sterile compounding supplies
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Chapter 3
Sterile Compounding Supplies
2012 Paradigm Publishing
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Learning Objectives Discover the origins of several sterile compounding supplies. Identify a variety of supplies used for preparing sterile
compounds. Describe various components of the most frequently used
sterile compounding supplies. Understand the rationale for using particular supplies in specific
compounding situations. Identify the critical sites of commonly used sterile compounding
supplies.
2012 Paradigm Publishing
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Topics Learning Objectives Introduction Correct Opening and Placement of Supplies Needles Specialty Needles Syringes IV Base Solutions IVPB Solutions Premixed Parenteral Products Vials Ampules IPA Swabs, Vented Dispensing Pins, IVA Seals, Sharps Containers Sterile IV Tubing Repeater Pumps Miscellaneous Sterile Compounding Supplies Chapter Summary
2012 Paradigm Publishing
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Introduction
The critical site is the part of the supply item that includes any fluid-pathway surface or fluid-pathway opening that is at risk for contamination by touch or airflow interruptioncritical sites must only be touched by a sterile tool to avoid
touch contamination Anything that interrupts the airflow from the HEPA
filter to the critical zone causes shadowing, another form of potential contamination
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Correct Opening and Placement of Supplies
Take great care when opening the outer packages of all supply itemsthe outer packaging is sometimes called a dust coverkeep the sterile supply item within the clean air zone
Along the entire outer edge of the hood’s work surface, measuring six inches into the hood, sterile air from the hood’s HEPA filter mixes with turbulent room airthis area is referred to as the outer six-inch zone, or the
zone of turbulence
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Correct Opening and Placement of Supplies…/2
All sterile compounding procedures must take place at least six inches inside of the hood, thereby avoiding the outer six-inch zone
2012 Paradigm Publishing
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Needles
The needle is attached to a syringe and is then used to either draw fluid into the syringe, (also known as a straight draw) or push fluid out of the syringe and into an IV bag or bottle
Regular needles, the most commonly used, are used specifically to withdraw or inject fluids for parenteral administration
Several components are common to every needle
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Needles…/2 The needle tip is at the
very end of the needle and is razor sharp
The tip of the needle has a slanted opening called the bevel
The heel is the rounded part of the bevel at the point where the slanted opening ends
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Needles…/3 The needle shaft provides length to the needle and
extends from the point where the colored needle hub attaches to the metal needle, to the needle tip
The inner core of the needle shaft is called the lumen, a hollow space through which fluid moves into or out of the syringe
The needle hub is the end point, which attaches to the syringe
A hard plastic cap covers the needle shaft and tip until the moment of use
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Needles…/4
Needle gauge refers to the diameter of the opening, or lumen, of a needlewhen drawing up a viscous liquid the IV technician would
choose a needle with a large gauge size but would select a needle with a small lumen when providing an IM medication for a neonate
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Needles…/5
IV technicians choose needle lengths according to the task being performed for most sterile
compounding procedures, they select a regular needle with a standard 1 ½" length
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Needles…/6 The standard recapping method requires the
technician to hold the filled syringe as she or he would a dart and then recap the needle by holding the cap between the thumb and forefinger of the nondominant hand and carefully slipping it over the tip of the needle
The scoop recapping method involves placing the tip of the needle into the cap that is lying on an IPA swab on the hood’s work surfacethe IV technician uses the needle-and-syringe unit to scoop
the needle cap onto the needle
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Specialty Needles The filter needle is a needle with a small, built-in
filter (sometimes referred to as a depth filter) between the needle’s shaft and hubused to remove particulate matter from a solution
Technicians use the vented needle primarily to dilute large-volume or multiple containers of parenteral medications in powder formthese medications must be reconstituted prior to use
The transfer needle transfers fluid from one vial or container to another
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Syringes Sterile compounding technicians use syringes to
withdraw or inject solutions as part of the preparation of almost all sterile products
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Syringes…/2
The syringe tip may be either Luer-lock or slip-tipto make a secure connection, you screw the needle onto a
Luer-lock syringea slip-tip syringe slides onto the hub of the needle
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Syringes…/3
The barrel of the syringe contains the calibration marks for measuring fluid volume
Inside the barrel of the syringe is a black, rubber-tipped piston plunger
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Syringes…/4
Behind the piston plunger is the inner shaft of the plunger
The flat end of the plunger, most distant from the needle end, is referred to as the flat knob, lip, or heel of the syringe
You can touch or hold the syringe only on the outer barrel or the flat knobthe critical sites of a syringe are the tip or hub, the piston
plunger, and the inner plunger shaft
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IV Base Solutions
A large volume of sterile fluid that is delivered via sterile IV tubingalso known as a large-volume
parenteral (LVP), base solution, primary IV, IV, or IV bag
contains a small plastic hang loop
the IV technician injects additives through the injection port
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IV Base Solutions…/2
The nurse removes the rubber cap covering the bag’s tubing port and inserts the tubing’s universal spike adaptor into the tubing port
The LVP is commonly the primary source of hydration for the patient and is run continuously while the patient is unable to take oral liquidsmost LVP solutions are made with varying concentrations of
sodium and/or dextrose mixed with sterile water During the sterile compounding process, personnel
prepare IV solutions that require medication additives2012 Paradigm Publishing
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Your Turn
2012 Paradigm Publishing
1) Most sterile compounding procedures use a regular needle with this length.a. 1″b. 1 ¼″c. 1 ½″d. 1 ¾″
2) Sterile compounding technicians use these to withdraw or inject solutions.a. adaptorsb. syringesc. portsd. plungers
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IVPB Solutions
An IVPB solution is a small volume of fluid mixed with an IV medication and administered via sterile IV tubingIVPBs are a type of small-
volume parenteral (SVP) product and are usually “piggybacked” through a primary IV line that contains the IV base solution
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IVPB Solutions…/2
IVPB bag components are similar to those of an IV base solution bag
The IVPB medication is administered to the patient intermittently, based on the frequency ordered by the prescriber
Many intravenously administered antibiotics are delivered via an IVPB
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Premixed Parenteral Products Some medications for
administration by IV or IVPB are supplied in the form of premixed, shelf-stable products IV bags that contain a standard
dose of potassium chlorideIVPB that contains a standard
dose of famotidineprefilled syringe provided for
IV push use2012 Paradigm Publishing
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Premixed Parenteral Products…/2
Various IVPBs are supplied in packages of 12, 24, or 48 and are shipped from the wholesale supplier in a container packed in dry ice
Other products commonly used are systems such as ADD-Vantage, MINI-BAG Plus, and Add-A-Vial
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Premixed Parenteral Products…/3
These products require sterile compounding personnel to screw or snap a specially built vial onto an IVPB designed for this type of attachmentperformed in the hood
One advantage of this type of IVPB is that it can be mixed just moments before the dose is requiredhelpful if the medication is not stable for long periods in its
mixed formreuse is possible because these systems are stable for up
to 30 days
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Vials Vials are sealed, sterile containers with a rubber top
most often contain a sterile medication, in a liquid or powder form, or a liquid diluent
most commonly used diluents are sterile water and normal saline
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Vials…/2
The two main types are single-dose vials (SDVs) that do not contain a preservative, and multiple-dose vials (MDVs) that do contain a preservative
Mix-O-Vial is used infrequently by IV technicians due to the limited number of immediate-use medications supplied in this type of containerdislocating the plug releases the liquid into the powder,
which dissolves and is then drawn up in solution by the IV technician for either an IV push or IVPB administration to a patient
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Ampules
An ampule is a sterile, sealed container made entirely of glass with a tapered neckIV technicians break the glass at this tapered, scored neck
and aseptically remove the liquid with a needle and syringe
the ampule is an appropriate container for drugs that are not compatible with the rubber top or other components of a vial
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IPA Swabs, Vented Dispensing Pins,IVA Seals, Sharps Containers
Sterile IPA swabs are wiped across most critical sites Vented dispensing pins are inserted into a vial or
glass bottle and then attached to a syringe
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IPA Swabs, Vented Dispensing Pins,IVA Seals, Sharps Containers…/2
IVA seals are small foil stickers that sterile compounding personnel place over the injection port of the prepared IV, IVPB, and various other compounded products
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IPA Swabs, Vented Dispensing Pins,IVA Seals, Sharps Containers…/3
The sharps container is a large bucket, usually red in color, made of thick plastic and used to safely dispose of used needles, syringes, and broken glasschemotherapy waste must
be disposed of in a special sharps container that is typically yellow in color
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Sterile IV Tubing
Sterile IV tubing is a supply item frequently used throughout the hospital
Primary IV tubing is sterile IV tubing with multiple injection portsnurses use primary IV tubing to administer an IV base
solution to the patient Secondary IV tubing is short, sterile IV tubing that
may or may not have an injection portIV technicians use secondary IV tubing to transfer a solution
from a source container to another bag or bottle
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Sterile IV Tubing…/2
Insert the universal spike adaptor into the tubing portobserve the drip
chamber to calculate the flow rate
the roll clamp is used to regulate the flow rate
the far end of the tubing is called the needle adaptor
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Repeater Pumps
Some sterile compounding facilities use repeater pumps to rapidly transfer sterile fluids from large-volume or bulk containers into small-volume containers such as syringes or vialswhen personnel must prepare large batches of fluid-filled
syringes of the same volume, a repeater pump is an excellent alternative to drawing up the syringes from a bulk container by hand
2012 Paradigm Publishing
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Miscellaneous Sterile Compounding Supplies
Other supplies that are less frequently used but still important to the work of an IV technician include syringe caps, Luer-to-Luer connectors, membrane filters, and empty evacuated containers
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Miscellaneous Sterile Compounding Supplies…/2
A syringe cap is a small, plastic cap that attaches to the tip of a filled syringe
A Luer-to-Luer connector is a plastic tube with Luer-lock hubs at both ends
Membrane filters (0.2 micron or smaller) are used to sterilize solutions that have been prepared using nonsterile ingredients
An empty evacuated container (EEC) is a sterile, empty vial or glass bottle whose volume ranges from 2 mL to 1000 mL
2012 Paradigm Publishing
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Your Turn
2012 Paradigm Publishing
3) The sharps container is usually this color.a. redb. yellowc. blued. black
4) Some sterile compounding facilities use these to rapidly transfer sterile fluids.a. drip chambersb. syringe capsc. membrane filtersd. repeater pumps
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