Question on Aseptic Technique for my Exam

[shaq786]

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Can someone please give a run down on these real quick.

1. When making IVs, I know there are a few situations where you have to withdraw X amount of mL from an IV bag first, then you inject X mL of your active ingredient into the bag to make it a certain concentration. What drugs does this kind of situation apply to?

2. Referring back to number one, do you SWITCH out your needle when you do so? For example, If I withdraw 10 mL from the Normal saline IV bag, do I then switch out the needle before I puncture the septum of my drug stock bottle?

3. How do you know when to withdraw mLs from the IV bag, then inject your active drug into the IV bag vs when to not do that? In other words, when does it matter?

4. You have two 10 mL vials of drug. You need 20 mLs. You would need 2 separate needles to puncture them right?

 

[EBT12]

Here is information based on what I have been told to do in practice. You will want to answer questions on your exam based on what you are taught though (aka real life is different than ideal sometimes).

1. In general, if you are adding >10% to the bag, you will withdraw the amount you are adding. However, you will want to check with each hospital; there is typically a standard policy.

2. Changing needles increases your changes of a needle stick. Very rarely do I actually have to change a needle (other than filter needle). If I had to use a new needle, I would get a new syringe and capped needle. In the example you described, generally, there would be no need to switch the needle between drawing the volume out of the bag and adding the volume to the stock bottle. Once again, check with the hospital you are at for specific policies.

3. Again, hospital specific. If you are reconstituting a powder with 10mL of NS and the directions are to add the reconstituted solution to a 50mL bag of NS, you may be able to remove the 10mL from the 50mL bag, reconstitute the powder, and add everything back into the 50mL NS bag.

4. Hospital specific. At a busy hospital I was at, you could use the same needle several times (again, you don't want to have to change the needle - increases risk of sticks). At the current hospital I am at, they would use 2 10mL syringes and needles.

Summary: check with the hospital!

 

[cycloketocaine]

Can someone please give a run down on these real quick.

1. When making IVs, I know there are a few situations where you have to withdraw X amount of mL from an IV bag first, then you inject X mL of your active ingredient into the bag to make it a certain concentration. What drugs does this kind of situation apply to?

2. Referring back to number one, do you SWITCH out your needle when you do so? For example, If I withdraw 10 mL from the Normal saline IV bag, do I then switch out the needle before I puncture the septum of my drug stock bottle?

3. How do you know when to withdraw mLs from the IV bag, then inject your active drug into the IV bag vs when to not do that? In other words, when does it matter?

4. You have two 10 mL vials of drug. You need 20 mLs. You would need 2 separate needles to puncture them right?

1 and 3 are pretty much the same question worded different ways, so I will answer it as such. Any medication that has a concentration-dependent delivery (mcg/min) instead of the usual mL/hr, mL/min, will need to have any overfill PLUS the volume of drug you are injecting withdrawn before adding the drug. Heart drugs are the big ones on this, norepi, dopmine, dobutamine, etc.

2. Yes, I use separate needles if I am puncturing different ingredients. I do not puncture bags with the same needles I puncture vials with.

4. I use the same needle unless puncturing a lot of vials, because then you worry about dulling. If its just 2-3, I use the same needle/syringe.

 

[owlegrad]

2. Yes, I use separate needles if I am puncturing different ingredients. I do not puncture bags with the same needles I puncture vials with.

4. I use the same needle unless puncturing a lot of vials, because then you worry about dulling. If its just 2-3, I use the same needle/syringe.

Interesting. How many needles do you go throw for each product then? Seems like it would be a minimum 2 for each bag.

 

[Ackj]

Here is information based on what I have been told to do in practice. You will want to answer questions on your exam based on what you are taught though (aka real life is different than ideal sometimes).

1. In general, if you are adding >10% to the bag, you will withdraw the amount you are adding. However, you will want to check with each hospital; there is typically a standard policy.

2. Changing needles increases your changes of a needle stick. Very rarely do I actually have to change a needle (other than filter needle). If I had to use a new needle, I would get a new syringe and capped needle. In the example you described, generally, there would be no need to switch the needle between drawing the volume out of the bag and adding the volume to the stock bottle. Once again, check with the hospital you are at for specific policies.

3. Again, hospital specific. If you are reconstituting a powder with 10mL of NS and the directions are to add the reconstituted solution to a 50mL bag of NS, you may be able to remove the 10mL from the 50mL bag, reconstitute the powder, and add everything back into the 50mL NS bag.

4. Hospital specific. At a busy hospital I was at, you could use the same needle several times (again, you don't want to have to change the needle - increases risk of sticks). At the current hospital I am at, they would use 2 10mL syringes and needles.

Summary: check with the hospital!

Pretty much agree with it all. For the amount to withdraw, the label will usually specify if you need to or not (at least where I've been). For example, our Precedex labels print out saying they go in 48ml NS, so you know to withdraw 2ml from the bag.

I typically would use the same needle for multiple punctures. Two for sure, but more than that the needle may become dull and you might want a fresh one. Bicarb comes to mind here where there are several punctures to remove volume from the bag, and then 3 vials to add.

 

[ttopping]

1 and 3 are pretty much the same question worded different ways, so I will answer it as such. Any medication that has a concentration-dependent delivery (mcg/min) instead of the usual mL/hr, mL/min, will need to have any overfill PLUS the volume of drug you are injecting withdrawn before adding the drug. Heart drugs are the big ones on this, norepi, dopmine, dobutamine, etc.

2. Yes, I use separate needles if I am puncturing different ingredients. I do not puncture bags with the same needles I puncture vials with.

4. I use the same needle unless puncturing a lot of vials, because then you worry about dulling. If its just 2-3, I use the same needle/syringe.

Seems like a waste of time and needles. There would be no reason to switch needles after drawing up a med from a vial before putting it into the bag. Assuming you've done everything correct, it should all still be sterile...

Edit: I saw your response to owlegrad, don't mind me =)

 

[Sparda29]

If the needle is getting dull, I don't even bother changing the needle. I get a new syringe and a new needle. Less chance of needle stick.

 

[DYSF777]

If the needle is getting dull, I don't even bother changing the needle. I get a new syringe and a new needle. Less chance of needle stick.

So you throw away the needle and syringe in the sharps?

 

[Sparda29]

So you throw away the needle and syringe in the sharps?

Yes.

 

[shaq786]

What about for drugs like KCl and preparing X mEq/mL of a IV bag solution...Would you want to withdraw mL's from the IV bag before you inject the drug in so that you can get the exact concentration?

Dont they also make chemo drugs in the EXACT EXACT concentration?

 

[Quiksilver]

What about for drugs like KCl and preparing X mEq/mL of a IV bag solution...Would you want to withdraw mL's from the IV bag before you inject the drug in so that you can get the exact concentration?

Dont they also make chemo drugs in the EXACT EXACT concentration?

You are asking hospital specific questions. Some withdraw, some don't. The hospital I was at even changed their policy while I was there. At one time they didn't remove volume unless, 1. there was literally no more room to put drug in or 2. it was a concentration dependent drug such as cardiac drugs. Then they changed it to remove the overfill + whatever was in the bag whenever they went over a certain mL per bag

As someone who made A LOT of chemo, not all chemos had to be at an exact concentration. Only a select few had to be at AN EXACT concentration. As pharmacokinetics would dictate, its not the concentration, per se, that dictates how much you give, its the dose. Concentration of drug is only important in terms of how much drug you can give over a period of time. Obviously, if you have to give a drug slowly, you need to dilute it. I think you are freaking out about concentration unnecessarily.

 

[xiphoid2010]

You are asking hospital specific questions. Some withdraw, some don't. The hospital I was at even changed their policy while I was there. At one time they didn't remove volume unless, 1. there was literally no more room to put drug in or 2. it was a concentration dependent drug such as cardiac drugs. Then they changed it to remove the overfill + whatever was in the bag whenever they went over a certain mL per bag

As someone who made A LOT of chemo, not all chemos had to be at an exact concentration. Only a select few had to be at AN EXACT concentration. As pharmacokinetics would dictate, its not the concentration, per se, that dictates how much you give, its the dose. Concentration of drug is only important in terms of how much drug you can give over a period of time. Obviously, if you have to give a drug slowly, you need to dilute it. I think you are freaking out about concentration unnecessarily.

exactly. See if you hospital has any policy or rules. Ask the older pharmacists there, but if there isn't, just use your common sense. +/- 5% (maybe even 10%) in concentration will likely have no clinically significant differences.

 

[sakigt]

Arent amiodarone bags and epidurals the main two? Regardless of volume?

 

[cycloketocaine]

Interesting. How many needles do you go throw for each product then? Seems like it would be a minimum 2 for each bag.

Not really sure why I posted that, I do puncture bags with the same needles I puncture vials with if I am injecting the drug into the bag. I think I had been at work since 4 that day.

 

[Praziquantel86]

Echoing everyone else, this is largely hospital specific. My current institution withdraws volume, my old one did not. Some account for overfill in bags, others do not.

In the context of school, it will be completely different from real-world practice. If you have an exam on the topic, there should have been lectures preceding it. What did they tell you there?

 

[owlegrad]

Not really sure why I posted that, I do puncture bags with the same needles I puncture vials with if I am injecting the drug into the bag. I think I had been at work since 4 that day.