…/3 2012 Paradigm Publishing  A limited number of IVPBs are supplied as premixed, shelf-stable, or frozen products other types are available in vial and bag systems the majority of ordered IVPBs must be compounded by an IV technician
  8. 8. Topics99 Compounding of IVPBs  A prescriber typically indicates the medication name, dose, and dosing interval or schedule, without specifying the base solution or volume 2012 Paradigm Publishing
  9. 9. Topics1010 Compounding of IVPBs…/2  The pharmacist considers several factors when choosing the most appropriate IVPB base solution and volume, including: the compatibility of the medication with the base solution the length of time over which the IVPB is to be administered the kidney function and hydration status of the patient recipient the minimum or maximum concentration required for safe administration of the drug 2012 Paradigm Publishing
  10. 10. Topics1111 Compounding of IVPBs…/3 Antibiotic Preparations  Antibiotics are antimicrobial medicines used to treat a variety of infections caused by certain types of microorganisms, such as fungi, protozoa, or bacteria not effective in the treatment of viruses  The terms antibiotic drugs and antibacterial drugs are sometimes used interchangeably 2012 Paradigm Publishing
  11. 11. Topics1212 Compounding of IVPBs…/4 Antibiotic Preparations…continued  Most bacterial microorganisms are said to be either gram-positive or gram-negative organisms in essence, gram-positive bacteria have thicker cell walls than gram-negative bacteria patients requiring IVPB antibiotic therapy often undergo blood testing (known as a culture and sensitivity test) to determine which pathogenic organism is causing the infection and—if the microorganism is a type of bacteria— whether the organism is gram-positive or gram-negative 2012 Paradigm Publishing
  12. 12. Topics1313 Administration of IVPBs  IVPBs are administered over a short period  Most IVPBs are administered by piggybacking them through a patient’s primary IV line occasionally, an IVPB medication is administered to a patient who does not have a primary IV line in this situation, the IVPB is administered through secondary IV tubing, directly into the patient’s vein, via a temporary injection port. This type of injection port— called a heparin lock, saline lock, or, simply, a lock—is attached to a flexible needle that is maintained in the patient’s vein 2012 Paradigm Publishing
  13. 13. Topics1414 Potential Complications of Parenteral Therapy  All patients receiving parenteral therapy should be monitored for the following complications: nosocomial infection allergic reaction (including anaphylaxis) phlebitis tissuing embolism extravasation cellulitis Stevens-Johnson syndrome nephrotoxicity 2012 Paradigm Publishing
  14. 14. Topics1515 Potential Complications of Parenteral Therapy…/2  For antibiotic SVPs, there is an increased likelihood for allergic reactions, including anaphylaxis; Stevens-Johnson syndrome; and nephrotoxicity 2012 Paradigm Publishing
  15. 15. Topics1616 Potential Complications of Parenteral Therapy…/3 Incompatibility Issues  In addition to these risks, IVPBs, due to their administration setup, have the potential for incompatibility issues for example, if two incompatible medications are administered through the same IV tubing, a precipitate could form, clogging the IV tubing and potentially causing injury to the patient 2012 Paradigm Publishing
  16. 16. Topics1717 Potential Complications of Parenteral Therapy…/4 Incompatibility Issues…continued  The primary IV tubing or the lock must be flushed after the IVPB medication has been administered if the patient is receiving a primary IV solution, the flush is performed by lowering the empty IVPB bag with secondary tubing attached to a height that allows gravity to force the primary IV solution to back up into the secondary tubing line for patients without a primary IV solution, the lock is usually flushed with a small volume of either NS solution, or a heparinized saline solution 2012 Paradigm Publishing
  17. 17. Topics1818 Potential Complications of Parenteral Therapy…/5 Antibiotic-Resistant Bacteria  IV technicians should be aware of a growing health concern in the use of antibiotic therapy—the development of antibiotic-resistant bacteria known as superbugs the evolution of superbugs has been influenced by two factors: the widespread use of antimicrobial disinfectants and the overuse of antibiotics 2012 Paradigm Publishing
  18. 18. Topics1919 Potential Complications of Parenteral Therapy…/6 Antibiotic-Resistant Bacteria …continued  Antimicrobial Overuse an antimicrobial is a substance or chemical compound capable of killing or inhibiting the growth of microorganisms antimicrobial agents may be found in many hand soaps, cleansers, and surface disinfectants, as well as some medicines the rise in the use of these products has helped to strengthen various microbes 2012 Paradigm Publishing
  19. 19. Topics2020 Potential Complications of Parenteral Therapy…/7 Antibiotic-Resistant Bacteria …continued  Antibiotic Overuse often, prescribers yield to a patient’s demand for an antibiotic for an illness that may be viral, not bacterial another source of antibiotic overuse comes from the use of antibiotics in the meat and dairy industries, whose policies allow for the administration of prophylactic antibiotic treatment to promote animal growth and to prevent and treat illness in livestock 2012 Paradigm Publishing
  20. 20. Topics2121 Potential Complications of Parenteral Therapy…/8 Superbugs as a Global Health Threat  Due to the widespread use of antimicrobials and antibiotics, superbugs such as methicillin-resistant Staphylococcus aureus (MRSA), carbapenem- resistant Klebsiella pneumoniae (CRKP), and New Delhi metallo-beta-lactamase (NDM-1) are on the rise and considered by many scientists to pose a serious threat to global health 2012 Paradigm Publishing
  21. 21. Topics2222 Potential Complications of Parenteral Therapy…/9 Superbugs as a Global Health Threat…continued  The World Health Organization (WHO) used World Health Day (April 7, 2011) to issue an urgent plea:  The message on this World Health Day is loud and clear. The world is on the brink of losing these miracle cures. The emergence and spread of drug-resistant pathogens has accelerated. More and more essential medicines are failing. The therapeutic arsenal is shrinking. The speed with which these drugs are being lost far outpaces the development of replacement drugs. In fact, the R&D pipeline for new antimicrobials has practically run dry. The implications are equally clear. In the absence of urgent corrective and protective actions, the world is heading towards a post-antibiotic era, in which many common infections will no longer have a cure and, once again, kill unabated. 2012 Paradigm Publishing
  22. 22. Topics23 Your Turn 2012 Paradigm Publishing 1) This is a substance or chemical compound capable of killing or inhibiting the growth of microorganisms. a. microbe b. antibiotic c. antimicrobial d. saline 2) These are considered by many scientists to pose a serious threat to global health. a. colds b. bacterial infections c. superbugs d. viruses In Slide Show view, click here to see the answer to Question 1. Then click again to advance to Question 2. In Slide Show view, click here to see the answer to Question 2.
  23. 23. Topics2424 USP Chapter <797> Guidelines for SVPs  During the preparatory and compounding procedures of SVPs, an IV technician must adhere to the overarching principles set forth in USP Chapter <797> these guidelines are reinforced in each facility’s P&P manual as well in accordance with these guidelines, sterile compounding personnel must pay strict attention to aseptic technique protocols both in the anteroom and clean room 2012 Paradigm Publishing
  24. 24. Topics2525 Understand the Resources and Supplies Essential Supplies  Most sterile compounding procedures require the same essential supply items to be available for use in both the anteroom and the clean room 2012 Paradigm Publishing
  25. 25. Topics2626 Understand the Resources and Supplies…/2 Procedure-Specific Supplies  IVPB Supplies – Vials most IVPB compounding procedures require an IV technician to reconstitute a powdered antibiotic within a vial to do so, the technician draws up diluent from a separate vial and injects that fluid into the vial containing the powdered antibiotic there are several methods that may be used to complete this procedure, including the use of the milking technique, a vented needle, or a repeater pump 2012 Paradigm Publishing
  26. 26. Topics2727 Understand the Resources and Supplies…/3 Procedure-Specific Supplies  IVPB Supplies – Vials…continued because positive pressure was created within the vial when the diluent was injected, the milking technique can be used to withdraw the dissolved powder from the vial without injecting air this method of reconstituting a powder within a vial is best used when preparing a single CSP in which the entire contents of a vial are injected into the IVPB to provide the desired dose 2012 Paradigm Publishing
  27. 27. Topics2828 Understand the Resources and Supplies…/4 Procedure-Specific Supplies  IVPB Supplies – Vented Needles in addition to regular needles, some IVPB sterile compounding situations require the use of a vented needle 2012 Paradigm Publishing
  28. 28. Topics2929 Understand the Resources and Supplies…/5 Procedure-Specific Supplies  IVPB Supplies – Vented Needles…continued a vented needle has a razor tip and is surrounded by a tiny aluminum needle sheath this unique design allows the injection of the diluent into the vial while simultaneously venting air from the vial this type of needle is used solely to reconstitute a powdered medication within a vial 2012 Paradigm Publishing
  29. 29. Topics3030 Understand the Resources and Supplies…/6 Procedure-Specific Supplies  IVPB Supplies – IVPB Base Solutions an IVPB base solution bag is very similar in design and function to that of an LVP bag the IVPB base solution bag is only available with a tail injection port when using an IVPB bag, the needle should be inserted directly into the injection port without regard to the position of the needle bevel, and without creating any bend to the needle, as is done when inserting a needle into a vial 2012 Paradigm Publishing
  30. 30. Topics3131 Understand the Resources and Supplies…/7 Critical Sites of Essential Supplies and IVPB Supplies  Before beginning preparatory procedures in the anteroom or clean room, the IV technician must recall the critical sites of the supplies  After identifying the critical sites of all supply items, care must be taken not to taint the critical site of any supply item through touch contamination, shadowing, or incorrect placement of the item within the hood 2012 Paradigm Publishing
  31. 31. Topics3232 Preview the Lab Procedure  Anteroom Preparatory Procedures verifying the CSP label against the medication order performing correct pharmacy calculations to determine type, size, and number of supply items needed gathering and cleaning of supplies performing aseptic garbing and hand washing donning a sterile gown 2012 Paradigm Publishing
  32. 32. Topics3333 Preview the Lab Procedure…/2  Clean Room Preparatory Procedures cleansing hands with sterile, foamed 70% IPA donning sterile gloves cleaning the hood  Once the hood has been cleaned, you must transfer the clean supplies from the transport vehicle or clean countertop to certain areas of the hood 2012 Paradigm Publishing
  33. 33. Topics3434 Preview the Lab Procedure…/3  SVP Compounding Procedure, Scenario One: Reconstitution Using the Milking Technique 2012 Paradigm Publishing
  34. 34. Topics3535 Preview the Lab Procedure…/4  SVP Compounding Procedure, Scenario Two: Reconstitution Using a Vented Needle 2012 Paradigm Publishing
  35. 35. Topics36 Your Turn 2012 Paradigm Publishing 3) This technique can be used to withdraw the dissolved powder from a vial without injecting air. a. shadowing b. reconstitution c. milking d. filtering 4) This type of needle has a razor tip and is surrounded by a tiny aluminum needle sheath. a. regular b. filter c. vented d. beveled In Slide Show view, click here to see the answer to Question 3. Then click again to advance to Question 4. In Slide Show view, click here to see the answer to Question 4.