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PHM 651/652: Professional Practice > PHM 652: Exam 2 (Parenteral Products) > Flashcards

PHM 652: Exam 2 (Parenteral Products) Flashcards

1
Q

Define Parenteral

A

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

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2
Q

all parenteral products and ophthalmic dosage forms must be what

A

STERILE

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3
Q

define aseptic technique

A

ability of personnel to manipulate sterile preparations, sterile packaging components, and sterile administration devices in a way that excludes the introduction of viable microorganisms

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4
Q

ex. of parenteral routes

A
  1. IV
    a. injection to venous (not arterial) system
    I.perioheral
    II. central
  2. Intraarterial (uncommon)
  3. Intramuscular (IM)
  4. Intrathecal (IT)
    a. injection into meninges of spinal cord)
  5. Epidural
    a. injection to tissues surrounding spinal cord, not spinal cord itself
  6. Intradermal (ID)
    a. injection within the skin
  7. SubQ
    a. injection beneath the skin
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5
Q

what does it mean to be sterile

A

freedom from all living organisms

an absolute. no such thing as almost sterile

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6
Q

medical devices used along with parenteral administration must be what

ex of these medical devices

A

STERILEEE

includes things like

needles
syringes
tubing
bags
etc
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7
Q

health status when compounding sterile products

A

need to be free from infectious disease

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8
Q

personal preparation

A

cover head and facial hair
remove cosmetics likely to flake
remove finger and wrist jewelry

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9
Q

how to wash hands

A

scrub hands and arms to elbows

pre wash

use 3-5ml for 30 seconds
wash hands even if gloves are to be worn

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10
Q

gloves

types:

composition

when should you change your gloves?

A

a.sterile vs non sterile
powdered vs non powdered

b.composition:
latex
vinyl
synthetic

c. depend on pharmacy but usually ~1 hr

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11
Q

better products for hand washing than plain soap in high risk situations

A 
alcohols
chlorhexidane gluconate
iodophors
hexaclorophene
parachlorometaxylenol
triclosan
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12
Q

gowns

composition

A

a. tyvek: non permeable substance

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13
Q

other coverings when preparing iv

A

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

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14
Q

what is the last step before entering iv room

A

WASH HANDS

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15
Q

Laminar air flow SYSTEM

types

how long should it be turned on for before using

A

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

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16
Q

HEPA

A

HIGH EFFICIENCY PARTICULATE AIR Filter

removes 99.9% of all particles 0.3 microns (um) or larger

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17
Q

disadvantage of laminar air flow

A

false sense of security

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18
Q

ISO classifications of particulate matter in room air

A

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

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19
Q

pyrogens

A

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

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20
Q

pharm effects of pyrogens

A
  1. vary
  2. in man, pyrogenic causes fever and chills
  3. after injection, rapid raise in body temp, chills and headache, malaise after 45-90 min latent period
  4. anaphylaxis
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21
Q

source of pyrogens in sterile compounding

A
  1. water (solvent)
  2. containers (packaging)
  3. chemicals (used for solution preparation)
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22
Q

how to eliminate pyrogens

A
  1. dry heat (for metal and glass ocntainers
  2. chemically : for solutions but can destroy durgs
  3. synthetic filter media:
  4. best approach . PREVENT THEM FROM OCCURING
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23
Q

unecessary factors that can cause microorganism intro to product in i room

A

talking
laughing
chewing gum
eat/drink

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24
Q

CSP (compounded sterile product) risk levels

definition:

A

assigned according to relative possibility that a compounded sterile product might be contaminated

LOW
MEDIUM
HIGH

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25
Q

what does this stand for

LAFS

also AKA

A

Laminar air flow system

aka horizontal flow hood

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26
Q

what does this stand for

BSC

A

biological safety cabinet (aka vertical flow hood)

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27
Q

what does this stand for

RBS

a. CAI
b. CACI

A

restricted barrier system

a. compounding aseptic isolator
b. compounding aseptic containment isolator

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28
Q

how to determine which iv bag to use

A
  1. 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

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29
Q

female IBW equation

A

45.5 +2.3(height over 5’ in inches)

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30
Q

male IBW eq.

A

50.0+2.3 (height over 5’ in inches)

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31
Q

10% rule with iv bags

A

if adding fluid greater than 10% to an iv bag, must remove that equiv. amount from iv bag first

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32
Q

refrigerated temp

A

2-4 degrees C

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33
Q

room temp

A

20C-25C

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34
Q

clean rooms. what are they

A

env. where contamination is controlled/limited form stuff such as

particles
organisms
pyrogens

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35
Q

environment control of clean rooms

A

temp
humidity
relative barometric pressure

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36
Q

conventional IV rooms ar always maintained at what kind of pressure

A

positive pressure

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37
Q

end product testing

A

container leaks and integrity
particulates in solution
solution color, volume, and odor

pursuant to individual products

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38
Q

analytical testing

A 
weight verification
refractometry
ph testing
microbial testing
etc.
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39
Q

process validation

what is it

when should it be conducted

A

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

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40
Q

stability

A

extent product remains within specified limits in terms of
chemical composition
physical composition
microbiologic activity

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41
Q

stability

at the time of use, a medication must be

A

at the stated potency

and safe for admin. to the pt.

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42
Q

product stability

subject to..
primary basis for..

A

subject to specific storage conditions

primary basis for an expiration date/ time

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43
Q

maintenance of stability

lyophilization

what is it?
what does it entail?

A 
process of 
rapid freezing
sublimation 
product becomes dry power
is more stable than in solution.
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44
Q

maintenance of stability

what are some methods of sterilization

A

0.22 micron filter

autoclave (applying heat to kill of microorganisms)

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45
Q

maintenance of stability

antioxidants
ex:

A 
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)
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46
Q

maintenance of stability

removal of O2 and insert of what inert and semi inert gassses

A

nitrogen
Carbon dioxide (CO2)
helium

b/c o2 is highly reactive

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47
Q

particulate matter

what are they

what are some sources

A

dust spores

sources: iv solution, packaging, iv tubing, preparation process (laminar now hood or pt bids)

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48
Q

iv fluid compatibility

A

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

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49
Q

therapeutic incompatibles

A

basically DDI

have very little to do with route of admin

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50
Q

physical incompatibility

A

combo of one or more drugs in solution resulting in compositional change and appearance.

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51
Q

chemical incompaitbility

A

degredation of drug substances as a result of being in solution or coming in contact w. other drugs

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52
Q

greatest single factor causing incompatibility btw iv fluids and their contents

A

variations in pH

solubility: physical
stability: chemical

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53
Q

how to minimize incompatibilities

A

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)

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54
Q

pros of parenteral admin:

A

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

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55
Q

cons of parenteral admin

A

special traning

invasive

painful

difficult to reverse

more expensive

incompatibilities

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56
Q

things to consider when determinining iv bag compatiility

A

use smallest bag

refrigerate vs room temp (look at test conditions)

light sensitivity

pay attention to manufacturers codes when provided

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57
Q

sterility and integrity requirements for sterile iv admixtures

free from…

A

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
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58
Q

ease of administration

Tonicity classifications

A

hypotonic: <277 mM
isotonic: ~ 277
hypertonic: >277 mM

also consider osmalrity

59
Q

iv route

peripheral vs central

A

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)

60
Q

indications for peripheral administration

A

admin of drugs

admin of fluids

surgery

transfusion of flood and blood preodcts

maintain or correct electrolyte imbalance

admin of nutritional solutions

61
Q

advantages of peripheral admin

A

veins are relatively easy to access

drugs, solutions and blood can be administered quick;y

admin is easy to see and monitor

62
Q

cons of peripheral admin

A

short term access

immobilization of limb

less forgiving of tonicity extremes

63
Q

indication for central admin

A

large fluids
hypo/hypertonic fluids

pH imbalanced fluids

64
Q

pros of central admin

A

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

65
Q

cons of central admin

A

risk of complications such as

  1. pneumothorax
  2. sepsis
  3. thromus/embolism
  4. organ perforation

decrease pt mobility

surgical implant

66
Q

other parenteral routes

A

interarticular: into joints (ex. hydrocortisone )
intrasynovial: injection to joint fluid areas
intraventricular: into ventricles of the brian
intracardiac: injection into heart (ex. epinephrine)

67
Q

phlebitis

what it is

SS

where is it located

A

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

68
Q

extravasation

A

liquids infused into peripheral space instead of in vein due do misplaced vascular access device (VAD)

undesirable

69
Q

infiltration

A

extravasation fluids are absorbed by surrounding tissues

undesirable

70
Q

SS of extravasation/ infiltration

drug specific cause”:

A 
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

71
Q

ss of local and systemic infection

A

local: contaminated iv site
sterile and non sterile necrosis
sepsis: tissue destruction)

systemis: fever, chills , malaise, septicemia (tissue destruction, widespread

72
Q

air embolism

what is it

SS

A

> 5 mL of air
right ventricle of the heart
cavitaion
fatal

respiratory distress
weak pulse
increased CVP
decreased bp
UNCONSCIOUSNESS
73
Q

Pediatric IVF maintenance

Max continuous infusion (daily) volume

A
  1. ABW: 1-10 kg: 100mL/kg/day
  2. > 11-20kg: 1000mL +50ML/kg/day
  3. > 21-30kg: 1500 mL +20mL/kg/day
  4. > 30kg: 1700mL +10mL/kg/day
74
Q

define injection:

A

a drug in solution (or lyophilized powder) in a suitable vehicle intended for parenteral administration

can be single dose

or multiple dose

75
Q

Intavenous fluid

A

IVF
intermittent, single, small volume dose:
available in 50 mL, 100mL

76
Q

sterile solids

drug labeling requirments for sterile drug and drug for injecrtion

A

labeled: sterile drug
a. no buffers
no diluents
no added substances

labeled: drug for injection
a. buffers
diluents
added substances

77
Q

sterile suspensions

what are they

labeling

ex:

A

drug initially in lyophilized form. yield suspension after reconstitution

labeled: sterile drug suspension

EXAMPLE: UNASYN (AMPICILLIN/SULBACTAM)

78
Q

solutions for irrigation.

A

used to bathe or flush open wounds and body actives

NEVER USE PARENTERALLY

79
Q

vehicles

A

water for in jection
sterile water for injection
bacteriostatic water for injection
oils for injection :i.e sesame oil

80
Q

solubilizing agents

A

PEG
propylene glycol
glycerin
ethyl alcohol

81
Q

admixture: definintion

A

combo of 2 or more parenteral dosage forms for admin. as a single entity

82
Q

define additive:

A

when a small volume of drug is added to a larger volume vehicle, drug may be referred to as additive

83
Q

convenience packaging

pros and cons of ampules

A

pros: do not require preservatives

cons: contamination by glass shards upon opening
filtration required

84
Q

convenience packaging

vials pros and cons

A

pros: dosing flexibility, decreased waste-multi dose vial

cons: coring
drug interaction with latex
latex allergy
increase waste-single dose vial

85
Q

define deadspace( needle syringe)

A

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

86
Q

how to calculate deadspace

A

mass of syringe/ needle primed minus mass of syringe needle dry

difference is in grams.
headspace units is in mL

87
Q

fluid dynamic equations

  1. pressure
  2. resistance
  3. flow rate
A

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

88
Q

vascular pressure

define:
what is it a function of

A
  1. pressure within a blood vessel (venous and arterial)
  2. function of..
    a. myocardial contractility
    b. smooth muscle activity in vasculature
    c. hydrostatic force (due to gravity)
89
Q

Infusion and vascular pressure

A

in order for liquids to flow, infusion device must develop a pressure greater than vascular pressure ar infusion site

90
Q

infusion pressures can be developed by which methods

A
  1. gravity

2. pump

91
Q

draw back with developing infusion pressure with gravity vs pump

A

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

92
Q

resistance to flow a function of …

A
  1. diamater tubbing:
    a. resistance increases as
    I. diameter decreases
    II. tube length increases

b. resistance decreases as
I. diamater increases
II. tube length decreased

  1. knicks in tubbing
  2. presence of inline filters
  3. solution viscosity

extravasation/infiltration

93
Q

infusion pump indications

A

greater degree of accuracy is required (complicated regimen)

high-pressures are required (IA infusion, etc.)

risk of fluid overload

94
Q

cons of infusion pumps

A

cost

special training

malfunction (pt harm)

95
Q

parenteral volume classifications

A
  1. small volume parenterals (SVP)
    a. = 150 mL
    b. ex: iv piggybacks, prefilled syringes
  2. Large volume parenterals (LVP)
    a. >/= 150 mL
    c: ex: hydration fluids (electrolytes), TPN
96
Q

Glass IV container types

  1. US CLASSIFCATIONS
  2. types
A
  1. must be resistance to water attack and release of alkali. available in size holding 1mL- 3000mL (3L)
  2. 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.

97
Q

pros of glass containers

A

protection against gas and vapor permeation

protection against punctures

easy to inspect contents

98
Q

cons of glass containers

A

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

99
Q

plastic containers

  1. Polyvinyl Chloride (PVC)
  2. Polyolefin
A
  1. PVC.- bags we use in iv room. easily pliable. adsorption and absorption can occur
  2. polyolefin: more rigid plastic iv bags. no drug sorption problems. impermeable to air
100
Q

pros of plastic containers

A

disposable

lightweight

inexpensive

unbreakable

minimal storage soace

can be frozen

no venting required (airborne contamination less likely)

101
Q

cons of plastic iv bags

A

ports awkward to manipulate (increase touch contamination)

absorption/ adsorption (PVC)

permeability (PVC)

difficult to determine fluid levels

difficult to detect particulates

puncture easily (PVC)

102
Q

iv administration sets

A
  1. primary. usually for a single, primary fluid. for continuous infusion
  2. secondary set. attaches to a primary set at a y site. for continuous or intermittent infusion
103
Q

filter size and what they can filter

5 micron

  1. 2
  2. 45
  3. 22
A

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

104
Q

define parenteral nutrition

central or peripheral adminisration?

A

provision of all basic metabolic and nutritional requirements via the IV (venous) route

central preffered because can higher larger extremes of pH and tonicity

105
Q

different names for tpn

A 
TPN
PN
hyperalimentation (HAL)
3 in 1 (fats, amino acids, dextrose)
FAD (",",")
PPN (Peripheral parenteral nutrition
106
Q

pros of TPN

what canbe given in tpn

A

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

107
Q

condo of tpn

A

NOT ALL nutrient admixtures are chemically stale

come combo can..

  1. precipitate
  2. will crack ( fat emulsion)
108
Q

pt indications for tpn

A

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

109
Q

Caloric requirements

What is the Harris-Benedict equation

equation for men:
equation for women:

A
  1. 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)]

110
Q

Basal energy expenditure (BEE)

Maintenance BEE

Anabolism BEE

A

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

111
Q

estimation of BEE eq.

draw back of using the quick estimates

A

without respect to sex
kg: ABW

BEE: 25kcal/ Kg
Maintenance: 30kcal/ kg
Anabolism: 35 kcal/kg

more accurate for younger pts than older pts

112
Q

Caloric TPN sources

Amino acids

dextrose

fat

A

amino acids: 4kcal/gram

dextrose: 3.4 kcal/ gram
fat: 9 kcal/gram

113
Q

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

A

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

114
Q

commercially available AA

A

10% w/v (most common)

15% w/v (fluid restrictive pts, expensive

115
Q

what is the key component in most TPN solutions

A

dextrose

used to provide 40-60% of total caloric intake

116
Q

contraindications to fat use in tpn

A

pts with altered lipid metabolism

hyperlipidemia

hypertriglyceridemeia

hypercholesterolemia

severe renal failure

egg yolk allergy

PPN (peripheral parenteral nutrition)

117
Q

how to do tpn calculations

A
  1. determine daily caloric requirement
    a. calculate BEE
    b. adjust BEE with stress factor based on pt condition
  2. 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
  3. 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.
  4. 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
  5. 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
  6. 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
  7. 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)
  8. 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

118
Q

vascular access devices

when are they used
examples

A

establish connection where administration of drugs and/or fluids to the venous system is indicated. maintenance required

  1. needles and syringes
  2. catheters
  3. implanted ports
119
Q

vascular device condiseratitions

A

vein location, condition and availability

specific indication

infusion rate

tonicity , pH and vesicant potential

duration of therapy

pt compliance/ cooperation

120
Q

locations of venipuncture vascular access

for long or short term?

A

access to arm or hand (sometimes leg or foot)

< 2 inches in length

metacarpal
cephalic (wrist)
basilic (and branches)

for short term vascular access

121
Q

central venous access.

what is it

types of catheter insertion

A

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)

122
Q

short term catheters compositoin

long term catheter composition

A
  1. a.polyurethane
    b. PVC
  2. a. silicone rubber (silastic)
123
Q

conc os short term catheters to long term catheters

A

tissue irritation

local infection

systemic infection

thrombus formation due to
PVC

vessel rupture

124
Q

pros and cons of long term catheters

A

pro: physiologic more compatible. less thrombogenic than polyurethane or pvc
con: insertion more difficult

125
Q

single and multi lumes

A

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

126
Q

Hickman catheter

indication (pro):
cons

A

pro: longterm cv access and at home therapy

cons: open ended
tears easily
requires routine heparin flush

127
Q

types of tunneled catheters

A

hickman
broviac
groshong:( like hickman but closed ended. doesn’t need to be flushed w. heparin. for long term infusion)

128
Q

PICC

pro

con

A

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

129
Q

cytotoxic drugs

A

a drug that damages or destroys cells is used to treat various types of cancer

such as

chemotherepetutic

antineoplastic

antimtabolic

cytotocic

130
Q

MOA of cytotoxic durgs

A

inhibition of cell growth and / or division

selective towards 
cancers
tumors
bone marrow
skin
epithelial tissues
fat tissues
hair follicles
131
Q

TI of cytotoxic drugs

A

narrow

132
Q

common sense conclusion of studies of cytotoxic agent effects on ppl handling them

A

operator protection is indicated

results conclusive

133
Q

known risks of cytotoxic drugs

A

suppress testicular function
spermatogensis

therefor. excuse pregnant or breastfeeding women for preparing..
and men trying to father a child.

134
Q

other precautions for handling cytotoxic drugs

A

use vertical flow hood

proper handling technique

135
Q

vertical flow hood (BSC)

A

BSC(biological safety cabinet)

air comes in downward direction.

blows air away from operator
protects personell

prevent release of aerosolized drug

136
Q

BSC types (4 types)

A

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

137
Q

bcc safety cabinet considerations

A

leave on all the time 24/7.

if have to shut down. throughly clean. cover operator opening with plastic and tape

138
Q

gloves when dealing with chemotherapeutic agents

A

change often

(usually) 2 pairs

  1. change outer pair immideiatly f contaminated
  2. both if outer is puncture or torn
    both if event of large spill
    both after each 1 hour of use
139
Q

masks when dealing w. chemo agents

A

no protection to you, just the product

if no BSC, use a hEPA FILTER MASK

140
Q

how to clean bsc

A

disinfect with 70% isopropyl alcohol

decontaminate on reg basis

141
Q

ampules

A

ensure tip contents transferred to main body. do this by..

gentle tapping against work surface
swirl
gentle finger snap

142
Q

negative pressure technique for liquid filled vials

A

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.

143
Q

negative pressure technique for powdered filled vials (need ot be reconstituted)

A

to draw diluent, use regular positive pressure methods.

use neg. pressure when putting that into the powder vial.

144
Q

chemo pin

A

creates a negative pressure automatically. no need to go out of way to do neg. pressure technique with chemo pin. just draw regularly

PHM 651/652: Professional Practice (6 decks)

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