Hospital pharmacy report intravenous admixtures

Guide Questions:
What are intravenous fluids?

What are the different types of intravenous fluids available in the Philippines?

What are the different components of an IV fluid?

What are the conditions where IV fluids are used?

Define isotonic, hypotonic and hypertonic solution.

When to use hypotonic, hypertonic and isotonic solution?

What are the different types of IV administration set/ equipments?

What is intravenous admixture?

How are IV admixtures prepared?

What are the different types of incompatibilities encountered in the preparation of
IV admixtures?

What are the complications associated with IV theraphy?

What are Intravenous fluids?
 Are large-volume injections
intended to be administered by
intravenous infusion.
•Included in the group of
sterile products refered to as
Large Volume Parenterals
(LVPs).

•Consists of single-dose
injections having a volume of
100mL or more and
containing Remington, 21st added
no Edition
substances.

What are Intravenous fluids?
 Are sterile solutions of simple
chemicals such as sugar, amino
acids, or electrolytes- materials
that easily can be carried by the
circulatory systemand
assimilated.
•Prepared with Water for
Injection, USP
•Pyrogen-free solutions

A solution (usually a balanced
electrolyte solution) administered
directly into the venous circulation.

What are the different types of intravenous
fluids available in the Philippines?

Intravenous Fluids may be classified into:
• Crystalloid Solutions
• Colloidal Solutions

Crystalloid Solutions
•contain small molecules that
pass freely through cell
membranes and vascular
system walls.
•Are primary fluids used for IV
theraphy.
•These solutions are useful as
fluid expanders and are stored
at room temperature.
•Useful source for electrolytes
and a temporary source of fluid
volume.

Saline Solutions- is a solution of sodium
chloride, or salt, in sterile water.

A. 0.9 % Normal Saline
contains 9g/L sodium chloride
has osmolarity of 308 mOsmol/L (calc).
It contains 154 mEq/L sodium and 154
mEq/L chloride.
is a solution commonly used for medical
purposes such as intravenous therapy
for severe dehydration.
It is also used as a rinse for contact
lenses, and is used in wound care for
irrigating, cleansing and hydrating
wounds.
Has green label

B. 0.45% Normal Saline Solution
Hypotonic Saline
contains 4.5 g/L Sodium Chloride
has osmolarity of 154 mOsmol/L
(calc).
It contains 77 mEq/L sodium and
77 mEq/L chloride.

C. 1.8, 3.0, 7.0, 7.5 and 10%
Saline Solution
Hypertonic Saline

Dextrose Solutions- used to supply
water and calories to the body. It is
also used as a mixing solution
(diluent) for other IV medications.

A. 5% Dextrose (D5W)
is a parenteral fluid and nutrient
replenisher.
Each 100 mL of 5% Dextrose
Injection, USP, contains dextrose,
hydrous 5 g in water for injection.
The caloric value is 170 kcal/L.
The osmolarity is 252 mOsmol/L
(calc.), which is slightly
hypotonic.
has red label

B. 5% Dextrose in 0.9% Saline
(D5NS)
is a sterile, nonpyrogenic
solution for fluid and electrolyte
replenishment and caloric supply
in single dose containers for
intravenous administration.
has yellow label

C. 5% Dextrose in 0.45% D. Dextrose 5% in
Saline (D51/2NS) Lactated Ringer’s
(D5LR)
has purple/ pink
label

Lactated Ringer’s Solution- is
an intravenous (IV) solution
used to supply water and
electrolytes
(e.g., calcium, potassium, sodiu
m, chloride), either with or
without calories (dextrose), to
the body. It is also used as a
mixing solution (diluent) for other
IV medications.
has blue label

Colloidal Solutions
It contains molecules that are frequently very
complex and much larger than those in the
crystalloid solutions.
It is needed when a solution is required to
remain in the vascular system.
It generally require refrigeration and can be
stored for a limited period.
Whole human blood U.S.P. and Hetastarch are
examples of colloid solutions.

What are the different components of an IV
fluid?
 Water- for patients with dehydration

 Amino Acids- for tissue growth and repair,
replacing body cells, healing wounds, and
synthesizing vitamins and enzymes

 Vitamins (A, D, E, K, B & C)- for the restorative
and replacement theraphies.

 pH- for the acidity and alkalinity of a solution.

fluid?
 Electrolytes- major additives for replacement
and restorative therapies.
-any compound that, in solution or in
molten form, conducts electricity and is
decomposed (electrolyzed) by it. It is an ionizable
substance in solution
-is any substance that contains free
ions that behaves as an electrically conductive
medium (conducts electricity).

Electrolytes Functions Sources

Sodium • Regulation for water Sodium Acetate
regulation
Sodium Phosphate
• It helps with
electrical signals in the
body, allowing
muscles to fire and the
brain to work
Potassium • Regulation of acid- Potassium Chloride
base balance
Potassium Phosphate
• It is essential in the
generation of the
electricial impulses in
the body that allow
muscles and the brain
to function


Magnesium • is involved with a Magnesium Sulfate
variety of metabolic
activities in the body, Magnesium
including relaxation of Phosphate
the smooth muscles
that surround the
bronchial tubes in the
lung, skeletal muscle
contraction, and
excitation of neurons
in the brain.

•It acts as a cofactor in
many of the body's
enzyme activities.


Calcium • Used in building and Calcium Gluconate
maintaining bones and
teeth. Calcium Chloride
• Aids in blood clotting,
nerve function, and
muscle contraction.
• Maintains normal
levels of blood
pressure and stomach
acid.


Phosphate • It helps form strong Phosphate salt of
bones and teeth in the sodium and potassium
human body.
• It helps filter waste
from the kidneys and
plays a vital role in the
production and
storage of energy in
the body.

• It is responsible for
maintaining the
balance of other
nutrients since it
combines with other
minerals to form
phosphate salts or
compounds.


Chloride •It travels primarily Chloride salt of
with sodium and water cations
and helps generate
the osmotic pressure
of body fluids.

•It is an important
constituent of stomach
hydrochloric acid
(HCl), the key
digestive acid.

•It is also needed to
maintain the body's
acid-base balance.

•It may also be helpful
in allowing the liver to

fluid?
 Nutrient Solutions- carbohydrates (dextrose,
glucose or fructose)
- water

Example:
 D5W (5% dextrose in water)
 5% dextrose in 0.45% NaCl (dextrose in half-
strength saline)

fluid?
 Electrolyte Solutions- cations and anions

Example:
 NSS (0.9% NaCl solution)
 Ringer’s Solution (Na, Cl, K and Ca)
 Lactated Ringer’s Solution (Na, Cl, K, Ca and
Lactate)

fluid?
 Alkalizing Solutions- for metabolic acidosis
 Acidifying Solutions- for metabolic alkalosis
 Blood Volume Expanders
Example:
Dextran
Plasma
Human serum albumin

What are the conditions where IV fluids are
used?
Intravenous fluids commonly are used with the
following conditions:
Correction of disturbances in electrolyte
balance (Na, K, Ca, PO4, Mg imbalance)
Correction of disturbances in boy fluids (volume
expander, blood loss)
Means of providing basic nutrition(provide
patients with difficulty in taking food and fluids
orally)
Basis for the practice of providing Parenteral
Nutrition
Vehicles for other drug substances (mixed with
fluids for medication needed in the body)

Define hypotonic, hypertonic and isotonic
solution.
 Hypertonic- is a solution having a larger
concentration of a substance than is found within the
cells themselves.
-it causes the cell to shrink, or crenate.

 Hypotonic-it contains a lesser concentration of
impermeable solutes on the external side of the
membrane.
-it causes the cell to swell

 Isotonic- a solution which has the same
concentration of dissolved substances as the blood
cells do.

Define hypotonic, hypertonic and isotonic
solution.

When to use hypotonic, hypertonic and
isotonic solution.
Hypotonic have a lesser concentration of
solutes
Solution have an osmolarity lower than 250
mOsm/L
often given to correct cellular
dehydration and hypernatremia
Used by patients for:
-hypertonic dehydration
-for water replacement
-diabetic ketoacidosis
Examples are:
-0.45% NaCl (half strength
saline)
-0.33% NaCl
-2.5% Dextrose in water

isotonic solution.
Hypertonic have a greater concentration of
solutes than plasma
Solution Have greater tonicity than blood.
Uses:
-to replace electrolytes
-to treat hypotonic dehydration
-temporary treatment of circulatory
insufficient and shock
Examples are:
-5% Dextrose in 0.45% NaCl
-5% Dextose in 0.9% NaCl
-5% Dextrose in lactated Ringer’s
-10% Dextrose in water
-Colloids (albumin 25%, Plasma
protein fraction)

isotonic solution.
Isotonic Solution
Have the same concentration of solutes (osmolarity)
as blood plasma.
Prevents sudden shifts of fluids and electrolytes in
the body
Used for:
-treatment of fluid loss
-dehydration
-hypernatremia (sodium excess)
Examples are:
-0.9% NaCl
-5% dextrose in water
-Lactated Ringer’s Solution

What are the different types of IV
administration sets and equipments?

IV Administration
Sets
IV Infusion can be administered either by:
1) Gravity alone
Example:
 Gravity Infusion set
2) With the use of an electronic infusion
device
Example:
 Infusion pumps
 Volumetric pumps

IV infusion administered by
gravity: Infusion Set
Gravity
 The height of the IV solution is of
greater importance than the
tubing.
 Most basic types of IV
tubes/tubing can be used in this
type of set.
 The higher the solution, the faster
the solution infuses.
 Preferred elevation of the solution
from the site of infusion: 18 to 24
inches (45 to 60 centimeters).

IV infusion administered with the use of an
electronic infusion device:
Infusion Pump
 Pressure is used in order to infuse
solutions
 Requires special tubing that contains
a device such as cassette to create a
sufficient pressure to push fluid into
the vein.
 Advantage: Programmed to deliver a
preset volume per hour.
 Disadvantage: If catheter or needle
within vein becomes misplaced, the

IV infusion administered with the use of an
electronic infusion device:
Volumetric Pump
 Do not depend upon gravity to force the
fluid into the vein.
 All volumetric pumps generally involve the
nurse entering the infusion rate in mL/hr.
The volumetric pump then automatically
maintains that rate.
 Volumetric pumps should still be checked
regularly to ensure that they are infusing
the medication correctly.
 Infiltration is possible when using a
volumetric pump because it forces the fluid
into the vein, even when it encounters
resistance.

IV Administration Equipments
Basic IV Setup consists of the following important
parts/equipment:
a) Drip chamber c) Slide clamp
b) Roller clamp d) Injection port

Other IV equipment:
a) IV Tubing d) Central IV Lines
b) Hypodermic needle e) Tunneled Lines/Broviac Line
c) Catheter needle f) Peripherally inserted
central catheter

Basic Parts & Equipments
A) Drip Chamber
 Located just below the IV bag.
 Inside this chamber, we can see the
fluid drip down from the bag into the
IV tubing.
 This is where we measure the
speed of a manual IV setup; we
look at this chamber and count the
number of drops we see per
minute.

B) Roller Clamp
 is what we use to control the rate at
which the IV fluid infuses.
 All roller clamps on a set of IV
tubing should be closed before we
attach a bag of IV fluid to the top of
the tubing; this ensures that no air
gets into the tubing.

Basic Parts & Equipments

C) Slide Clamp
 slide clamp is used when we want
to completely stop the IV from
flowing without having to adjust the
roller clamp.

D) Injection port
 A place where medicine or fluids
other than those in the current IV
bag can be injected so that they
will infuse into the patient's vein
through the IV tubing.


a)Drip chamber
b) Roller clamp
c) Slide clamp
d) Injection port

Other IV Equipments
A) IV Tubing
 Plastic conduit used to
administer various fluids to
patients through a needle
inserted into one of the patient’s
vein.

B) Hypodermic Needle
 Commonly used with a syringe
to inject substances into the
body or extract fluids from it.

C) Catheter Needle
 Used for the injection of fluids
into the human body. This device
is widely used in hospitals.

Other IV Equipments
D) Central IV Lines
 Have the capacity to deliver
fluids that are considered to
be irritating to peripheral
veins. Also, medications
introduced in this manner are
quickly distributed throughout
the body.

E) Tunneled Lines/Broviac Lines
 A type of central line in which
Hickman line or Broviac
catheter is inserted into the
target vein then tunneled
under the skin to emerge a
short distance away.

F) Peripherally Inserted Central
Catheter
 Used when IV administration
requires to be in a prolonged period
or when the substance to be infused
would cause damage if infused
quickly.

G) More Equipments:

What is Intravenous Admixture?

 It is a combination of one
or more sterile products
added to an IV fluid for
administration.
 Intravenous admixtures
must be sterile and free
from pyrogens since it
will be administed into
the body.
 Aseptic technique is
used to mixed the
products.

How are Intravenous Admixture prepared?

 The pharmacist must be knowledgeable in
preparing a form for the combination of drugs
and IV solutions that will be suitable for
administration to the patient.
 Products used in preparing the admixture must
be sterile and not contaminated.
 Proper conditions for aseptic handling can be
provided by laminar-flow hoods.
 IV push and IV infusion dose forms are prepared
in the laminar-flow hoods.

Before the preparation of admixtures:
 Both hands must be thoroughly cleaned.
 Accessories/jewelries must be removed.
 Gloves must be used during the procedure.
 Laminar-flow hoods must be kept running.
 All surfaces of the work area must be cleaned and disinfected.
During the preparation of admixtures:
 One must work in the center of the area within the laminar-flow
hood.
 Proper procedures must be followed in handling sterile
devices and containers.


 The plunger and the tip of the syringe must not be
touched for they are sterile.
 One must use the smallest syringe which can hold the
desired amount of solution.
 Additives may be packaged in vials or ampules.

After the preparation of admixtures:
 Properly dispose used gloves and syringes.
 Clean the work area

Drawing liquid from a vial:
Choose the smallest gauge
needle and handle carefully the
rubber top of the vial
thus, preventing particulates
from entering.

Attach needle to the
syringe.

Draw into the syringe an amount of
air equal to the amount of solution
to be drawn from the vial.

HOW ARE INTRAVENOUS ADMIXTURES
PREPARED?
 Drawing liquid from a vial:


Swab alcohol on the top of vial. Enter
the laminar flow hood. Puncture the
rubber top of vial with needle bevel up.
Bring needle and syringe straight up.
Penetrate the stopper then
depress the plunger of the
syringe, emptying the air to the
vial.
Invert the vial with the attached
syringe then draw up the required
amount for the preparation.



Withdraw the needle of the
syringe from the vial.

Remove and properly dispose the
needle and the cap of the
syringe.

Prepare the product by
introducing the withdrawn drug
from the vial into the IV container.


Opening an ampule:
Carefully tap the top of the
ampule so that medication will
settle on the lower portion of the
ampule.
Clean the neck using an alcohol
swab then, grasp the ampule
between the thumb and index
finger at the neck with the swab
still in place.
Forcefully snap the neck away
from you.


Opening an ampule:

Drawing liquid from an ampule:
Tilt the ampule then place the
needle bevel of a filter needle or tip
of a filter straw in the corner near
the opening. Withdraw the
medication.
Use a needle with a filter to filter out
any glass particles, fibers, or other
materials which may have fallen in the
ampule.

Before putting the contents of the syringe
to an IV, needle must be replaced with a
filter device to prevent introduction of
particulates into the admixture.


Labeling of the admixture:
Labels for admixtures should contain the following
information:
- Patient’s name and identification number
- Room number
- Fluid and amount
- Drug name and potency
- Infusion period
- Flow rate (e.g. 50mL/hr or infuse in a 30 minute period)
- Expiration date and time
- Any needed additional information

What are the different types of incompatibilities
encountered in preparing IV admixtures?

 Intravenous fluids incompatibilities are the
undesirable reactions that can occur when two or more
drugs must be administered through single IV line or
given in a single solution.
 Types:
1) Physical Incompatibilities
2) Chemical Incompatibilities
3) Therapeutic Incompatibilities
4) Drug IV Container Incompatibilities


 Physical Incompatibility
The incompatibility that is more on solubility changes and
container interactions.

Type Ways to Prevent
INSOLUBILITY -Do not administer a precipitate
forming drug.
SORPTION PHENOMENA - Avoid mixing drugs prepared
in special diluents with other
GAS FORMATION drugs.
- In administration of multiple
SOLUTION PH intravenous medications,
prepare each drug in a
separate syringe.


 Chemical Incompatibility
Results from the molecular changes or rearrangement and
leads to chemical decomposition.

Type Ways to Prevent
HYDROLYSIS Store drugs in relatively water-
proof containers.
OXIDATION REACTION Store drugs in amber bottles. This
will minimize oxidation reaction.
REDUCTION REACTION Keep away from suspected
reducing agents.
PHOTOLYSIS Storing drugs in lightproof
containers can usually prevent
photolysis.


 Therapeutic Incompatibility
Result of antagonistic pharmacological effects of several
drugs in one patient.

Example Intervention
Heparin and antibiotics It is best to avoid mixing
heparin with antibacterial
preparations because
Heparin can affect the
stability of certain
antibiotics.


 Drug-IV Container Incompatibility
Incompatibility that arise from the chemical reaction of the
drug and the Intravenous container.

Type Definition
ADSORPTION The property of a solid/liquid to
attract and hold to its surface a
gas, liquid, solute or
suspension.
ABSORPTION The act of taking up liquids or
other substances through a
surface of the body into body
fluids and tissues.

INTRAVENOUS INCOMPATIBILITIES

Factors causing IV Incompatibility
Type Intervention
Difference in pH Refer to drug incompatibility
tables.
High Concentration Determine the chemically
compatible concentration of
both drugs.
High Temperature Refrigerate the IV admixture if
not used within 1 hour after
mixing.
Order of Mixing Alternate the administration

Length of Time in Solution The Iv drug should be mixed
and discarded if not used
within 24 hours.

INTRAVENOUS INCOMPATIBILIES

Ways to prevent or minimize incompatibilities

1. Mix thoroughly when a drug is added to the
preparation
2. Minimize the number of drugs mixed together in an IV
solution.

3. Solutions should be administered promptly after
mixing so that occurrence potential reactions can be
minimized.
4. Always refer to compatibility references.

What are the complications associated with
the IV therapy?

Local Complications Systemic
Complications
 Infiltration
 Phlebitis  Septicemia

 Thrombosis  Fluid overload and
pulmonary edema
 Thrombophlebitis
 Air embolism
 Bruising
 Catheter embolism
 Hematoma
 Speed shock

Local Complications
 Infiltration
o Happens when the needle or
catheter in which the product
is entering the blood vessel
(vein) is dislodged from the
vein.
o Remedy: Product should be
administered in another site.

 Phelibitis
o Inflammation of vein caused
by mechanical, bacterial or
chemical irritation.
o Characterized by redness
and pain at the
administration site.
o Remedy: Solution should be
administered in another site.

Local Complications
 Thrombosis
o Occurs when blood flow
through a vein is obstructed by
a local thrombus.
o Remedy: remove IV device,
restart infusion, apply warm
soaks.

 Thrombolphlebitis
o Similar to phlebitis but a clot
(thrombus) is involved.
o At times, the IV cannula staying
inside the body can cause
irritation which can trigger
clotting mechanisms.

Local Complications

• Bruising
o A type of minor hematoma of
tissue in which capillaries and
sometimes venules are
damaged due to trauma
allowing blood to collect to the
surrounding tissues.

• Hematoma
o Collection of blood caused by
internal bleeding. This can
happen when a catheter
punctures through the vein
and cause bleeding.

Systemic Complications
• Septicemia
o A febrile disease process that
resulted from the presence of
microorganisms or their toxic
products in the circulatory
system.

• Fluid Overload and
w/ edema Pulmonary edema
o Excessive administration of
intravenous fluids is the main
cause.
o High blood pressure may
result due to increased fluid
Normal volume.
o Also, pulmonary edema may
also happen due to abnormal
fluid accumulation in the


• Air embolism
o Results when a sizeable
volume of air enters the
circulatory system.
o This may happen when air
from the intravenous
administration set enters the
bloodstream.

• Catheter embolism
o Happens when a piece of the
catheter breaks off and travel
through the circulatory system.

• Speed Shock
o Occurs when a foreign substance (e.g
medication) is rapidly infused or introduced into
the circulation.

Remember:

“Early detection and good communication between
patient and healthcare provider are both important in
minimizing IV therapy complications.”

Group 1

AYCO, IVY LENA
DONGGON, JOHN JEFFERSON
BALLESTA, MARIA ZARA
BULAONG, KRISTINE
DAILEG, KRISTINE
DURO, GALE MICAH
RAMIREZ, RHEA
VILLANUAEVA, MARIA PIA
VILLACORTE, ILY

THANK YOU! XD

Hospital pharmacy report intravenous admixtures

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