PHM 652: Exam 2 (Parenteral Products) Flashcards
Define Parenteral
administered by any way other than through the mouth; applied, for ex. , to the introduction of drugs or other agents into the body BY INJECTION
all parenteral products and ophthalmic dosage forms must be what
STERILE
define aseptic technique
ability of personnel to manipulate sterile preparations, sterile packaging components, and sterile administration devices in a way that excludes the introduction of viable microorganisms
ex. of parenteral routes
- IV
a. injection to venous (not arterial) system
I.perioheral
II. central - Intraarterial (uncommon)
- Intramuscular (IM)
- Intrathecal (IT)
a. injection into meninges of spinal cord) - Epidural
a. injection to tissues surrounding spinal cord, not spinal cord itself - Intradermal (ID)
a. injection within the skin - SubQ
a. injection beneath the skin
what does it mean to be sterile
freedom from all living organisms
an absolute. no such thing as almost sterile
medical devices used along with parenteral administration must be what
ex of these medical devices
STERILEEE
includes things like
needles syringes tubing bags etc
health status when compounding sterile products
need to be free from infectious disease
personal preparation
cover head and facial hair
remove cosmetics likely to flake
remove finger and wrist jewelry
how to wash hands
scrub hands and arms to elbows
pre wash
use 3-5ml for 30 seconds
wash hands even if gloves are to be worn
gloves
types:
composition
when should you change your gloves?
a.sterile vs non sterile
powdered vs non powdered
b.composition:
latex
vinyl
synthetic
c. depend on pharmacy but usually ~1 hr
better products for hand washing than plain soap in high risk situations
alcohols chlorhexidane gluconate iodophors hexaclorophene parachlorometaxylenol triclosan
gowns
composition
a. tyvek: non permeable substance
other coverings when preparing iv
shoe covers and sticky mats
masks: put on right b4 going in hood and changeeverytime leaving compounding area
note: surgical masks only protect product that you’re making, not you
what is the last step before entering iv room
WASH HANDS
Laminar air flow SYSTEM
types
how long should it be turned on for before using
Horizontal flow hoods (LAFS)(laminar air flow system): filtered air directed toward pharmacist/ tech located at back of hood
vertical flow hood (BSC)(Biological safety cabinets)
filtered air directed downward from a pen located at the top of hood. used for chemo. more preotection
at least 15 min. but UB SPPS policy is 30 min
HEPA
HIGH EFFICIENCY PARTICULATE AIR Filter
removes 99.9% of all particles 0.3 microns (um) or larger
disadvantage of laminar air flow
false sense of security
ISO classifications of particulate matter in room air
requires air quality in IV rooms iso class 5 or better (room mustn’t contain more than 3520 particles that are >/= 0.5 um in size)
(class 5: a.US class 100 b. Particle size I. ISO m3: 3520 FS 209E, ft3
besicaly the smaller the number, the better the air quality
pyrogens
metabolic products of living organisms, or dead microorganisms
lipopolysaccharides: soluble in water but insoluble in organic solvents
aseptic technique ideally prevents the intro to parenteral products
pharm effects of pyrogens
- vary
- in man, pyrogenic causes fever and chills
- after injection, rapid raise in body temp, chills and headache, malaise after 45-90 min latent period
- anaphylaxis
source of pyrogens in sterile compounding
- water (solvent)
- containers (packaging)
- chemicals (used for solution preparation)
how to eliminate pyrogens
- dry heat (for metal and glass ocntainers
- chemically : for solutions but can destroy durgs
- synthetic filter media:
- best approach . PREVENT THEM FROM OCCURING
unecessary factors that can cause microorganism intro to product in i room
talking
laughing
chewing gum
eat/drink
CSP (compounded sterile product) risk levels
definition:
assigned according to relative possibility that a compounded sterile product might be contaminated
LOW
MEDIUM
HIGH
what does this stand for
LAFS
also AKA
Laminar air flow system
aka horizontal flow hood
what does this stand for
BSC
biological safety cabinet (aka vertical flow hood)
what does this stand for
RBS
a. CAI
b. CACI
restricted barrier system
a. compounding aseptic isolator
b. compounding aseptic containment isolator
how to determine which iv bag to use
- determine conc. of drug in possible iv bag selection
2. compare to compatibility chart . must be below the max compatible concentration threshold stated on the chart
female IBW equation
45.5 +2.3(height over 5’ in inches)
male IBW eq.
50.0+2.3 (height over 5’ in inches)
10% rule with iv bags
if adding fluid greater than 10% to an iv bag, must remove that equiv. amount from iv bag first
refrigerated temp
2-4 degrees C
room temp
20C-25C
clean rooms. what are they
env. where contamination is controlled/limited form stuff such as
particles
organisms
pyrogens
environment control of clean rooms
temp
humidity
relative barometric pressure
conventional IV rooms ar always maintained at what kind of pressure
positive pressure
end product testing
container leaks and integrity
particulates in solution
solution color, volume, and odor
pursuant to individual products
analytical testing
weight verification refractometry ph testing microbial testing etc.
process validation
what is it
when should it be conducted
more general
basic process n institution commands products to ensure sterility
involves manipulation of microbial growth media according to aseptic process being validated
SHOULD BE CONDUCTED AT RANDOM INTERVALS AND NOT AT THE OPERATORS KNOWLEDGE, if possible
stability
extent product remains within specified limits in terms of
chemical composition
physical composition
microbiologic activity
stability
at the time of use, a medication must be
at the stated potency
and safe for admin. to the pt.
product stability
subject to..
primary basis for..
subject to specific storage conditions
primary basis for an expiration date/ time
maintenance of stability
lyophilization
what is it?
what does it entail?
process of rapid freezing sublimation product becomes dry power is more stable than in solution.
maintenance of stability
what are some methods of sterilization
0.22 micron filter
autoclave (applying heat to kill of microorganisms)
maintenance of stability
antioxidants
ex:
metasulfate and sulfate ions used as preservatives. a.sodium salts b. K+ salts: I. metabisulfits (for low pH) II. bisulfites (intermediate pH) sulfite (high pH ranges)
maintenance of stability
removal of O2 and insert of what inert and semi inert gassses
nitrogen
Carbon dioxide (CO2)
helium
b/c o2 is highly reactive
particulate matter
what are they
what are some sources
dust spores
sources: iv solution, packaging, iv tubing, preparation process (laminar now hood or pt bids)
iv fluid compatibility
occurs when a drug is combined with an IV fluid , or another drug to produce by physiochemical mens, a product unsuitable for administration to the pt.
ex: phenytoin in D5W
therapeutic incompatibles
basically DDI
have very little to do with route of admin
physical incompatibility
combo of one or more drugs in solution resulting in compositional change and appearance.
chemical incompaitbility
degredation of drug substances as a result of being in solution or coming in contact w. other drugs
greatest single factor causing incompatibility btw iv fluids and their contents
variations in pH
solubility: physical
stability: chemical
how to minimize incompatibilities
use freshly prepared solutions whenever possible
encourage use of few additions as possible
study to demonstrate proficiency in iv therapy
educate mds, RNs
be skillful with reference materials (ex. trissells, clinical pharmacology)
pros of parenteral admin:
fast
some drugs not effective orally
uncomplicated admin where pt is uncooperative, npo, NAUSEOUS , unconcious,
pt compliance (md control when and how they get it)
correction of fluid/ electrolyte imbalance
tPN ADMINSTRATION
cons of parenteral admin
special traning
invasive
painful
difficult to reverse
more expensive
incompatibilities
things to consider when determinining iv bag compatiility
use smallest bag
refrigerate vs room temp (look at test conditions)
light sensitivity
pay attention to manufacturers codes when provided
sterility and integrity requirements for sterile iv admixtures
free from…
free from..
1.living organisms
2.dead organisms
3.pyrogens
a. h2o insolubule
I. dead organisms
II. parts of dead organisms
metabolic products of organisms
b.h20 soluble I. lipopolysacharides II.metabolic products of organisms 4. freedom from particulates 5. physical, chemical, microbiologic stability
ease of administration
Tonicity classifications
hypotonic: <277 mM
isotonic: ~ 277
hypertonic: >277 mM
also consider osmalrity
iv route
peripheral vs central
IV is access to veins(low pressure system)
peripheral: access to vein in arm or leg
central: access to major veins like superior and inferior vena cava, subclavian vein (PICC line)
indications for peripheral administration
admin of drugs
admin of fluids
surgery
transfusion of flood and blood preodcts
maintain or correct electrolyte imbalance
admin of nutritional solutions
advantages of peripheral admin
veins are relatively easy to access
drugs, solutions and blood can be administered quick;y
admin is easy to see and monitor
cons of peripheral admin
short term access
immobilization of limb
less forgiving of tonicity extremes
indication for central admin
large fluids
hypo/hypertonic fluids
pH imbalanced fluids
pros of central admin
rapid infusion of large volumes
means of measuring Central venous pressure (CVP)
eliminates repeat peripheral venipunctures
a. decrease vein irritation
decrease vein damage
decrease pt discomfort
cons of central admin
risk of complications such as
- pneumothorax
- sepsis
- thromus/embolism
- organ perforation
decrease pt mobility
surgical implant
other parenteral routes
interarticular: into joints (ex. hydrocortisone )
intrasynovial: injection to joint fluid areas
intraventricular: into ventricles of the brian
intracardiac: injection into heart (ex. epinephrine)
phlebitis
what it is
SS
where is it located
inflammation of vein
can be induced by insertion of vascular access devices (VAD)
ss: tenderness redness pufffiness hardness increased temp
located at tip of VAD and in direction of blood flow
extravasation
liquids infused into peripheral space instead of in vein due do misplaced vascular access device (VAD)
undesirable
infiltration
extravasation fluids are absorbed by surrounding tissues
undesirable
SS of extravasation/ infiltration
drug specific cause”:
pain discomffort burning feeling of tightness decreased temp cant black flow blood decreased flow rate
drug specific SS: hypo-hypertonic solutions very irritation
tissue necrosis: chemo, dopamine, epinephrine
ss of local and systemic infection
local: contaminated iv site
sterile and non sterile necrosis
sepsis: tissue destruction)
systemis: fever, chills , malaise, septicemia (tissue destruction, widespread
air embolism
what is it
SS
> 5 mL of air
right ventricle of the heart
cavitaion
fatal
respiratory distress weak pulse increased CVP decreased bp UNCONSCIOUSNESS
Pediatric IVF maintenance
Max continuous infusion (daily) volume
- ABW: 1-10 kg: 100mL/kg/day
- > 11-20kg: 1000mL +50ML/kg/day
- > 21-30kg: 1500 mL +20mL/kg/day
- > 30kg: 1700mL +10mL/kg/day
define injection:
a drug in solution (or lyophilized powder) in a suitable vehicle intended for parenteral administration
can be single dose
or multiple dose
Intavenous fluid
IVF
intermittent, single, small volume dose:
available in 50 mL, 100mL
sterile solids
drug labeling requirments for sterile drug and drug for injecrtion
labeled: sterile drug
a. no buffers
no diluents
no added substances
labeled: drug for injection
a. buffers
diluents
added substances
sterile suspensions
what are they
labeling
ex:
drug initially in lyophilized form. yield suspension after reconstitution
labeled: sterile drug suspension
EXAMPLE: UNASYN (AMPICILLIN/SULBACTAM)
solutions for irrigation.
used to bathe or flush open wounds and body actives
NEVER USE PARENTERALLY
vehicles
water for in jection
sterile water for injection
bacteriostatic water for injection
oils for injection :i.e sesame oil
solubilizing agents
PEG
propylene glycol
glycerin
ethyl alcohol
admixture: definintion
combo of 2 or more parenteral dosage forms for admin. as a single entity
define additive:
when a small volume of drug is added to a larger volume vehicle, drug may be referred to as additive
convenience packaging
pros and cons of ampules
pros: do not require preservatives
cons: contamination by glass shards upon opening
filtration required
convenience packaging
vials pros and cons
pros: dosing flexibility, decreased waste-multi dose vial
cons: coring
drug interaction with latex
latex allergy
increase waste-single dose vial
define deadspace( needle syringe)
space collectively occupied by; needle bore, needle hub, lure couplings and all fluid occupying space in a syringe when the plunger is set to zero ml
how to calculate deadspace
mass of syringe/ needle primed minus mass of syringe needle dry
difference is in grams.
headspace units is in mL
fluid dynamic equations
- pressure
- resistance
- flow rate
Pressure= resistance x flow rate
units: PSI, mmHg, Torr, Volts
Resistance=pressure/Flow rate
units: mmHg*min/mL, Ohms
Flow rate= Pressure/ resistance
units: gallos/ sec, mL/min, get/min, Amperes
vascular pressure
define:
what is it a function of
- pressure within a blood vessel (venous and arterial)
- function of..
a. myocardial contractility
b. smooth muscle activity in vasculature
c. hydrostatic force (due to gravity)
Infusion and vascular pressure
in order for liquids to flow, infusion device must develop a pressure greater than vascular pressure ar infusion site
infusion pressures can be developed by which methods
- gravity
2. pump
draw back with developing infusion pressure with gravity vs pump
for gravity, drip chamber must be at a sufficient height.
multiply the millimeters by the density of mercury (13.534) to get the height needed for the infusion.
ex: IV infusion: 60mm x 13.534=812.04 mm~ 32’’
IA infusion: 140 mm x 13.534=1894.76 mm ~ 75’’ (about 6 ft)
the height required for IA infusion with gravity is usually not feasible bus we are limited to sealing height.
PUMPS HAVE NO HEIGHT REQUIREMENT, BECAUSE THEY USE MECHANICAL PRESSURE
SOOOO…
Gravity or infusion pump can be used for IV infusions
IA infusions can only use infusion pumps
resistance to flow a function of …
- diamater tubbing:
a. resistance increases as
I. diameter decreases
II. tube length increases
b. resistance decreases as
I. diamater increases
II. tube length decreased
- knicks in tubbing
- presence of inline filters
- solution viscosity
extravasation/infiltration
infusion pump indications
greater degree of accuracy is required (complicated regimen)
high-pressures are required (IA infusion, etc.)
risk of fluid overload
cons of infusion pumps
cost
special training
malfunction (pt harm)
parenteral volume classifications
- small volume parenterals (SVP)
a. = 150 mL
b. ex: iv piggybacks, prefilled syringes - Large volume parenterals (LVP)
a. >/= 150 mL
c: ex: hydration fluids (electrolytes), TPN
Glass IV container types
- US CLASSIFCATIONS
- types
- must be resistance to water attack and release of alkali. available in size holding 1mL- 3000mL (3L)
- type 1
a. borosilicate glass. highly stable. may be sterilized before or after fulling
type2. glass treated with lime soda. sterilize w. dry heat before filling. ph contents must be <7 for entire time until exp. date suitable for solutions, powders, oils
type3. soda lime glass. sterilize w. dry heat before filling. pH must be <7 for entire time until exp date.
pros of glass containers
protection against gas and vapor permeation
protection against punctures
easy to inspect contents
cons of glass containers
ph changes due to ion leaching
flaking of components of glass due to phosphates, citrate, tartrates
breakbale
storage and disposable complications
difficult to detect hairline fractures
plastic containers
- Polyvinyl Chloride (PVC)
- Polyolefin
- PVC.- bags we use in iv room. easily pliable. adsorption and absorption can occur
- polyolefin: more rigid plastic iv bags. no drug sorption problems. impermeable to air
pros of plastic containers
disposable
lightweight
inexpensive
unbreakable
minimal storage soace
can be frozen
no venting required (airborne contamination less likely)
cons of plastic iv bags
ports awkward to manipulate (increase touch contamination)
absorption/ adsorption (PVC)
permeability (PVC)
difficult to determine fluid levels
difficult to detect particulates
puncture easily (PVC)
iv administration sets
- primary. usually for a single, primary fluid. for continuous infusion
- secondary set. attaches to a primary set at a y site. for continuous or intermittent infusion
filter size and what they can filter
5 micron
- 2
- 45
- 22
5: filters most non-living particles
1. 2: filters most-non living particles (candida)
0.45: filters gross particulates,
filters most fungi and bacteria
0.22 micron: filters all bacteria except rickettsia
does not filter pyrogens or viruses
define parenteral nutrition
central or peripheral adminisration?
provision of all basic metabolic and nutritional requirements via the IV (venous) route
central preffered because can higher larger extremes of pH and tonicity
different names for tpn
TPN
PN
hyperalimentation (HAL)
3 in 1 (fats, amino acids, dextrose)
FAD (",",")
PPN (Peripheral parenteral nutritionpros of TPN
what canbe given in tpn
all nutrients in single container
ex: dextrose, amino acids fats electrolyte, trace elements insulin, drugs
all in one iv pump
one administration st
touch/ manipulation contamination is minimized due to single bag
condo of tpn
NOT ALL nutrient admixtures are chemically stale
come combo can..
- precipitate
- will crack ( fat emulsion)
pt indications for tpn
inability to eat
rapid involuntary weightloss (10% of ABWor more)
persistent nitrogen deficit
severe malabsorption
upper gi hemmorhage
intractable diarrhea
intestinal obstruction
high risk respiratory aspiration
Caloric requirements
What is the Harris-Benedict equation
equation for men:
equation for women:
- Harris Benedict eq.
measures Basal energy expenditure (BEE): (amount of nutritional substance estimates for a pt if the pt was asleep or post operatively sedated
equation for men:
BEE= 66.67+[13.75xMass (kg)] +[5xheight (cm]-[6.76 x age(yrs)]
eq. for women
BEE= 655.1 +[9.56xMass (kg)] +[1.85xheight (cm]-[4.68 x age(yrs)]
Basal energy expenditure (BEE)
Maintenance BEE
Anabolism BEE
BEE: calculated with equation
Maintenance BEE: (confined to bed, concsious)
BEE kcal/day x 1.2
Anabolism BEE: (getting out of bed)
BEE x 1.5
estimation of BEE eq.
draw back of using the quick estimates
without respect to sex
kg: ABW
BEE: 25kcal/ Kg
Maintenance: 30kcal/ kg
Anabolism: 35 kcal/kg
more accurate for younger pts than older pts
Caloric TPN sources
Amino acids
dextrose
fat
amino acids: 4kcal/gram
dextrose: 3.4 kcal/ gram
fat: 9 kcal/gram
protein requirements for tpn
normal to low stress:
a. basal
b. maintenance
c. anabolism
high stress:
a. hypermetabolic
b. severe burn
renal failure:
a. no dialysis
b. dialysis
hepatic failure:
a. severe hepatic failure
basal: 1-1.2 g/kg/day
maintenance: 1-1.2 g/kg/day
anabolism: 1.3-1.7 g/kg/day
hyper metabolic: 1.5-2.5g/kg/day
severe burn: 2-3 g/kg/day
no dialysis: 0.6-1 g/kg/day
dialysis: 1.2-2.7 g/kg/day
severe hepatic failure: 0.5-1.5 g/kg/day
commercially available AA
10% w/v (most common)
15% w/v (fluid restrictive pts, expensive
what is the key component in most TPN solutions
dextrose
used to provide 40-60% of total caloric intake
contraindications to fat use in tpn
pts with altered lipid metabolism
hyperlipidemia
hypertriglyceridemeia
hypercholesterolemia
severe renal failure
egg yolk allergy
PPN (peripheral parenteral nutrition)
how to do tpn calculations
- determine daily caloric requirement
a. calculate BEE
b. adjust BEE with stress factor based on pt condition - determine protein requirement
a. (md gave eq. for protein)
* note: also figure out how much calories is being provided by each macronutrient. so [protein requirement x 4Kcal]= kcal protein provides - figure out nitrogen balance
*in normal pt: nitrogen balance(nitrogen in -nitrogen out)=0
tpn patients are allow nitrogen balance of +3-+6g/day
1g nitrogen in 6.25 g of protein
how to calculate amount of nitrogen leaving body:
use urea conc in urine.
a. convert urea nitrogen conc (g/dL) to g/L
b. determine urine volume collection in 24 hrs
c. calculate amount of nitrogen by multiplying urea nitrogen by total24 hr urine volume
d. add this nitrogen amount to the reg amount of nitrogen lost due to insensible losses. which is about 4g.
e.nitrogen in:
1g nitrogen/6.25g of protein
f. subtract nitrogen out from nitrogen in. - calculate volume of AA needed
a. simply use conc of AA available . (ex: 10% w/v) and figure out how many ml needed to get amount of g of AA needed - calculate fat requirmeent
a. fat needs to be 20-30% of daily caloric intake. pick a percentage in that range. figure out the equivalent mass from the pts total caloric intake. then figure out volume needed to get that amount - determine dextrose:
a. add up protein and fat calorie requirements. subtract from total calorie requirements and remaining will be dextrose requirement.
b. use kcal/mass ratio of dextrose (3.4kcal/ 1 g) to determine mass of dextrose needed
c. figure out volume of dextrose needed using available source concentration - figure out total TPN volume
a. (from lecture ex. physician gave infusion rate and asked for an additional 50 mL for priming. )so add the volume of over 24 hrs + the additional 50) - calculate amount of each electrolyte needed by setting up how much needed for volume of tpn being administerd
ex: K+: 20mEq/L is contained in each standard. so for 1610 total tpn fluid, find out how much meq is needed.
20mEq/ 1000mL [or 1 L]= X mEq/ 1610 mL
vascular access devices
when are they used
examples
establish connection where administration of drugs and/or fluids to the venous system is indicated. maintenance required
- needles and syringes
- catheters
- implanted ports
vascular device condiseratitions
vein location, condition and availability
specific indication
infusion rate
tonicity , pH and vesicant potential
duration of therapy
pt compliance/ cooperation
locations of venipuncture vascular access
for long or short term?
access to arm or hand (sometimes leg or foot)
< 2 inches in length
metacarpal
cephalic (wrist)
basilic (and branches)
for short term vascular access
central venous access.
what is it
types of catheter insertion
indirect connection to superior or inferior vena cava. but most common subclavian vein.
over the needle
through the needle
over a guide wire (most common, similar to over the needle)
short term catheters compositoin
long term catheter composition
- a.polyurethane
b. PVC - a. silicone rubber (silastic)
conc os short term catheters to long term catheters
tissue irritation
local infection
systemic infection
thrombus formation due to
PVC
vessel rupture
pros and cons of long term catheters
pro: physiologic more compatible. less thrombogenic than polyurethane or pvc
con: insertion more difficult
single and multi lumes
single: admin of only 1 fluid at a time
multi: allows admin of more than 1 fluid. separated by 3/4 ‘ intervals for fluids that cant be mixed in a bag together
Hickman catheter
indication (pro):
cons
pro: longterm cv access and at home therapy
cons: open ended
tears easily
requires routine heparin flush
types of tunneled catheters
hickman
broviac
groshong:( like hickman but closed ended. doesn’t need to be flushed w. heparin. for long term infusion)
PICC
pro
con
peripherally insertated central venous catheter
pro: bedside insertion. long term venous access, can be used for ppl w. head or neck injury
con: may occlude peripheral vessels. long path to central venous circulation
cytotoxic drugs
a drug that damages or destroys cells is used to treat various types of cancer
such as
chemotherepetutic
antineoplastic
antimtabolic
cytotocic
MOA of cytotoxic durgs
inhibition of cell growth and / or division
selective towards cancers tumors bone marrow skin epithelial tissues fat tissues hair follicles
TI of cytotoxic drugs
narrow
common sense conclusion of studies of cytotoxic agent effects on ppl handling them
operator protection is indicated
results conclusive
known risks of cytotoxic drugs
suppress testicular function
spermatogensis
therefor. excuse pregnant or breastfeeding women for preparing..
and men trying to father a child.
other precautions for handling cytotoxic drugs
use vertical flow hood
proper handling technique
vertical flow hood (BSC)
BSC(biological safety cabinet)
air comes in downward direction.
blows air away from operator
protects personell
prevent release of aerosolized drug
BSC types (4 types)
type A: 70% of air goes back into cabinet
remainder returns to room
under positive pressure
type b1:
30% of air goes back into cabinet
remainder vented to outside of filter
under neg. pressure (airwon’t go outside if breeched)
type b2: 100% air vented to outside
negative pressure
typeb3 : 70% of air goes back into cabinet. remainder vented outside
negative pressure
bcc safety cabinet considerations
leave on all the time 24/7.
if have to shut down. throughly clean. cover operator opening with plastic and tape
gloves when dealing with chemotherapeutic agents
change often
(usually) 2 pairs
- change outer pair immideiatly f contaminated
- both if outer is puncture or torn
both if event of large spill
both after each 1 hour of use
masks when dealing w. chemo agents
no protection to you, just the product
if no BSC, use a hEPA FILTER MASK
how to clean bsc
disinfect with 70% isopropyl alcohol
decontaminate on reg basis
ampules
ensure tip contents transferred to main body. do this by..
gentle tapping against work surface
swirl
gentle finger snap
negative pressure technique for liquid filled vials
purpose: avoids aerosolized spills of hazardous materials.
draw back air in syringe
insert needle into vial
invert vial
withdraw fluid by pulling younger from desired volume greater than the desired volume
never past initial starting air volume. seesaw back and forth until syringe is full
. when ready to take needle out. turn vial back around. (needle on top, vial on bottom.
make usr needle is not immersed in liquid.
pull back plungers slightly until a few bubbles are drawn into syringe.
pull needle from vial.
negative pressure technique for powdered filled vials (need ot be reconstituted)
to draw diluent, use regular positive pressure methods.
use neg. pressure when putting that into the powder vial.
chemo pin
creates a negative pressure automatically. no need to go out of way to do neg. pressure technique with chemo pin. just draw regularly
