Hospital pharmacy report intravenous admixtures

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Hospital pharmacy report intravenous admixtures

  1. 1. INTRAVENOUSADMIXTURES
  2. 2. Guide Questions: What are intravenous fluids? What are the different types of intravenous fluids available in the Philippines? What are the different components of an IV fluid? What are the conditions where IV fluids are used? Define isotonic, hypotonic and hypertonic solution. When to use hypotonic, hypertonic and isotonic solution? What are the different types of IV administration set/ equipments? What is intravenous admixture? How are IV admixtures prepared? What are the different types of incompatibilities encountered in the preparation of IV admixtures? What are the complications associated with IV theraphy?
  3. 3. What are Intravenous fluids? Are large-volume injections intended to be administered by intravenous infusion. •Included in the group of sterile products refered to as Large Volume Parenterals (LVPs). •Consists of single-dose injections having a volume of 100mL or more and containing Remington, 21st added no Edition substances.
  4. 4. What are Intravenous fluids?  Are sterile solutions of simple chemicals such as sugar, amino acids, or electrolytes- materials that easily can be carried by the circulatory systemand assimilated. •Prepared with Water for Injection, USP •Pyrogen-free solutions A solution (usually a balanced electrolyte solution) administered directly into the venous circulation.
  5. 5. What are the different types of intravenousfluids available in the Philippines?Intravenous Fluids may be classified into:• Crystalloid Solutions• Colloidal Solutions
  6. 6. What are the different types of intravenousfluids available in the Philippines? Crystalloid Solutions •contain small molecules that pass freely through cell membranes and vascular system walls. •Are primary fluids used for IV theraphy. •These solutions are useful as fluid expanders and are stored at room temperature. •Useful source for electrolytes and a temporary source of fluid volume.
  7. 7. What are the different types of intravenousfluids available in the Philippines?Saline Solutions- is a solution of sodium chloride, or salt, in sterile water. A. 0.9 % Normal Saline contains 9g/L sodium chloride has osmolarity of 308 mOsmol/L (calc). It contains 154 mEq/L sodium and 154 mEq/L chloride. is a solution commonly used for medical purposes such as intravenous therapy for severe dehydration. It is also used as a rinse for contact lenses, and is used in wound care for irrigating, cleansing and hydrating wounds. Has green label
  8. 8. What are the different types of intravenousfluids available in the Philippines?B. 0.45% Normal Saline Solution Hypotonic Saline contains 4.5 g/L Sodium Chloride has osmolarity of 154 mOsmol/L (calc). It contains 77 mEq/L sodium and 77 mEq/L chloride.
  9. 9. What are the different types of intravenousfluids available in the Philippines? C. 1.8, 3.0, 7.0, 7.5 and 10% Saline Solution Hypertonic Saline
  10. 10. What are the different types of intravenousfluids available in the Philippines? Dextrose Solutions- used to supply water and calories to the body. It is also used as a mixing solution (diluent) for other IV medications. A. 5% Dextrose (D5W) is a parenteral fluid and nutrient replenisher. Each 100 mL of 5% Dextrose Injection, USP, contains dextrose, hydrous 5 g in water for injection. The caloric value is 170 kcal/L. The osmolarity is 252 mOsmol/L (calc.), which is slightly hypotonic. has red label
  11. 11. What are the different types of intravenousfluids available in the Philippines?B. 5% Dextrose in 0.9% Saline (D5NS) is a sterile, nonpyrogenic solution for fluid and electrolyte replenishment and caloric supply in single dose containers for intravenous administration. has yellow label
  12. 12. What are the different types of intravenousfluids available in the Philippines?C. 5% Dextrose in 0.45% D. Dextrose 5% in Saline (D51/2NS) Lactated Ringer’s (D5LR) has purple/ pink label
  13. 13. What are the different types of intravenousfluids available in the Philippines?Lactated Ringer’s Solution- is an intravenous (IV) solution used to supply water and electrolytes (e.g., calcium, potassium, sodiu m, chloride), either with or without calories (dextrose), to the body. It is also used as a mixing solution (diluent) for other IV medications. has blue label
  14. 14. What are the different types of intravenousfluids available in the Philippines?Colloidal Solutions It contains molecules that are frequently very complex and much larger than those in the crystalloid solutions. It is needed when a solution is required to remain in the vascular system. It generally require refrigeration and can be stored for a limited period. Whole human blood U.S.P. and Hetastarch are examples of colloid solutions.
  15. 15. What are the different components of an IVfluid? Water- for patients with dehydration Amino Acids- for tissue growth and repair, replacing body cells, healing wounds, and synthesizing vitamins and enzymes Vitamins (A, D, E, K, B & C)- for the restorative and replacement theraphies. pH- for the acidity and alkalinity of a solution.
  16. 16. What are the different components of an IVfluid? Electrolytes- major additives for replacement and restorative therapies. -any compound that, in solution or in molten form, conducts electricity and is decomposed (electrolyzed) by it. It is an ionizable substance in solution -is any substance that contains free ions that behaves as an electrically conductive medium (conducts electricity).
  17. 17. Electrolytes Functions SourcesSodium • Regulation for water Sodium Acetate regulation Sodium Phosphate • It helps with electrical signals in the body, allowing muscles to fire and the brain to workPotassium • Regulation of acid- Potassium Chloride base balance Potassium Phosphate • It is essential in the generation of the electricial impulses in the body that allow muscles and the brain to function
  18. 18. Electrolytes Functions SourcesMagnesium • is involved with a Magnesium Sulfate variety of metabolic activities in the body, Magnesium including relaxation of Phosphate the smooth muscles that surround the bronchial tubes in the lung, skeletal muscle contraction, and excitation of neurons in the brain. •It acts as a cofactor in many of the bodys enzyme activities.
  19. 19. Electrolytes Functions SourcesCalcium • Used in building and Calcium Gluconate maintaining bones and teeth. Calcium Chloride • Aids in blood clotting, nerve function, and muscle contraction. • Maintains normal levels of blood pressure and stomach acid.
  20. 20. Electrolytes Functions SourcesPhosphate • It helps form strong Phosphate salt of bones and teeth in the sodium and potassium human body. • It helps filter waste from the kidneys and plays a vital role in the production and storage of energy in the body. • It is responsible for maintaining the balance of other nutrients since it combines with other minerals to form phosphate salts or compounds.
  21. 21. Electrolytes Functions SourcesChloride •It travels primarily Chloride salt of with sodium and water cations and helps generate the osmotic pressure of body fluids. •It is an important constituent of stomach hydrochloric acid (HCl), the key digestive acid. •It is also needed to maintain the bodys acid-base balance. •It may also be helpful in allowing the liver to
  22. 22. What are the different components of an IVfluid? Nutrient Solutions- carbohydrates (dextrose, glucose or fructose) - waterExample: D5W (5% dextrose in water) 5% dextrose in 0.45% NaCl (dextrose in half- strength saline)
  23. 23. What are the different components of an IVfluid? Electrolyte Solutions- cations and anionsExample: NSS (0.9% NaCl solution) Ringer’s Solution (Na, Cl, K and Ca) Lactated Ringer’s Solution (Na, Cl, K, Ca andLactate)
  24. 24. What are the different components of an IVfluid? Alkalizing Solutions- for metabolic acidosis Acidifying Solutions- for metabolic alkalosis Blood Volume Expanders Example: Dextran Plasma Human serum albumin
  25. 25. What are the conditions where IV fluids areused?Intravenous fluids commonly are used with thefollowing conditions: Correction of disturbances in electrolyte balance (Na, K, Ca, PO4, Mg imbalance) Correction of disturbances in boy fluids (volume expander, blood loss) Means of providing basic nutrition(provide patients with difficulty in taking food and fluids orally) Basis for the practice of providing Parenteral Nutrition Vehicles for other drug substances (mixed with fluids for medication needed in the body)
  26. 26. Define hypotonic, hypertonic and isotonicsolution. Hypertonic- is a solution having a larger concentration of a substance than is found within the cells themselves. -it causes the cell to shrink, or crenate. Hypotonic-it contains a lesser concentration of impermeable solutes on the external side of the membrane. -it causes the cell to swell Isotonic- a solution which has the same concentration of dissolved substances as the blood cells do.
  27. 27. Define hypotonic, hypertonic and isotonicsolution.
  28. 28. When to use hypotonic, hypertonic andisotonic solution.Hypotonic have a lesser concentration of solutesSolution have an osmolarity lower than 250 mOsm/L often given to correct cellular dehydration and hypernatremia Used by patients for: -hypertonic dehydration -for water replacement -diabetic ketoacidosis Examples are: -0.45% NaCl (half strength saline) -0.33% NaCl -2.5% Dextrose in water
  29. 29. When to use hypotonic, hypertonic andisotonic solution.Hypertonic have a greater concentration of solutes than plasmaSolution Have greater tonicity than blood. Uses: -to replace electrolytes -to treat hypotonic dehydration -temporary treatment of circulatory insufficient and shock Examples are: -5% Dextrose in 0.45% NaCl -5% Dextose in 0.9% NaCl -5% Dextrose in lactated Ringer’s -10% Dextrose in water -Colloids (albumin 25%, Plasma protein fraction)
  30. 30. When to use hypotonic, hypertonic andisotonic solution.Isotonic Solution Have the same concentration of solutes (osmolarity) as blood plasma. Prevents sudden shifts of fluids and electrolytes in the body Used for: -treatment of fluid loss -dehydration -hypernatremia (sodium excess) Examples are: -0.9% NaCl -5% dextrose in water -Lactated Ringer’s Solution
  31. 31. What are the different types of IVadministration sets and equipments? IV Administration Sets IV Infusion can be administered either by: 1) Gravity alone Example:  Gravity Infusion set 2) With the use of an electronic infusion device Example:  Infusion pumps  Volumetric pumps
  32. 32. What are the different types of IVadministration sets and equipments?IV infusion administered bygravity: Infusion Set Gravity The height of the IV solution is of greater importance than the tubing. Most basic types of IV tubes/tubing can be used in this type of set. The higher the solution, the faster the solution infuses. Preferred elevation of the solution from the site of infusion: 18 to 24 inches (45 to 60 centimeters).
  33. 33. What are the different types of IVadministration sets and equipments?IV infusion administered with the use of anelectronic infusion device: Infusion Pump  Pressure is used in order to infuse solutions  Requires special tubing that contains a device such as cassette to create a sufficient pressure to push fluid into the vein.  Advantage: Programmed to deliver a preset volume per hour.  Disadvantage: If catheter or needle within vein becomes misplaced, the
  34. 34. What are the different types of IVadministration sets and equipments?IV infusion administered with the use of anelectronic infusion device: Volumetric Pump Do not depend upon gravity to force the fluid into the vein. All volumetric pumps generally involve the nurse entering the infusion rate in mL/hr. The volumetric pump then automatically maintains that rate. Volumetric pumps should still be checked regularly to ensure that they are infusing the medication correctly. Infiltration is possible when using a volumetric pump because it forces the fluid into the vein, even when it encounters resistance.
  35. 35. What are the different types of IV administration sets and equipments?IV Administration Equipments Basic IV Setup consists of the following important parts/equipment: a) Drip chamber c) Slide clamp b) Roller clamp d) Injection port Other IV equipment: a) IV Tubing d) Central IV Lines b) Hypodermic needle e) Tunneled Lines/Broviac Line c) Catheter needle f) Peripherally inserted central catheter
  36. 36. What are the different types of IVadministration sets and equipments? Basic Parts & Equipments A) Drip Chamber  Located just below the IV bag.  Inside this chamber, we can see the fluid drip down from the bag into the IV tubing.  This is where we measure the speed of a manual IV setup; we look at this chamber and count the number of drops we see per minute. B) Roller Clamp  is what we use to control the rate at which the IV fluid infuses.  All roller clamps on a set of IV tubing should be closed before we attach a bag of IV fluid to the top of the tubing; this ensures that no air gets into the tubing.
  37. 37. What are the different types of IVadministration sets and equipments?Basic Parts & EquipmentsC) Slide Clamp slide clamp is used when we want to completely stop the IV from flowing without having to adjust the roller clamp.D) Injection port A place where medicine or fluids other than those in the current IV bag can be injected so that they will infuse into the patients vein through the IV tubing.
  38. 38. What are the different types of IVadministration sets and equipments?a)Drip chamberb) Roller clampc) Slide clampd) Injection port
  39. 39. What are the different types of IVadministration sets and equipments?Other IV Equipments A) IV Tubing  Plastic conduit used to administer various fluids to patients through a needle inserted into one of the patient’s vein. B) Hypodermic Needle  Commonly used with a syringe to inject substances into the body or extract fluids from it. C) Catheter Needle  Used for the injection of fluids into the human body. This device is widely used in hospitals.
  40. 40. What are the different types of IVadministration sets and equipments?Other IV Equipments D) Central IV Lines  Have the capacity to deliver fluids that are considered to be irritating to peripheral veins. Also, medications introduced in this manner are quickly distributed throughout the body. E) Tunneled Lines/Broviac Lines  A type of central line in which Hickman line or Broviac catheter is inserted into the target vein then tunneled under the skin to emerge a short distance away.
  41. 41. What are the different types of IVadministration sets and equipments? F) Peripherally Inserted Central Catheter  Used when IV administration requires to be in a prolonged period or when the substance to be infused would cause damage if infused quickly. G) More Equipments:
  42. 42. What is Intravenous Admixture?  It is a combination of one or more sterile products added to an IV fluid for administration.  Intravenous admixtures must be sterile and free from pyrogens since it will be administed into the body.  Aseptic technique is used to mixed the products.
  43. 43. How are Intravenous Admixture prepared? The pharmacist must be knowledgeable in preparing a form for the combination of drugs and IV solutions that will be suitable for administration to the patient. Products used in preparing the admixture must be sterile and not contaminated. Proper conditions for aseptic handling can be provided by laminar-flow hoods. IV push and IV infusion dose forms are prepared in the laminar-flow hoods.
  44. 44. How are Intravenous Admixture prepared?Before the preparation of admixtures: Both hands must be thoroughly cleaned. Accessories/jewelries must be removed. Gloves must be used during the procedure. Laminar-flow hoods must be kept running. All surfaces of the work area must be cleaned and disinfected.During the preparation of admixtures: One must work in the center of the area within the laminar-flow hood. Proper procedures must be followed in handling sterile devices and containers.
  45. 45. How are Intravenous Admixture prepared? The plunger and the tip of the syringe must not be touched for they are sterile. One must use the smallest syringe which can hold the desired amount of solution. Additives may be packaged in vials or ampules.After the preparation of admixtures: Properly dispose used gloves and syringes. Clean the work area
  46. 46. How are Intravenous Admixture prepared? Drawing liquid from a vial: Choose the smallest gauge needle and handle carefully the rubber top of the vial thus, preventing particulates from entering. Attach needle to the syringe. Draw into the syringe an amount of air equal to the amount of solution to be drawn from the vial.
  47. 47. HOW ARE INTRAVENOUS ADMIXTURESPREPARED?  Drawing liquid from a vial:
  48. 48. How are Intravenous Admixture prepared? Drawing liquid from a vial:Swab alcohol on the top of vial. Enterthe laminar flow hood. Puncture therubber top of vial with needle bevel up.Bring needle and syringe straight up. Penetrate the stopper then depress the plunger of the syringe, emptying the air to the vial. Invert the vial with the attached syringe then draw up the required amount for the preparation.
  49. 49. How are Intravenous Admixture prepared? Drawing liquid from a vial:
  50. 50. How are Intravenous Admixture prepared? Drawing liquid from a vial:Withdraw the needle of thesyringe from the vial. Remove and properly dispose the needle and the cap of the syringe. Prepare the product by introducing the withdrawn drug from the vial into the IV container.
  51. 51. How are Intravenous Admixture prepared? Opening an ampule:Carefully tap the top of theampule so that medication willsettle on the lower portion of theampule. Clean the neck using an alcohol swab then, grasp the ampule between the thumb and index finger at the neck with the swab still in place. Forcefully snap the neck away from you.
  52. 52. How are Intravenous Admixture prepared? Opening an ampule:
  53. 53. How are Intravenous Admixture prepared? Drawing liquid from an ampule:Tilt the ampule then place theneedle bevel of a filter needle or tipof a filter straw in the corner nearthe opening. Withdraw themedication. Use a needle with a filter to filter out any glass particles, fibers, or other materials which may have fallen in the ampule. Before putting the contents of the syringe to an IV, needle must be replaced with a filter device to prevent introduction of particulates into the admixture.
  54. 54. How are Intravenous Admixture prepared?Labeling of the admixture:Labels for admixtures should contain the following information:- Patient’s name and identification number- Room number- Fluid and amount- Drug name and potency- Infusion period- Flow rate (e.g. 50mL/hr or infuse in a 30 minute period)- Expiration date and time- Any needed additional information
  55. 55. What are the different types of incompatibilitiesencountered in preparing IV admixtures? Intravenous fluids incompatibilities are the undesirable reactions that can occur when two or more drugs must be administered through single IV line or given in a single solution. Types: 1) Physical Incompatibilities 2) Chemical Incompatibilities 3) Therapeutic Incompatibilities 4) Drug IV Container Incompatibilities
  56. 56. What are the different types of incompatibilitiesencountered in preparing IV admixtures? Physical IncompatibilityThe incompatibility that is more on solubility changes and container interactions. Type Ways to Prevent INSOLUBILITY -Do not administer a precipitate forming drug. SORPTION PHENOMENA - Avoid mixing drugs prepared in special diluents with other GAS FORMATION drugs. - In administration of multiple SOLUTION PH intravenous medications, prepare each drug in a separate syringe.
  57. 57. What are the different types of incompatibilitiesencountered in preparing IV admixtures? Chemical IncompatibilityResults from the molecular changes or rearrangement and leads to chemical decomposition. Type Ways to Prevent HYDROLYSIS Store drugs in relatively water- proof containers. OXIDATION REACTION Store drugs in amber bottles. This will minimize oxidation reaction. REDUCTION REACTION Keep away from suspected reducing agents. PHOTOLYSIS Storing drugs in lightproof containers can usually prevent photolysis.
  58. 58. What are the different types of incompatibilitiesencountered in preparing IV admixtures? Therapeutic Incompatibility Result of antagonistic pharmacological effects of several drugs in one patient. Example Intervention Heparin and antibiotics It is best to avoid mixing heparin with antibacterial preparations because Heparin can affect the stability of certain antibiotics.
  59. 59. What are the different types of incompatibilitiesencountered in preparing IV admixtures? Drug-IV Container IncompatibilityIncompatibility that arise from the chemical reaction of the drug and the Intravenous container. Type Definition ADSORPTION The property of a solid/liquid to attract and hold to its surface a gas, liquid, solute or suspension. ABSORPTION The act of taking up liquids or other substances through a surface of the body into body fluids and tissues.
  60. 60. INTRAVENOUS INCOMPATIBILITIESFactors causing IV Incompatibility Type Intervention Difference in pH Refer to drug incompatibility tables. High Concentration Determine the chemically compatible concentration of both drugs. High Temperature Refrigerate the IV admixture if not used within 1 hour after mixing. Order of Mixing Alternate the administration Length of Time in Solution The Iv drug should be mixed and discarded if not used within 24 hours.
  61. 61. INTRAVENOUS INCOMPATIBILIES Ways to prevent or minimize incompatibilities 1. Mix thoroughly when a drug is added to the preparation 2. Minimize the number of drugs mixed together in an IV solution. 3. Solutions should be administered promptly after mixing so that occurrence potential reactions can be minimized. 4. Always refer to compatibility references.
  62. 62. What are the complications associated withthe IV therapy?Local Complications Systemic Complications Infiltration Phlebitis  Septicemia Thrombosis  Fluid overload and pulmonary edema Thrombophlebitis  Air embolism Bruising  Catheter embolism Hematoma  Speed shock
  63. 63. Local Complications Infiltration o Happens when the needle or catheter in which the product is entering the blood vessel (vein) is dislodged from the vein. o Remedy: Product should be administered in another site. Phelibitis o Inflammation of vein caused by mechanical, bacterial or chemical irritation. o Characterized by redness and pain at the administration site. o Remedy: Solution should be administered in another site.
  64. 64. Local Complications  Thrombosis o Occurs when blood flow through a vein is obstructed by a local thrombus. o Remedy: remove IV device, restart infusion, apply warm soaks.  Thrombolphlebitis o Similar to phlebitis but a clot (thrombus) is involved. o At times, the IV cannula staying inside the body can cause irritation which can trigger clotting mechanisms.
  65. 65. Local Complications• Bruising o A type of minor hematoma of tissue in which capillaries and sometimes venules are damaged due to trauma allowing blood to collect to the surrounding tissues.• Hematoma o Collection of blood caused by internal bleeding. This can happen when a catheter punctures through the vein and cause bleeding.
  66. 66. Systemic Complications • Septicemia o A febrile disease process that resulted from the presence of microorganisms or their toxic products in the circulatory system. • Fluid Overload and w/ edema Pulmonary edema o Excessive administration of intra- venous fluids is the main cause. o High blood pressure may result due to increased fluidNormal volume. o Also, pulmonary edema may also happen due to abnormal fluid accumulation in the
  67. 67. Systemic Complications• Air embolism o Results when a sizeable volume of air enters the circulatory system. o This may happen when air from the intravenous administration set enters the bloodstream.• Catheter embolism o Happens when a piece of the catheter breaks off and travel through the circulatory system.
  68. 68. Systemic Complications • Speed Shock o Occurs when a foreign substance (e.g medication) is rapidly infused or introduced into the circulation. Remember: “Early detection and good communication between patient and healthcare provider are both important in minimizing IV therapy complications.”
  69. 69. Group 1AYCO, IVY LENADONGGON, JOHN JEFFERSONBALLESTA, MARIA ZARABULAONG, KRISTINEDAILEG, KRISTINEDURO, GALE MICAHRAMIREZ, RHEAVILLANUAEVA, MARIA PIAVILLACORTE, ILY THANK YOU! XD

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