Techniques for Sterile Compounding

Waste Disposal

Hazardous waste buckets should be accessible; needles in an IV preparation should be disposed in a sharps container

Place to Avoid Touching or Blocking Airflow During Preparation

Portions of equipment, containment,& devices which come into contacts with sterile product ex) Needle shaft, inside of needle hub, syringe plunger, tip of syringe barrel that attached to need hub, surface of rubber entry on vial/bottle/bag

Withdraw Liquid from an Ampule

*Ampules are containers made entirely of glass *Broken at the neck, which is usually pre-weakened *Wipe neck of ampule with alcohol swab, wrap gauze pad around neck when breaking it open to reduce chance of cutting fingers *Break away from yourself, tilt/insert filter needle/straw attached to syringe [MUST be used when withdrawing liquid from ampules to prevent glass particles from being introduced in to the product/patient]

Withdrawing Liquid from a Vial

*Remove cover of the vial & wipe rubber surface with an alcohol swab *Withdraw same volume of air into the syringe as the volume of drug intended to be withdrawn *Uncap needle & insert it with the bevel side up at 45 degree angle

Liquid into a Glass Intravenous Bottle

*Remove the protective cover from the IV bottle & clean the rubber closure with an alcohol swab *after withdrawing the syringe, place a protective covering over the injection site to prevent contamination

Liquid into a Plastic IV Bag

*Removed the plastic IV bag from outer wrap & inspect for leaks/tears *swab rubber port of the bag with alcohol & inside of medication port is a diaphragm *Needle must be at least 1/2" to penetrate the diaphragm so liquid drug will reach IV solutions [make sure medication is diluted]

Parenteral Product Label

*Solution name, lot number & volume *Patient's name, record number & room number *Bottle/bag sequence number *Additive names, strengths [concentration] & quantities *Date of preparation & initials of preparer *Expiration time & date *Flow rate *Time, date,& by whom product was administered *Appropriate auxiliary labels

Prevent Shadowing

Blocking areas of preparation, which must remain sterile from the airflow so no contamination [be careful not to place hands/equipment/vials in front of critical areas]; "dead spaces" are created behind objects in the airflow *products that must remain sterile must never be placed in dead spaces

Disinfections of a Laminar Air Flow Hood

Disinfect the hood at the beginning & end of the work shift, hourly during operation & after spills/known contamination *to clean use parallel sweeping motions from the back of the hood to the front [NOT CIRCULAR]

Reconstituting a Sterile Powder in a Vial

Necessary to reconstitute with a suitable diluent, usually specified in the vial/package insert.

Prior to Compounding

Remove rings, watches, and bracelets [ideal to bacteria]; wash hands & forearms to the elbow with an appropriate germicidal agent & done for 30 seconds

Location of Sterile Room

Sterile product preparation area should be free of dust, esp cardboard, as it is a source of airborne particles.

Working in a Laminar Air Flow Hood

should be running for at least 30 minutes prior to use, avoid working over open containers or preparations to prevent contaminates falling into the preparation area & do not introduce items that are not essential for preparation process [ex) paper/pencils/etc] *work 6 inches within the hood