UNIVERSITY OF TECHNOLOGY, JAMAICA

Faculty of Health and Applied Sciences

School of Pharmacy

STERILE TECHNOLOGY
Post Diploma / B.Pharm.4 - Elective

PARENTERAL INFUSION

Definition - any liquid substance (other than blood) introduced into the body via
the vein for therapeutic purposes.

Bone Marrow Infusion – a method of obtaining immediate vascular access, esp.

in children. Access is obtained by percutaneous insertion of a bone marrow
aspiration needle into the bone marrow cavity of a long bone, usually into the
proximal tibia. Once access is gain substance may be injected into the bone
marrow where they are absorbed almost immediately into the general circulation.
This avenue of access does not collapse in the presence of shock or peripheral
circulatory collapse.

Continuous Infusion
A controlled method of prolonged drug administration that includes the ability to
control the delivery rate. This route permits the drug to be delivered at a
prescribed level.
Large Volume Parenterals (LVP) > 100cc
Small Volume Parenterals (SVP) < 100cc
LVP – given by continuous infusion.

Intermittent Infusion
3 types.
Piggy Back
-a small volume added to run simultaneously with the main fluid therefore two
separate bags or bottles are used. The liquids will converge at a point.
IV Push
-use needle and syringe
-different from IV infusion because you literally push
-can be injected directly into patient or through the Y-site.
Volume Control
-e.g. Soluset, Buretrol, Volutrol (calibrated chambers used to ensure accurate
measurements of small amount of intravenous fluids and to prevent fluid infusion
overload).

Patient Controlled Administration

Patient self administration - at a preset rate as needed. E.g. analgesic, insulin,
-needs a pump.

Cyclic Administration – achieved by administering medicine for a specific rate

during a specified time interval.

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 EXAMPLES OF INTRAVENOUS FLUIDS

Dextrose Solutions
-exist as 5% to 70% (D5W to D70W)
-glucose preparation. The most important of the monosaccharide group.

Normal Saline (NaCl 0.9%)

-isotonic
-contains no antimicrobial agents
-can be used as a sterile vehicle for preparing certain solutions or suspensions
for parenteral use.

Ringer’s Solution
- fluid and electrolyte replenisher
-solution containing 8.6g sodium chloride, 0.3g potassium chloride, 0.33g calcium
chloride per litre.
-the salts are in concentration similar to that in physiology.

Ringer’s Lactate (Hartmann’s Solution)

-has similar ingredients as above but in different concentration plus sodium
lactate.
-0.6g of sodium chloride, 0.03g of potassium chloride, 0.02g of calcium chloride
and 0.31g of sodium lactate in 100ml water for injection.
-fluid and electrolyte replenisher and a systemic alkalizer.

Mannitol
-a carbohydrate obtained from a plant source.
-use as an osmotic diuretic, to reduce cerebrospinal spinal fluid pressure and in
prophylaxis for acute renal failure.
-Available as 5%, 10%, 20% solution.

Amino Acid Solution

E.g. Aminosyn, Freamine III, Travsol, Nephramine
-for amino acid replacement .
-usually combined with dextrose to complete the nutritional requirements.

Fat Emulsion
E.g. Intralipid, Soyacil, Travemulsion

Total Nutrition – dextrose 10% or more + fat lipid (any concentration) + amino
acid (any concentration).
Large Volume Parenterals
Uses:

1. Fluid Replacement
- normal rate 250cc/hour

2. For Replacement Of Electrolyte

- e.g. after diarrhoea, vomiting
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 - the amount of Na+, K+, Ca2+, Mg2+ given dependents on where they
were lost from.
Source of Sodium
-from NaCl, Na acetate, Na phosphate

Source of Potassium
-from potassium chloride, potassium acetate, potassium phosphate
(the endpoint of acetate and phosphate is HCO 3).

Source of Magnesium
Magnesium Sulphate salt - only soluble salt available.
- also associated with incompatibilities

Source of Calcium
Calcium Chloride and Calcium Gluconate
- also associated with incompatibility because of multivalence of Ca 2+
ions..
- When combining Mg2+,Ca2+,PO4 be very careful of incompatibility.
- Calcium chloride has more Ca2+ (13.6mEq per 10ml) than calcium
gluconate (4.65mEq per 10ml).
- Calcium gluconate therefore has a lower potential for developing
incompatibilities.
- Micro-precipitation may occur therefore it is advisable to filter.

3. Supplement For Nutrition

- For patients who are not receiving enough nutrients from the
enteral route
- Any dextrose solution would provide nutrients but only > 10%
provides any notable contribution to nutrition; 3.4 calories / gram.

4. Vehicle For Administration Of Drugs

- primary vehicles are D5W, normal saline
- also can have incompatibility problems
- therefore important to have a stability chart.
- Fluids can be used to make the drug less irritating in solution e.g.
calcium, epinephrine, dopamine etc.

5. As A Total Parenteral Nutrition

Hypotonic
Sterile water for injection should not be administered alone. Can lead to
oedema.
Option – ½ normal saline or D 5W or combination product of the two at a rate of
100cc / hour.

Hypertonic
D5W 80cc / hour should not be given for long and should be given through a
central line where there is a large supply of blood to reach equilibrium quicker
(than peripheral line).
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Complications of Large Volume IV
Local Effect
Haematoma – bruising, blood clot forming in area where the IV is.
Infiltration – IV slip out and fluid go to surround area.
Extravasation – not only infiltration but also there is damage to the surrounding
tissues, by vesicant drugs, e.g. doxorubicin.
Phlebitis – inflammation in the veins.

Systemic Effect
1. Clinical overload
2. Contamination

Sean Moncrieffe B.Pharm. MPH

2000-06-08