Intravenous admixture
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Intravenous admixture

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Intravenous admixture

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1. Intravenous admixture Objectives Definitions Intravenous Medications Method of Intravenous Administration Intravenous admixture system Preparing IV admixture

3. Intravenous Admixture Service

4. Intravenous admixture Rx Amikin 450 mg + D5W 50 ml iv OD Meropenem 280 mg + D5W 30 ml q 8 hr Phenytoin 70 mg + NSS 50 ml iv q 12 hr Amphotericin B 7 mg + D5W 70 ml iv OD

5. Intravenous admixture Definitions IV admixture: ???????????????????????????????????????????????????? > or = 1 ???? ??????????????????????????????? SVP: ???????????????????????????? ????????? < 100 ml LVP: ???????????????????????????? ????????? > or = 100 ml Stability: ?????????????????? ????????????????? ????????????????????????? 90%??????????????????? ????????????????????????????? Incompatibility: ??????????????????????????????/???? ?????????? 2 ??????????????? ?????????????????????????

6. Intravenous admixture IV admixture System: ??????????????????????????? ?.?.?.??????????????????????????????????????????????????????????????????????????????? Aseptic technique ??????? Compatibility, Stability ?????????????????????????????????????????????????????? ??????????

7. Intravenous admixture Pharmacy IV admixture Service: ???????????????????????????????????????????????????????????????????????????? ???? ????????????????????????????????????? ????????????????????? syringe ???????? ?????????????????????????????????????????????????????? Ampule ???? Vial ????? syringe ???????????????

8. Intravenous admixture Intravenous medications Aqueous solution Suspension ready for injection Lyophilized powders requiring aqueous diluent Lyophilized powders supplied with special diluent Lyophilized powders requiring aqueous diluent without preservative Non-aqueous solution ready to administer

9. Intravenous admixture Method of Intravenous Administration Continuous therapy Intravenous infusion Hook up Intermittent therapy Direct IV injection / IV push Volume control method (Soluset) Piggyback method (Automatic piggyback administration set) Prefilled partial fill container Prefilled piggyback units

10. Intravenous admixture Small volume IV injection Glass ampule Single dose vial Multiple dose container Prefilled syringe Premixed IV bag and bottle (CRIS, ADD-Vantage) Lyophilized single dose container

11. Intravenous admixture Large volume IV injection Example of LVPs Dextrose injection: D5W Dextrose and Sodium Chloride Injection USP Mannitol injection USP Ringers Injection USP Lactated Ringer Injection USP Sodium Chloride Injection USP

12. Intravenous admixture Basic Administration Set Plastic spike Drip chamber Polyvinyl chloride tube with gum rubber injection port Adjustable clamp (screw/ roller type) Air tube/ Air inter filters

13. Intravenous admixture IV admixture system Small volume IV system: ????????? (solution drug/ lyophylized drug ??? reconstitute ????/ prefilled syringe) ???? small plastic IV bag ???? glass bottle ???????????? D5W ???? 0.9% NSS Syringe: ???????????? single dose ???? multiple dose Syringe pump Gravity-fed syringe Volumetric chamber-type IV set (Soluset) Single Dose Lyophilized Drug in Final IV Container Premixed and Frozen Premixed Bags and Bottles

14. Intravenous admixture Large volume IV system: ?????????????? reconstitute ???????????????????? LVP ???? D5W ???? 0.9%NSS Premixed Large-Volume IV Solution Isoosmotic Osmolarity Special IV Admixture System Controlled Release Infusion System Specially Designed IV Bag with a Drug Vial Port

15. Intravenous admixture ????????????? IV admixture 1. Procurement and Selection 2. Procedure 3. Quality control & Quality assurance ?????????????????????????????? IV admixture ????????????????????? ???????????????? ????? pyrogen Aseptic technique ????????????????????????????????? ???????????????? particulate matter

16. Intravenous admixture ??????????????????????? 1. Contamination 2. Compatibility 3. Stability 4. Cost 5. Error 6. Quality 7. Process 8. Pharmaceutical care 9. Safety

17. Intravenous admixture ???????????????????????? IV admixture Preparation area Policy and Procedure Personnel Storage space Economic consideration Admixture system

18. Tile, washable floor covered with a coat of vinyl or epoxy sealant to provide a continuous surface Hand washing facilities Laminar air flow hoods: horizontal and/or vertical air flow Refrigerator Preparation equipment: needles, syringes, alcohol prep pads, gloves, masks, gowns, receptacles for disposables, small-volume parenterals, diluents, and solutions Good lighting Adequate counter space Restricted area or minimized traffic flow Prohibition of smoking, beverages, food, and unauthorized personnel Preparation area: Clean room

19. Policy and Procedure Stability Incompatibility (Physical, Chemical, Therapeutic) Aseptic technique IV profiling Labeling and check system Quality control and Quality assurance Auxiliary label Equipment

20. Stability: ?????????????????????????????? Incompatibility Physical (?? ???????? ??????? ????): ???-???? ???????????????????? Chemical: oxidation, phytolysis, complexation, inactivated drug Therapeutic: drug-drug interaction, drug-disease interaction

21. Labeling Patient name, identification number, and room number Bottle sequence number Name and amount of drug added Name and volume of admixture solution Approximate final total volume of the admixture Prescribed flow rate (ml/hr) Date and time of scheduled administration Date and time of preparation Expiration date Initials of the person who prepares and/ or checks the IV admixture Ancillary labeling (supplemental instructions and precaution)

22. Auxiliary labeling Protect from light Do not refrigerate or Do not allow to freeze Caution: Chemotherapy agent - Dispose of properly Caution: Vesicant/ Tissue irritant For epidural use only Checking ?????????????????????????????? ?????????? ??????????

23. Quality control ???????????????????????????????? ???????????????????????????????????????????????????????????????? ?????????????????????? Sterility test ???????????????????????????????????????

24. Intravenous Admixture Service

25. 1. ?????????????????? 2. ???????????? 70% alcohol ???? Benzalkonium Chloride Solution 3. ??????????????? 4. ??????? Laminar air flow hood ?????????????????????????? 6 ???? 5. ????????????????? 70% alcohol ?????????????????? ???????????????? IV admixture

26. ???????????????? IV admixture 6. ?????????????? LVPs ????????????????? 6.1 Ampule ??????? LVP ?????? Needle ??? Syringe 6.2 Vial ??????? LVP ??????????????????? Vial ???????????? (recostitute) ????????????????????? Vial ?????? Needle ??? Syringe (?????? Double needle) 6.3 Special designed vial (Pintop, Mix-O-Vial, Act-O-Vial) 7. ????? ???????????????????? ?????????????????????????????????????????????-??

27. ???????????????? IV admixture 8. ????????? ????????????? drop/minute ???????????????????????????????????? 9. ????????????????????? ???????????????? ???????????????????? ??????????????? 24 hr ??????? ??????????????

28. Intravenous admixture Flow rates of IV infusion fluids Flow rate (drop/min) = drip rate (drop/ml) x ?????????????? (ml) ???????????????????? (min) ???????? drip rate ??????? Administration set ?????? LVP Administration set Drip rate (drop/ml) Cutter set 20 Abbott set 15 Baxter set 10 McGaw set 13

29. Phenytoin Sodium Solution 250 mg/5 ml Diluted with NSS 50 ml Precipitate at pH < = 11.5 IV Infused within 1 hr after mixed LD 15-20 mg/kg, MD 5 mg/kg/day ?????????????????????????

30. Bactrim Solution 5 ml/ampule TMP 80 mg + SMX 400 mg D5W 100 -125 ml ??????????? ??????? pH ??? aqueous solution (??????????????????????????????) IV Infused 60-90 min. ?????????????????

31. Amphotericin B Powder 50 mg (?????????????) Reconstitute with SWFI 10 ml (Conc. 5 mg/ml) Dilute with D5W (Conc 0.1 mg/ml) Incompatibility with NSS IV Infuse up to 6 hr

32. Vancomycin Powder 500 mg Reconstitute with SWFI 10 ml (Conc. 50 mg/ml) D5W or NSS 100- 200 ml IV Infused 1 hr

33. Gentamicin Sulfate solution 80 mg/ 2 ml Dilute with D5W or NSS (Conc. 1 mg/ml) Infuse 30-60 min ????????????????

34. Cloxacillin Powder 500 mg, 1 g For IV, reconstitute with SWFI 5 ml Dilute with D5W or NSS (Conc 20 mg/ml) ????????????? ???? Temp ????


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