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I.V. ADMIXTURE

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by

Mohammad Albaz

on 27 October 2013

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Transcript of I.V. ADMIXTURE

I.V. ADMIXTURE
Types of IV Administration
Infusions
Continuous
more effective & less toxic than when given intermittently
basic fluid & electrolyte therapy
blood products
drugs that require tight administration control
Intermittent
periodic administration increases efficacy
reduces toxicity
polus
Type of admixtures
1- Pre-mixed admixture .
2- Pharmacy prepared admixture .
I.V. system consists of :
catheter : may be central or peripheral .
I.V. set attached to the container .
dripping set : control rate of infusion by roller clamp .
container :
Large Volume Parenterals (LVPs)
Small Volume Parenterals or “Piggyback” Systems
Add-Vantage®
Vial Spike Systems
Flexible Plastic Bags
Glass Containers
Glass containers
Add-vintage
Vial Spike Systems
Pre-Mixed Admixtures
Manufactured LVPs with additives
stable in solution for longer periods of time
available in many of sizes (250 mL, 500 mL, 1000 mL)
Examples
lidocaine
potassium
nitroglycerin
dopamine
aminophylline
Advantages
Reduce handling by pharmacy
Reduce potential for contamination
Emergency situations-stocked in patient care area
Standard concentrations of IV medications
decrease potential medication errors in compounding & administration
LVP and Piggyback
Admixture preparation program
It includes development & maintenance of :
1- good aseptic technique in personnel who prepare & administer sterile products
2- sterile compounding area, complete with sterilized equipment & supplies
3- skills needed to properly use laminar airflow workbench (LAFW) or laminar airflow hood
Sterile Compounding Area
Compounded sterile products (CSPs) must be free of
living microorganisms & pyrogens
visible particles
Reduce number of particles in air
Clean work surfaces & floors daily
Clean walls, ceilings, & shelving monthly
Segregate compounding area
minimize traffic in sterile compounding area
remove trash d frequently & regularly
Filter incoming air
Ultraviolet irradiation
Air-lock entry portals
Use anteroom for non-aseptic activities
order processing
handling of stock
Laminar Airflow Workbenches
Principle of LAFWs
twice-filtered laminar layers of aseptic air
continuously sweep work area inside hood
prevents entry of contaminated room air
2 common types of LAFWs
horizontal flow
vertical flow
Preparation order
1- Check the physician’s orders.
2- Assemble all equipment and supplies needed in a designated work area, free of traffic, preferably and isolated area.
3- Assure the designated work area is clean.
4- Complete the appropriate label to include:
Patient’s name, location and medical record number
Name of drug, amount of drug, name of basic parenteral
solution and solution volume
Date and time of the addition
5- Name of operator of the admixture.
6- If there are any questions about compatibility of medications, check .
Incompatibility
Incompatibility is an undesirable reaction that
occurs between the drug and the solution, container or another drug. The two types of incompatibilities associated with intravenous
administration are physical and chemical
Types of incompatibility
1. Physical reactions
Physical reactions of drugs usually refer to either phase separation or precipitation (e.g. after the dilution of alcoholic solutions) due to a change of the relation between ionization and nonionization and solubility

2. Chemical reactions
A chemical incompatibility means that the drug is chemically degraded, due to oxidation, reduction, hydrolysis, or decomposition.
Chemical reactions can manifest themselves through turbidity, precipitation and color changes
Causes
drugs and inappropriate IV solutions as diluent
two drugs (drug-drug incompatibility) when they are mixed together, e.g. within the same infusion line(simultaneous infusion) and/or IV container administered one after the other, but within the same infusion line
drugs and adjuvants (preservative, buffer, stabilizer, solvent)
drugs and materials of IV containers (e.g. PVC) or medical devices,which can concern the nature of the material used and/orreactions at the inner surface (e.g. adsorption)
preventive strategies
plausibility check
strict indications for each drug preparation
separation of drug doses by time and place
consistent check of alternative modes of administration
usage of multi-lumen catheters
HLAFW
VLAFW
Definition
An IV admixture is the preparation of a pharmaceutical mixture of two or more drugs into a large bag or bottle of IV fluid. This is always done under the direction of a doctor, monitored by nurses and controlled by trained pharmacists. This is to be sure that no one is accidentally overdosed, or given the wrong medications.
Drip set
Peripheral catheter
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