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IV ADMIXTURE

Introduction

According to Joint Commission on Accreditation of Healthcare Organizations (JCAHO) Intravenous (IV) admixture is the preparation of pharmaceutical product that requires the measured additive of a medication to a 50 ml or larger bag or bottle of IV fluid (e.g., IV, IM, IT, SC, etc). When a licensed pharmacy is available, only the pharmacy compounds or admixes all sterile medications, IV admixtures, or other drugs except in emergencies or when not feasible

Objectives

+To make the students learn about the components of an intravenous administration set.
+To make the students learn handling, preparation and administration procedures for IV drug products in an aseptic environment.
+To train the students to prepare labels for IV admixtures.
+To train the students to calculate the intravenous rates.


Procedure

• Obtain the physician’s orders for IV admixtures and identify the patient
• Components of IV admixtures set include syringes, needles, medication vials and ampoules, 70% isopropyl alcohol, bag or bottle. They must be sterilized before use
• Perform proper garbing and gowning procedure and assemble all equipment and supplies needed in a laminar airflow workbench.Working area must be free of interruption
• Complete the appropriate label to include: Patient’s name, location and medical record number, room number, name of drug, amount of drug, name of basic parenteral solution and solution volume, expiry date and time.
• Select the appropriate diluents as per the IV admixture order
• Remove the protective cap from the diluents container.
• Swab the diaphragm or stopper of the vial with alcohol swab and allow drying.
• Draw up the recommended amount of diluents and inject the diluents into the drug vial
• Mix the drug and diluents as directed and check for incompatibilities
• Swab the stopper and port of entry on the IV bag with alcohol swab and allow drying
• Pull up the required amount of medication and inject into the bag
• Complete and affix the Medication Additive label to the mixture
• Double check against physician’s orders before hanging

• A common problem when using a syringe to withdraw a solution from a vial is that air bubbles can form in the barrel. These will prevent accurate measurements and must be removed. First, hold the syringe upright and pull back the plunger slightly to allow a space for the bubble to go to the top. Firmly tap the sides of the syringe to allow the bubble to travel to the top. Expel the air in the syringe by slowly pushing the plunger up until the fluid fills the barrel completely. Read the measurement by looking at the rubber end of the plunger aligned with the graduations on the barrel

Intravenous fluid must be given at a specific rate, neither too fast nor too slow. The specific rate may be measured as ml/hour, L/hour or drops/min. To control or adjust the flow rate only drops per minute are used.
To measure the rate we must know:
(a) The number of drops
(b) Time in minutes.

The formula for working out flow rates is:

volume (ml) X drop factor (gtts / ml)
---------------------------------------------
time (min) = gtts / min
(flow rate)
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