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Sterile Compounding Practice Labs

Practice Labs For The IV Certification Program


Before you start practicing, review the details listed below. These details will be important to keep in mind in the work environment. The list below is not all inclusive.

If you are new to sterile compounding always refer to the manufacturers package insert for important details regarding the drug you are compounding. Other factors to consider include.

Reconstitution
⁃ When reconstituting a powder vial make sure the diluent is compatible with the powdered drug in the vial.
⁃ Make sure the base solution such as sodium chloride or dextrose in which you will be injecting the reconstituted or non-reconstituted solution is compatible with the drug you are injecting.

Dilution of the compounded drug in a base solution

⁃ Ask yourself. What should the maximum concentration of the drug in the base solution be? For Vancomycin shown below the maximum concentration must be 5 mg/ml if diluting 500 mg in a base solution of sodium chloride, for example. So you would dilute the 500 mg in 100 ml of sodium chloride to achieve the concentration above. This is to prevent thrombophlebitis or inflammation and clotting in the vein.

Storage requirements

⁃ Consider whether the drug you are compounding should be the only drug in a IV solution or can it be mixed with other drugs depending on what the physician has ordered. In other words, find out the IV compatibility of the compounded drug with the base solution and other drugs that may be injected into the same base solution (IV bag) if the physician order calls for it.

Single dose vs Multi-dose
⁃ Make sure you’re not drawing multiple doses out of single-dose vials which are included in the supplies.
⁃ A multi-dose vial which is bigger may be used to withdraw multiple doses.
⁃ Ensure you have the correct size syringe and correct size needle.
⁃ See below.


Practice Labs

Complete the practice labs below and email me your answers and document your practice hours. Let me know whether you practiced on your own at home OR at your facility if applicable and send me the documentation via email as a text attachment.

  • Complete ALL the labs below using the supplies you received.
  • Also, if you received a filter straw instead of a filter needle then draw the liquid from the ampule with the straw and remove and secure a regular needle and inject in the appropriate bag.
  • Pharmacists must spend a minimum of 2 hrs practicing and documenting the practice.
  • The 2 hrs also includes the final evaluation which takes about 30-40 minutes to complete.
  • Pharmacy Technicians must spend a minimum of 22 hrs practicing and documenting the practice. 
  • The 22 hrs also includes the final evaluation. See example below.

Example of documentation

 Sunday, October 3rd. 1.5 hours of training. Went through the kits and learned to put on sterile gloves. I was very slow and awkward, but the gloves remained sterile. Will need more practice. Monday, October 11th. 2 hours of training. Worked on small volume and large volume vials. Didn't get all the way through the large volume, as I stuck myself with a needle. I was removing the cap in the wrong way. Will try again later. Tuesday, October 12th. 4 hours of training. Got a private lesson from our pharmacist etc.

Start with the lab below
 

Ertapenem Lab

The physician wrote an order for Ertapenem 15mg/kg IV BID infused over 30 minutes X 7 Days to treat a patient’s skin Infection. Assuming the patient has normal renal function and weighs 140 lbs.

*Round the weight in KG up or down to the nearest tenth when converting lbs to kg and answer the following questions.

1. What is the total prescribed dose?
2. How much of the Ertapenem is required daily?
3. How much of the Ertapenem is required per dose?

Hands-on Practice

**Look up dilution information for Ertapenem here: https://dailymed.nlm.nih.gov/dailymed/fda/fdaDrugXsl.cfm?setid=468105b9-48b3-4477-82c7-e7fb92460e28&type=display

1. Calculate how much Ertapenem is required based on your answer for #3 above?
2. How much of the diluent is required to reconstitute the entire powder vial of Ertapenem?
3. What is the final concentration after reconstitution?
4. How much Ertapenem should be withdrawn and injected into the sodium chloride IV bag after reconstitution?
5. List the supplies and quantity (how many syringes, needles etc.) you will need to reconstitute the powder vial and draw out the appropriate volume and injecting into the IV bag that is provided.
6. Document the entire compounding process including the steps required prior to compounding such as garbing process etc. steps required during and after compounding such as wiping the supplies before placing them in the hood, aseptic technique, cleaning the surface of the hood after completing compounding etc.

Vancomycin Lab

The physician wrote an initial order for Vancomycin 15mg/kg IV Q8H to be infused over 30 minutes and subsequent doses to be determined per pharmacy protocol to treat a patient’s MRSA (Methicillin Resistant Staphylococcus Aureus) infection. Assuming the patient has normal renal function and weighs 70 lbs.
*Round the weight in KG up or down to the nearest tenth when converting lbs to kg and answer the following questions.

1. What is the total prescribed dose?
2. How much of the Vancomycin is required daily?
3. How much of the Vancomycin is required per dose?

Hands-on Practice

*Look up the dilution information for Vancomycin here: https://dailymed.nlm.nih.gov/dailymed/fda/fdaDrugXsl.cfm?setid=07834f80-a546-47b0-b899-8649fb1a5fbc&type=display

1. Calculate how much Vancomycin is required based on your answer for #3 above.
2. How much of the diluent is required to reconstitute the entire powder vial of Vancomycin?
3. What is the final concentration after reconstitution?
4. How much Vancomycin should be withdrawn and injected into the sodium chloride IV bag after reconstitution?
5. List the supplies and quantity you will need to reconstitute the powder vial and draw out the Appropriate volume and injecting the volume into the IV bag that is provided.
6. Document the entire compounding process including the steps required prior to compounding such as garbing process etc. steps required during and after compounding such as wiping the supplies before placing them in the hood, aseptic technique, cleaning the surface of the hood after completing compounding etc.

Tranexamic Acid Lab

The physician wrote an initial order for Tranexamic acid 15mg/kg IV Q8H over 16 hrs to be infused over 15-30 minutes and subsequent doses to be determined per hospital protocol for a patients knee surgery. Assuming the patient has normal renal function and weighs 100 lbs.
**Round the weight in KG up or down to the nearest tenth when converting lbs to kg and answer the following questions.

1. What is the total prescribed dose?
2. How much of the Tranexamic acid is required per dose?

Hands-on Practice
1. Calculate how much Tranexamic acid is required based on your answer for #2 above.
2. How much Tranexamic acid should be withdrawn and injected into the sodium chloride IV bag?
3. List the supplies and quantity you will need to draw out the appropriate volume and inject the volume into the IV bag that is provided.
4. Document the entire compounding process including the steps required prior to compounding such as garbing process etc. steps required during and after compounding such as wiping the supplies before placing them in the hood, aseptic technique, cleaning the surface of the hood after completing compounding etc.

Ampule manipulation

For this lab you will be performing a straight draw from an ampule and drawing out the entire contents of the ampule and injecting into the IV bag.

1. List the supplies and quantity required to perform this manipulation.
2. Document the entire compounding process including the steps required prior to compounding such as garbing process etc. steps required during and after compounding such as wiping the supplies before placing them in the hood, aseptic technique, cleaning the surface of the hood after completing compounding etc.

Final Evaluation Lab - ONLY TO BE DEMONSTRATED IN FRONT OF THE INSTRUCTOR

After having watched the TPN videos in the online course you should have a basic understanding of how TPNs are made and the white TPN bag included in your supplies is the final product after all the base solutions have been infused into the TPN using the compounder you saw in the videos.

Keep in mind there are many other manufacturers of TPN compounders.

As you saw in the TPN videos in the online course, the other ingredients have to be drawn up by hand and injected into the TPN bag.

For this lab…

The physician wants to initiate a TPN for a patient and wants the following ingredients added to the TPN.

⁃ 12mM of sodium phosphate
⁃ 5% calcium gluconate
⁃ 2 mL of trace elements from the ampule
⁃ 2 mL of the reconstituted powder solution.

Based on the details above and the supplies provided for this lab… 
1. How many mLs of sodium phosphate are required?
2. How many mLs of calcium gluconate are required?
3. How much diluent is required to reconstitute the powder vial? (add 2 mLs of diluent to the powder vial IF you received the small 2 mL powder vial)
4. What is the final concentration of the solution in the reconstituted vial? (will not apply if you received the small 2 mL powder vial)
5. List the supplies and quantity required to perform this manipulation.
6. Document the entire compounding process including the steps required prior to compounding such as garbing process etc. steps required during and after compounding such as wiping the supplies before placing them in the hood, aseptic technique, cleaning the surface of the hood after completing compounding etc.

Email me your answers for everything above and the documentation as explained above.