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• Intravenous Admixtures


  Combination of sterile added to an IV fluid for parenteral administration

  • IV admixtures are considered as sterile and pyrogen free

  • In the preparation of IV admixtures, aseptic technique must be followed
• Aseptic Technique


  • Manipulating sterile products without compromising sterility

  • Most important factors to prevent contamination of sterile products

  – Proper use of Laminar airflow workbench/ hood (LAFW/ LAFH)

  – Strict aseptic technique
• Parenteral, Ophthalmic, Irrigation products


  • Free from chemical and physical contaminants

  • accurately and correctly compounded

  • sterile

  • pyrogen free

  • stable until beyond use date

  • Properly packaged and labeled for use
• Packaging Requirements


  • Choice of package for sterile preparation should take into account the use of the preparation

  • Final container for a compounded sterile preparation must:

  – Be sterile and maintain the sterility of the preparation to the beyond use date

  – protect the final preparation from chemical degradation especially if it is photosensitive
• Labeling Requirements


  • Proper labeling is integral in safe medication system, because it

  identifies the following:

  – medication

  – quantity of the medication

  – for who the medication is for

  – dose of the medication
• SPECIFIC REQUIREMENTS for Labeling

  • Name and amount or concentrations of ingredients

  • Total volume of the compounded sterile preparation/IV admixture

  • Beyond use date

  • Appropriate route of administration

  • Storage conditions

  • Cautionary statements, initials of responsible pharmacists, disposal instructions
• PATIENT SPECIFIC Labeling

  • Patient name

  • Patient identification number

  • Patient location or room number

  • Name and amount of drugs added and the name of the admixture solution
• Drug Incompatibility


  • Occurs when one drug is mixed with others and produces unsuitable products that are no longer safe or effective for

  patient’s use

  • Types

  – physical Incompatibilities

  – chemical Incompatibilities

  – therapeutic Incompatibilities
• Factors Affecting Compatibility

  • pH of admixture

  • Complexation

  • Light

  • Degree of dilution

  • Time

  • Parenteral solution

  • Temperature

  • Buffer capacity of additive or solution

  • Order of mixing
• Medication administration of IV fluids

  • IV Bolus

  • IV Push

  • Continuous IV

  • Intermittent IV

  – IV Piggyback

  • Heparin Lock

  • IV Pump
• IV Bolus


  • Injection of small amount of undiluted medication either directly into the

  – vein

  – heparin lock

  – Port on the IV tubing

  • Used to achieve an immediate effect

  • Example: Lasix 20 mg push now
• PATIENT SPECIFIC Labeling • Time and date of scheduled administration • Time and date of preparation • Administration instructions • Initials of the persons who prepared and check the IV admixture
• Continuous IV


  • AKA: drip infusion

  • slower, primary line infusion of an IV

  preparation

  • Used to achieve maintenance of either:

  – therapeutic drug level

  –Fluid and electrolyte replacement
• Continuous IV


  • Hung at the patient’s beside

  • Allowed to drip slowly into a vein by:

  – gravity flow

  – Electrical battery-operated volumetric infusion

  pumps
• Intermittent IV Infusion


  • Used to achieve specific interval of drug administration (Ex: q4h, q6h, q12h)

  • IV piggyback falls under this category
• IV Piggyback


  • Medication is added to a small volume container

  • Then, connected as a secondary infusion to a primary IV line
• Heparin Lock


  • AKA: heparin well system

  • Medical device

  • Consists of an IV needle attached to a short plastic tube which ends in a rubber seal
• IV Pump


  • Delivers fluids, nutrients and medications into a patient’s body in controlled amounts

  • Example: Alaris IV Pump
• Alaris IV Pumps 


  • Has a variety of IV administration sets available for:

  – Primary set-up for continuous infusion

  – Secondary set-up for intermittent infusion

  • All sets consist of IV tubings, some types of drip chamber, a regulator clamp and protective caps to maintain sterility
• Alaris IV Pumps


  • Size of the opening into the drip chamber determines the size of the drop delivered

  • MACRODRIP sets

  – Delivers 10, 15 or 20 drops per mL

  –For quick and large infusion

  • MICRODRIP sets

  – Deliver 60 drops per mL

  – designed to administer small and very precise amount of fluid