Wednesday, July 30, 2014

H-IPPE: Sterile Products Area

Of all our locations during the IPPE month, the Sterile Products Area (SPA) worried me the most.  We would be required to fill IV bags with medicines that would go to an actual patient in the hospital.  Sure we learned and demonstrated aseptic technique during the lab class, but this was real.  Messing up in here could lead to an infection in the patient or overdose or underdose.  There are a lot of ways to be wrong when filling IV bags or syringes.

Going into the room was just as predicted.  No ties or jewelry. Put on the bonnet, face mask and shoe covers.  After a thorough hand/forearm washing, you don the gown and step into the sterile area.  Apply some alcohol to your hands in case you missed anything and put on the special, tight, sterile gloves.  Oh and some more alcohol.  Essentially, in the SPA the answer is always alcohol.  Now you are ready to get to work.

After collecting a long list of medication orders, you fill a table with the appropriate drug and bag.  Then you start filling.  Now at the table, more aseptic procedures prevent contamination.  In lab, we worked with a horizontal air flow.  Nothing should get in between the filter and their products.  In this hospital, we had a vertical air flow, so nothing should be above the needle or bags.  This includes your hands.  Clean your area with some alcohol, spray your gloved hands, and the ports on the vials and bags.  Now you are ready to stick a needle into the vial.  After withdrawing the correct amount, inject that into the IV bag of normal saline or dextrose.  At all times, remember the air flow comes from above.  If you accidentally pass over the bag, spray the port with some alcohol.  Finally, cap your needle and put into the sharps container.  Place the label on the bag and hand it off to the pharmacist.

I was really nervous for the first couple of bags, but I had no problems and started to move along.  We did some reconstitutions by adding sterile water for injection into a vial of dry powder before putting it into the bag.  We used a transfer needle which squeezes the bag's fluid into the vial, mixes the solution and passes the medicine into the bag.  Everything was moving along until my partner had a major accident.  While I was dutifully removing air bubbles from the syringe, a rather large needle went flying past my face along with a few choice words.  She had accidentally stuck herself in the thumb.  Before I could turn around, she was gone.  There wasn't much I could do other than clean up the area and finish my batch.  I felt really bad for her.

All of that was before lunch.  After our lunch meeting, I came back to the SPA to work with the pharmacist.  We checked the bags that the technicians (including me) filled.  You check the contents of the bag, the drug from the vial and the volume from the syringe.  Everything must match up to the order before putting your legal initials on the label.  We went to the nutrition area to check the TPN (total parenteral nutrition) for the patients that can't eat.  A lot of products do into a yellow fluid to provide calories, carbs, proteins and fats to an unconscious patient - also a lot for babies in the NICU.

Some IPPE students that the other hospitals throughout the state spent an entire week in the IV room.  We worked in the SPA for one morning, about 3 hours.  I would have liked more time to fill IV bags and use the aseptic technique we worked on.  But I don't know what I would have wanted to give up more time there.  The SPA technique is complicated, but a simple checklist helps prevent you from missing anything that might hurt a patient.  I believe I would be comfortable as a pharmacist in the IV area.  You have to know a lot about compatibility between the drug and the fluid.  A lot can go wrong in the area, but you definitely use a lot of the knowledge you accumulate in pharmacy school.

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