IV Admixture

Introduction:

The preparation of parenteral admixture usually involves the addition of one or more drugs to large volume solutions such as intravenous and nutrients fluids.

Introduction:

Components of an IV program Preparation area Policies and procedures Personnel Storage space Admixture systems

Cont’:

Components of an IV programPreparation area Ideally in separate room in the

pharmacy “clean room” Size vary

Cont”:

Components of an IV programPolices and procedures Guidelines for preparing parenteral

products should be outlines in the pharmacy’s policy and procedure manual.

Detailed information regarding preparation, labeling, storage and expiration dating of parenteral products should be readily available in the pharmacy

These policy help to provide quality control for the parenteral products

Cont”:

Components of an IV programPolices and procedures Stability Put in your mind that stability is

affected by place, environmental condition, diluent used to administer the product, other drugs that may be mixed with

Stability and sterility! Gives the expiration date

Cont”:

Components of an IV programPolices and procedures incompatibilityPhysical: visible change e.g. precipitationChemical: may or not visible change,

deterioration or inactivation of an active ingredient.

Therapeutic: drug-drug or drug-disease interaction that lead to potentiating of drug effect, drug toxicity, deterioration.

Cont”:

Components of an IV programPolices and procedures Aseptic TechniqueMethod of handling sterile products, a

sterile parenteral dosage form is free from living microorganisms, particulate matter, and pyrogens.

Cont”:

Components of an IV programPolices and procedures Labeling and check systemsReviewed against the patient’s current

medication profile.

Cont”:

Components of an IV programPersonnelCarefully trainedWho will prepare? Pharmacist or

technicianProper training in aseptic technique

and sterile product information is necessary.

Cont”:

Components of an IV programStorage spaceWill depend on the type of system one

chooses to use.

Calculations involving IV admixture: Examples: A medication order for a

patient weighing 70 kg calls for 0.25 mg of amphotericin B per kg of body weight to be added to 500 ml of 5 % dextrose injection. If the amphotericin B is to be obtained from a reconstituted injection that contain 50 mg per 10 ml, how many milliliters should be added to the dextrose injection?

Sol.

Total quantity needed for the patient:

0.25 x 70 = 17.5 mg Reconstituted solution contain 50 mg per

10 ml 50 mg 10

ml 17.5 mg XX= 3.5 ml

Example:

An intravenous infusion is to contain

15 mEq of potassium ion and 20 mEq of sodium ion in 500 ml of 5 % dextrose injection. Using an injection of potassium chloride containing 6 g per 30 ml and 0.9 % injection of sodium chloride, how many milliliters of each should be used to supply the required ions?

Sol.:

15 mEq of K+ will be supplied by 15 mEq of KCl

And 20 mEq of Na+ will supplied by 20 mEq of NaCl

1 mEq of KCl = 74.5 mg 15 mEq of Kcl = 1117.5 mg or 1.118 g 6 g 30 ml 1.118 g X X= 5.59 ml

Cont”:

1 mEq of NaCl = 58.5 mg 20 mEq of NaCl = 1170 mg or 1.17 g

0.9 g 100 ml 1.17 g X X = 130 ml.

Example:

The following is a formula for a desired TPN solution. Using the source of each drug as indicated, Calculate the amount of each component required in preparing solution.

TPN solution formula Component Source (a) Sodium Chloride 35 mEq Vial, 5 mEq per 2 ml(b) Potassium Acetate 35 mEq Vial, 10 mEq pre 5 ml(c) Magnesium Sulphate 8 mEq Vial, 4 mEq per ml(d) Calcium Gluconte 9.6 mEq Vial, 4.7 mEq per 10 ml(E) Potassium Chloride 5 mEq Vial, 40 mEq per 20 ml(f) Folic Acid 1.7 mg Ampul, 5 mg per ml(g) Multple vitamin infusion 10 ml Ampul, 10 ml To be added to: Amino Acid Infusion (8.5 %) 500 ml Dextrose injection (50 %) 500 ml

Sol.:

(a) (c) X= 14 ml. X= 2 ml (b) (d) X= 17.5 ml X= 20.4

ml

(e) (f)

X= 2.5 ml X= 0.34 ml

(g) 10 ml.

Example:

A medication order calls for 1000 ml of D5W to be administered over an 8-hour period. Using an IV administration set which delivers 10 drops per ml, how many drops per minute should be delivered to the patient?

Sol.: Volume of fluid = 1000 ml 8 hour = 480 minutes 1000/ 480 = 2.1 ml per min2.1 ml/min x 10 (drops per ml) = 21

drops/minute

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