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Dosage Forms II > Exam 2 Parenteral Products 6 > Flashcards

Exam 2 Parenteral Products 6 Flashcards

1
Q

What are components of peripheral vein access devises?

A

IV administration sets

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2
Q

When are central vein access devices typically used?

A

usually for serious conditions

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3
Q

What are components of central vein access devices?

A

catheters and access ports

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4
Q

What are the two different types of vascular access devices?

A
  1. peripheral (veins on the limbs) → needle, over the needle catheter
  2. central (basically the door to the heart) → peripherally inserted central catheter (PICC) which is surgically implanted
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5
Q

What does a typical IV set look like?

A
  1. all patients in the hospital will be put onto an IV set → usually just NS for hydration
  2. the SVP will be higher than the LVP so it has higher hydrostatic pressure
  3. the back check valve prevents back flow
  4. the proximal Y site connects the two different solutions
  5. the roller clamp controls the speed of the drip of either solution
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6
Q

What are the different methods of peripheral access that a patient can be connected to?

A
  1. metered burette → reconstituted drug injected in burette, diluent from the primary IV bag used to dilute dosage to proper volume
  2. partial fill container → reconstituted drug added to plastic bag containing diluent
  3. partial fill premix → drug and diluent are premixed in plastic IV bag, less table drugs, delivered frozen, must be thawed
  4. ADD-Vantage → vial containing drug attached to a partial fill bag, internal seal separating the drug from the diluent is removed and the two components mixed
  5. syringe pump infusion → reconstituted drug is withdrawn into syringe, delivery is by positive pressure exerted on syringe plunger →→ common method in which the pump is used to control speed of flow more accurately
  6. vented syringe infusion → reconstituted drug is withdrawn into syringe, special IV set vents syringe so drug may be delivered by gravity
  7. drug manufacturer’s piggyback/Faspak → diluent added to container prefilled with single dose of drug
  8. CRIS → two position valve in primary line, vial of reconstituted drug attaches directly to CRIS adapter
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7
Q

What are the different peripheral access administration sets?

A
  1. basic set
  2. add-a-line set
  3. volume control set
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8
Q

What is the difference between the basic set and the add-a-line set?

A

the add-a-line set has an additional y site (has two y sites) compared to the basic set that just has one y site → the basic set is also more of a curvature while the add-a-line set is more jagged

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9
Q

What are some advantages of the volume control set?

A

volume is well controlled and there is less variability since every bag won’t have exactly what it says on the label → contains a volume control chamber and is much bulkier than the other administration sets

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10
Q

What is the ADD-Vantage System?

A

2 piece ready to mix administration set that does not require a syringe and reduces contamination and medication error since the medication is screwed onto the IV bag and the medication enters the bag → very fast and takes about 10-15 seconds to be done but is very expensive

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11
Q

What are the two main different types of IV administration sets?

A
  1. macrodrip → regular one and is more commonly used

2. microdrip → the same as macrodrip but has a smaller diameter so has smaller droplets with more control

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12
Q

What are some things to note about macrodrip?

A
  1. delivers large quantities
  2. faster rates
  3. 10, 15 or 20 gtt/mL
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13
Q

What are some things to note about microdrip?

A
  1. delivers smaller amounts
  2. 60 gtt/mL
  3. used in pediatrics
  4. patients who need small or closely regulated amounts of IV solution
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14
Q

What is Poiseuille’s Law?

A

flow rate (Q) = deltaPpir^4 / 8viscositylength of tubing = driving force/resistance

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15
Q

What affects resistance?

A
  1. viscosity → the more viscous it is, the harder for it to flow
  2. length of the tubing → the longer the tubing, resistance increases because of friction
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16
Q

What is an example of resistance?

A

blood pressure → something that stops/resists flow

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17
Q

What is an example of driving force?

A

height of SVP (piggyback container) since it is higher up → something pushing it in and driving the rate of flow

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18
Q

What are components of resistance to flow?

A
  1. the tubing → macrobore v microbore
  2. in line filter (may or may not be used)
  3. viscosity of IV fluid
  4. length of tubing
  5. venous backpressure
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19
Q

What is the concept behind overages and volume fill?

A

there will be excess volume because we want to be able to pull out of the bottle the stated amount (not any less)

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20
Q

Why is there more excess volume for viscous fluids?

A

viscous fluids are more difficult to pull out of the bottle so volume of excess increases to compensate for that

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21
Q

What is the trend with % overages with labeled size?

A

% overages get smaller as labeled size increases → don’t need as much excess for a large amount

22
Q

What is the drop conversion factor?

A
  1. an initial educated guess

2. seldom the exact conversion factor for actual parenteral preparations

23
Q

What do the actual number of drops/mL depend on?

A
  1. viscosity of the CSP
  2. surface tension
  3. density
24
Q

What is the butterfly needle?

A
  1. used for peripheral access
  2. needle goes into the vein and lays usually on top of the hand
  3. the butterfly gets fixed on the hand so it won’t move around and be free to move and cause the patient discomfort
25
Q

What is the over the needle catheter?

A
  1. used for peripheral access
  2. use the needle to pierce the skin and then use a plastic catheter that won’t create too much damage if it moves → less risk of discomfort for the patient
26
Q

When is central venous therapy used?

A
  1. for infusion of large volume of fluid
  2. multiple infusions
  3. long term infusion therapy
  4. infusion or irritating medications like potassium
  5. infusion of fluids of high osmolarity
  6. total parenteral nutrition → repeated, everyday, high osmolarity (hyperosmotic)
27
Q

What is an important thing to note about peripherally inserted central catheters (PICC)?

A

it is peripherally inserted (peripheral access) but is put into the central vein

28
Q

What is the main procedure in putting in a PICC line?

A

insert needle in first and then the catheter once the needle is withdrawn!

29
Q

What are the two ways of getting central venous access?

A
  1. through the basilic vein

2. through the internal jugular vein → less common

30
Q

How is the central vein catheter (CVC) placed?

A

it is surgically implanted

31
Q

What is unique about the central vein catheter (CVC)?

A
  1. has 3 different lines
  2. all 3 lines are separate from one another with only 1 incision needed to be made → the different lines do not come into contact with one another until it is put into the patient
32
Q

What are the two most common names of central lines?

A
  1. Hickman

2. Broviac

33
Q

What are some points about the Hickman catheter?

A
  1. requires surgical insertion
  2. has a Dacron cuff that prevents excess motion → is a sticky polymer that keeps the catheter in place and not swinging around
  3. want to make sure the patient does not develop an infection from the incision wound
34
Q

What are some things to note about the vascular access port (VAP)?

A
  1. size of a small battery/watch that gets inserted under the skin → patient is able to shower and do things
  2. the port can be pierced so it would be easy to take a blood sample
35
Q

Vascular access port (VAP) requires what?

A

non coring needle! if a straight bevel is used, it would cut all around the rubber stopper (aka core) which creates a tiny piece and a hole so things can come in and out (potential for contamination) → a non coring needle will not make a hole → instead, want to angle it 90 degrees to use the tip of the needle as a blade to make a slit (not a hole) so it can be sealed back

36
Q

What are advantages of central venous therapy?

A
  1. access to central veins
  2. rapid infusion of large amounts of fluid
  3. a way to draw blood and measure CV pressure
  4. reduced need for repeated venipunctures
  5. reduced risk of vein irritation from infusing irritating substances
37
Q

What are some risks of central venous therapy?

A
  1. sepsis
  2. thrombus formation
  3. perforation of vessel and adjacent organs
  4. air embolism → if air gets in
38
Q

What are some disadvantages of central venous therapy?

A
  1. cost

2. requires more skill to insert than peripheral therapy

39
Q

What are some risks associated with infusion?

A

complications from damage to the inner lining of the vein (intima) → stenosis (narrowing), thrombus (clot), venous occlusion, chemical inflammation (phlebitis) and pain

40
Q

What are the two methods of instrumented flow control?

A
  1. controllers → use gravity as a driving force (not really used anymore)
  2. pumps → powered devices
41
Q

What do controllers have?

A

a drop counting sensor and an automatic clamping device (controller)

42
Q

What are infusion pumps?

A
  1. powered devices
  2. pumps provide pressures in the range of 2-12 psi (100-600 mmHg) → the high end of this pressure range is used for intra-arterial infusions
  3. caution → the use of excessive infusion pressures can be a hazard with respect to infiltration at the site of injection →→ the problem could be that the needle is not in the right place not that the pump is not working well
43
Q

What are features of infusion pumps?

A
  1. volumetric delivery, independent of vascular back pressure, position of patient, composition of infusion solution, or tubing resistance
  2. safety features (alarms) → occlusion of line, infusion complete, air in line, empty container, flow rate error
  3. becoming increasingly smart
44
Q

What are two common IV infusion pumps?

A
  1. Symbiq Infusion System

2. Omni-Flow 4000 Plus Complex Therapy (can program multiple drugs)

45
Q

What is important to note when using infusion pumps?

A

use of infusion pumps does not turn the drip chamber into an ornamental item → the drip gives a sense of right/wrong to the human looking at it

46
Q

What are some things to note about syringe pumps?

A
  1. use commercial syringes
  2. smart machines → just need to type in syringe and the volume since it has a built in mechanism that will do everything for you
  3. especially useful for giving intermittent IV medications
  4. provide the best control for small volume infusions
  5. useful for pediatric patients
47
Q

What are three other types of parenteral pumps?

A
  1. patient controlled analgesia (PCA)
  2. ambulatory pumps
  3. implantable pumps
48
Q

What is patient controlled analgesia (PCA)?

A

patient is able to control their pain relief in which pain relief is generally obtained at a lower total dose of drug

49
Q

What are ambulatory pumps?

A

pumps that can be located outside, refers to the size and weight of the pump as well as its ability to operate without an external power source

50
Q

What is an implantable pump?

A

usually with reservoirs of about 50 mL and used for IV, intra-spinal, and intra-arterial routes that can deliver as low as 1 microliter/hr

Dosage Forms II (20 decks)

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