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Pediatric Preparations
- 2. Topics2 Chapter 12 Pediatric Preparations 2012 Paradigm Publishing
- 3. Topics3 Learning Objectives Recognize the origins of pediatric medicine and pharmacy. Identify the special situations and actions that must be considered when preparing medicine for pediatric use. Identify the USP Chapter <797> procedures that must be performed when compounding pediatric preparations. Demonstrate correct technique in preparing a pediatric special dilution. 2012 Paradigm Publishing
- 4. Topics4 Topics Learning Objectives Introduction Pediatric CSPs Pediatric Dosing Pediatric Formulations Administration of Pediatric CSPs Potential Complications of Pediatric CSPs USP Chapter <797> Guidelines for Pediatric CSPs Understand the Resources and Supplies Preview the Lab Procedure Chapter Summary 2012 Paradigm Publishing In Slide Show view, click the desired topic to the left to link directly to the related slide. To return to this slide at any point in the presentation, click the Topics button below.
- 5. Topics55 Introduction Pediatric medicine, as well as pediatric pharmacy, acknowledges the specific healthcare needs of children by providing specialized sterile preparations that are safe and effective for this patient population 2012 Paradigm Publishing
- 6. Topics66 Pediatric CSPs Pediatric CSPs are sterile solutions that typically have a volume of 500 mL or less the most commonly prepared pediatric CSPs include IV push antibiotics, LVP solutions for hydration, and total parenteral nutrition solutions the physical and chemical properties of parenteral pediatric medications vary somewhat, but most of these medications are generally isotonic, isoosmotic, and pH neutral 2012 Paradigm Publishing
- 7. Topics77 Pediatric Dosing During child growth and development, the biochemical and physiological processes that control drug disposition undergo important changes this is especially true for the first three years of a child’s life at this young age, drugs may be absorbed or eliminated more slowly or more rapidly than in adults 2012 Paradigm Publishing
- 8. Topics88 Pediatric Dosing…/2 Many factors must be considered when determining pediatric dosing for a patient, including: pediatric anatomy and physiology body weight or body surface area (BSA) age diagnosis drug disposition organ functioning 2012 Paradigm Publishing
- 9. Topics99 Pediatric Formulations Pediatric dosing has long been based on adult- strength formulations of medications This method of dosing continues to be used today, with prescribers using body weight or BSA to help them determine appropriate dosages for parenteral medications 2012 Paradigm Publishing
- 10. Topics1010 Pediatric Formulations…/2 2012 Paradigm Publishing The high concentrations of adult-strength medications make reduction to child-sized doses difficult
- 11. Topics1111 Pediatric Formulations…/3 Many manufacturers have reformulated certain adult-strength medications into diluted concentrations, or pediatric-strength formulations, making pediatric dose preparation easier and more accurate 2012 Paradigm Publishing
- 12. Topics1212 Pediatric Formulations…/4 Regardless of whether the pediatric medication is based on an adult-strength formulation or a pediatric-strength formulation, all drugs for pediatric use are required to undergo studies prior to approval by the Food and Drug Administration this federal law—included in a 2007 amendment to the Federal Food, Drug, and Cosmetic Act— was established to improve the safety and efficacy of pediatric medications 2012 Paradigm Publishing
- 13. Topics1313 Administration of Pediatric CSPs Pediatric CSPs are primarily given as continuous IV infusions or as intermittent doses using the IV push route of administration Continuous IV Infusion Many pediatric patients receive a continuous IV infusion during their hospitalization are generally comprised of an IV base solution to which an additive, such as potassium chloride, is injected during sterile compounding procedures 2012 Paradigm Publishing
- 14. Topics1414 Administration of Pediatric CSPs…/2 Continuous IV Infusion…continued Administration of a Continuous IV Infusion a peripheral access point is established for some pediatric patients, it may be more practical for the nursing staff to establish a central line or gain IV access through a femoral line or umbilical line 2012 Paradigm Publishing
- 15. Topics1515 Administration of Pediatric CSPs…/3 Continuous IV Infusion…continued Administration of a Continuous IV Infusion…continued once an access point has been established, nursing personnel use an IV pump programmed to deliver the medication at a flow rate designated by the prescriber 2012 Paradigm Publishing
- 16. Topics1616 Administration of Pediatric CSPs…/4 Intermittent CSP Administration Parenteral medications requiring intermittent dosing are commonly administered by the IV push route 2012 Paradigm Publishing
- 17. Topics1717 Administration of Pediatric CSPs…/5 Intermittent CSP Administration…continued Compounded Syringes compounded syringes are syringes of medication that are compounded in the pharmacy and then sent to a nursing unit for patient administration are typically sent without an attached needle using a syringe cap rather than a capped needle is a precautionary measure taken to avoid a needle stick from the accidental dislodgment of the needle cap during transport 2012 Paradigm Publishing
- 18. Topics1818 Administration of Pediatric CSPs…/6 Intermittent CSP Administration…continued Compounded Syringes…continued once the syringe cap is attached, an IVA syringe seal is then placed over the cap to ensure that the contents of the syringe remain sterile 2012 Paradigm Publishing
- 19. Topics1919 Administration of Pediatric CSPs…/7 Intermittent CSP Administration…continued Empty Evacuated Containers often, a pediatric IV push medication is compounded into patient-specific vials or empty plastic bags known as empty evacuated containers (EECs) useful for neonatal patients whose size dictates further dilution of a pediatric-strength drug with preservative-free (PF) sterile water or NS 2012 Paradigm Publishing
- 20. Topics2020 Administration of Pediatric CSPs…/8 Intermittent CSP Administration…continued Empty Evacuated Containers…continued EECs have several advantages for nursing and pharmacy personnel: • EECs can still be used if the patient dosage changes • EECs are transported as vials, not as syringes • preparing batches of EECs is easier and more convenient one disadvantage of EECs is that they are more costly than the syringe dosage form 2012 Paradigm Publishing
- 21. Topics2121 Administration of Pediatric CSPs…/9 Intermittent CSP Administration…continued Administration of Pediatric Push Medications should be administered either by a syringe pump or by the use of a buretrol 2012 Paradigm Publishing
- 22. Topics2222 Administration of Pediatric CSPs…/10 Intermittent CSP Administration…continued Administration of Pediatric Push Medications…continued a buretrol is a special type of tubing that contains a large, tube-shaped cylinder the IV push medication is injected into the cylinder, where it mixes with a specific volume of fluid from the patient’s primary IV solution the diluted medication is then administered through the tubing via a pump programmed to slowly inject the medication over a preset period 2012 Paradigm Publishing
- 23. Topics23 Your Turn 2012 Paradigm Publishing 1) Often, a pediatric IV push medication is compounded into patient- specific vials or empty plastic bags known as this. a. CCEs b. CEEs c. ECCs d. EECs 2) This is a special type of tubing that contains a large, tube-shaped cylinder. a. buretrol b. special dilution c. nasogastric d. secondary In Slide Show view, click here to see the answer to Question 1. Then click again to advance to Question 2. In Slide Show view, click here to see the answer to Question 2.
- 24. Topics2424 Potential Complications of Pediatric CSPs All patients receiving parenteral therapy should be monitored for the following complications: nosocomial infection allergic reaction (including anaphylaxis) phlebitis tissuing embolism extravasation cellulitis Stevens-Johnson syndrome nephrotoxicity 2012 Paradigm Publishing
- 25. Topics2525 Potential Complications of Pediatric CSPs…/2 Preparation Risks During the compounding of pediatric preparations, pediatric CSP ingredients must be considered benzyl alcohol may cause damage to multiple organ systems, potentially triggering a life-threatening condition called benzyl alcohol gasping syndrome for this reason, only preservative- free (PF) ingredients should be used in pediatric CSPs 2012 Paradigm Publishing
- 26. Topics2626 Potential Complications of Pediatric CSPs…/3 Preparation Risks…continued The compounding of pediatric CSPs requires additional oversight to ensure the accuracy of pharmacy calculations because of the small size and delicate nature of pediatric patients, even minor errors in dosage calculation of a pediatric CSP could be fatal 2012 Paradigm Publishing
- 27. Topics2727 Potential Complications of Pediatric CSPs…/4 Administration Risks Because children, especially neonates, are so small, the total volume of parenteral fluid being administered to this patient population must be significantly smaller than the fluid volumes given to adult patients 2012 Paradigm Publishing
- 28. Topics2828 Potential Complications of Pediatric CSPs…/5 Administration Risks…continued If too much fluid were to be administered to a neonate too quickly (generally referred to as accidental rapid administration), hypervolemia, cardiac arrest, or death may result the cause of such an error is most commonly a nursing or IV pump error 2012 Paradigm Publishing
- 29. Topics2929 Potential Complications of Pediatric CSPs…/6 Administration Risks…continued Many hospitals avoid accidental fluid overload by enacting policies that prohibit the use of 1000-mL IV bags with pediatric patients in addition, facilities limit the size of an IV bag to 250 or 500 mL for neonates 2012 Paradigm Publishing
- 30. Topics3030 USP Chapter <797> Guidelines for Pediatric CSPs IV technicians must adhere to strict dosage verification and aseptic protocols when preparing pediatric CSPs any breach in these protocols may result in medication errors, sepsis, or, possibly, death for patient recipients as an IV technician, you bear primary responsibility for the preparation and integrity of the CSPs 2012 Paradigm Publishing
- 31. Topics3131 Understand the Resources and Supplies Essential Supplies Most sterile compounding procedures require the same essential supply items to be available for use in both the anteroom and the clean room 2012 Paradigm Publishing
- 32. Topics3232 Understand the Resources and Supplies…/2 Procedure-Specific Supplies The type, number, and amount of procedure-specific supply items are determined by the IV technician prior to performing the procedure, based on information provided on the CSP label and the medication additive label 2012 Paradigm Publishing
- 33. Topics3333 Understand the Resources and Supplies…/3 Procedure-Specific Supplies…continued Pediatric Special Dilution Supplies the process of compounding certain pediatric CSPs involves the manipulation of regular needles and, in particular, medication, diluent, and EEC vials 2012 Paradigm Publishing
- 34. Topics3434 Understand the Resources and Supplies…/4 Procedure-Specific Supplies…continued Pediatric Special Dilution Supplies…continued PF Gentamicin Vial - check the vial’s medication label for the word Pediatric (or Pedi) and for the words preservative-free or the abbreviation PF 2012 Paradigm Publishing
- 35. Topics3535 Understand the Resources and Supplies…/5 Procedure-Specific Supplies…continued Pediatric Special Dilution Supplies…continued PF Diluent Vial—the type of diluent most often used when preparing pediatric CSPs is normal saline (NS) EECs—are used to prepare custom-made CSPs • pediatric special dilutions provide accurate parenteral medication dosing 2012 Paradigm Publishing
- 36. Topics3636 Understand the Resources and Supplies…/6 Critical Sites of Essential Supplies and Pediatric CSP Supplies Before beginning preparatory procedures in the anteroom or clean room, the IV technician must recall the critical sites of the supplies identifying the critical site of each supply item helps you determine the proper procedure for handling the supply item once you have entered the clean room and begin working in the hood 2012 Paradigm Publishing
- 37. Topics3737 Preview the Lab Procedure Anteroom Preparatory Procedures verifying the CSP label against the medication order performing correct pharmacy calculations to determine type, size, and number of supply items needed gathering and cleaning of supplies performing aseptic garbing and hand washing donning a sterile gown Clean Room Preparatory Procedures cleansing hands with sterile, foamed 70% IPA donning sterile gloves cleaning the hood 2012 Paradigm Publishing
- 38. Topics3838 Preview the Lab Procedure…/2 Pediatric Special Dilution Compounding Procedure bring the PF gentamicin vial into the direct compounding area (DCA) you are now ready to begin the compounding procedure in preparation for the verification check, position the filled and capped diluent syringe next to the diluent vial on the hood’s work surface after the verification check, reposition the EEC vial upon completion of the pediatric special dilution compounding procedure, dispose of used vials and supply items in the appropriate waste container 2012 Paradigm Publishing
- 39. Topics39 Your Turn 2012 Paradigm Publishing 3) Many hospitals avoid accidental fluid overload by prohibiting the use of these IV bags with pediatric patients. a. 50-mL b. 500-mL c. 1000-mL d. 100-mL 4) This is the type of diluent most often used when preparing pediatric CSPs. a. sterile water b. dextrose c. lactated Ringer’s d. normal saline In Slide Show view, click here to see the answer to Question 3. Then click again to advance to Question 4. In Slide Show view, click here to see the answer to Question 4.