IV ADMIXTURE

Introduction:

 The preparation of parenteral admixture

usually involves the addition of one or more
drugs to large volume solutions such as
intravenous and nutrients fluids.
Introduction:

 Components of an IV program
 Preparation area
 Policies and procedures
 Personnel
 Storage space
 Admixture systems
Cont’:

Components of an IV program
Preparation area
 Ideally in separate room in the pharmacy
“clean room”
 Size vary
Cont”:

Components of an IV program
Polices and procedures
 Guidelines for preparing parenteral products
should be outlines in the pharmacy’s policy and
procedure manual.
 Detailed information regarding preparation,
labeling, storage and expiration dating of
parenteral products should be readily available in
the pharmacy
 These policy help to provide quality control for
the parenteral products
Cont”:

Components of an IV program
Polices and procedures
 Stability
 Put in your mind that stability is affected by
place, environmental condition, diluent used
to administer the product, other drugs that
may be mixed with
 Stability and sterility! Gives the expiration
date
Cont”:

Components of an IV program
Polices and procedures
 incompatibility
Physical: visible change e.g. precipitation
Chemical: may or not visible change, deterioration
or inactivation of an active ingredient.
Therapeutic: drug-drug or drug-disease interaction
that lead to potentiating of drug effect, drug
toxicity, deterioration.
Cont”:

Components of an IV program
Polices and procedures
 Aseptic Technique
Method of handling sterile products, a sterile
parenteral dosage form is free from living
microorganisms, particulate matter, and
pyrogens.
Cont”:

Components of an IV program
Polices and procedures
 Labeling and check systems
Reviewed against the patient’s current
medication profile.
Cont”:

Components of an IV program
Personnel
Carefully trained
Who will prepare? Pharmacist or technician
Proper training in aseptic technique and sterile
product information is necessary.
Cont”:

Components of an IV program
Storage space
Will depend on the type of system one chooses
to use.
Calculations involving
IV admixture:
 Examples:
A medication order for a patient
weighing 70 kg calls for 0.25 mg of
amphotericin B per kg of body weight to be
added to 500 ml of 5 % dextrose injection. If
the amphotericin B is to be obtained from a
reconstituted injection that contain 50 mg
per 10 ml, how many milliliters should be
added to the dextrose injection?
Example:

 An intravenous infusion is to contain

15 mEq of potassium ion and 20 mEq of sodium
ion in 500 ml of 5 % dextrose injection. Using
an injection of potassium chloride containing
6 g per 30 ml and 0.9 % injection of sodium
chloride, how many milliliters of each should
be used to supply the required ions?
Example:
 The following is a formula for a desired TPN solution. Using
the source of each drug as indicated, Calculate the amount of
each component required in preparing solution.
TPN solution
formula Component Source
(a) Sodium Chloride 35 mEq Vial, 5 mEq per 2 ml
(b) Potassium Acetate 35 mEq Vial, 10 mEq pre 5 ml
(c) Magnesium Sulphate 8 mEq Vial, 4 mEq per ml
(d) Calcium Gluconte 9.6 mEq Vial, 4.7 mEq per 10 ml
(E) Potassium Chloride 5 mEq Vial, 40 mEq per 20 ml
(f) Folic Acid 1.7 mg Ampul, 5 mg per ml
(g) Multple vitamin infusion 10 ml Ampul, 10 ml
To be added to:
Amino Acid Infusion (8.5 %) 500 ml
Dextrose injection (50 %) 500 ml
Example:

 A medication order calls for 1000 ml of D5W

to be administered over an 8-hour period.
Using an IV administration set which delivers
10 drops per ml, how many drops per minute
should be delivered to the patient?