1. 5
Aseptic Technique

2. Preparation Personal Protective Equipment (PPE)
Must be worn when compounding
No jewelry, nail polish, artificial nails, makeup
Must be disposable, nonshedding, low-permeable
Don all PPE in anteroom

3. Preparation (cont’d) Remove all PPE before leaving sterile area
Gown may be reused during shift
All other PPE must be disposed of

4. Preparation (cont’d) Order of donning PPE (remove in reverse order)
Shoe covers
Head and facial hair covers
Face/eye masks
Eye shields (required for hazardous drugs)
Aseptically wash hands

5. Preparation (cont’d)
Order of donning PPE (remove in reverse order) (cont’d)
Nonshedding gown with snug fitting cuffs
Clean hands with waterless alcohol scrub
Sterile powder-free gloves

6. Proper Dressing
FIGURE 5-1 Proper dressing

7. Preparation (cont’d) Handwashing
Perform before entering direct compounding area
Run hands under warm water
Use nail cleaner & soap to clean under nails
Wash hands & forearms at least 30 sec with soap

8. Preparation (cont’d) Handwashing (cont’d)
Wash around & between all fingers
Scrub up to elbow, covering entire area with soap
Rinse completely
Dry with lint-free paper towels or electric dryer

9. Proper Handwashing
FIGURE 5-2 (A) Proper handwashing

10. Proper Handwashing (cont’d)
FIGURE 5-2 (B) Proper handwashing (cont’d)

11. Proper Handwashing (cont’d)
FIGURE 5-2 (C) Proper handwashing (cont’d)

12. Proper Handwashing (cont’d)
FIGURE 5-2 (D) Proper handwashing (cont’d)

13. Proper Handwashing (cont’d)
FIGURE 5-2 (E) Proper handwashing (cont’d)

14. Proper Handwashing (cont’d)
FIGURE 5-2 (F) Proper handwashing (cont’d)

15. Proper Handwashing (cont’d)
FIGURE 5-2 (G) Proper handwashing (cont’d)

16. Proper Handwashing (cont’d)
FIGURE 5-2 (H) Proper handwashing (cont’d)

17. Manipulation Avoid touching:
Swabbed area (vial top, bag port, ampule neck)
Uncapped needles
Hub of needle
Syringe tip
Syringe plunger
Open tip of filter or dispensing pin
Uncapped tip of any tubing

18. Manipulation (cont’d)
Swab with 70% isopropyl alcohol
Vial tops
Ampule necks
Tops of bottles
Ports of any IV or IVPB bags

19. Manipulation (cont’d)
Proper use of alcohol pad
Place pad on area to be swabbed
Allow alcohol to saturate surface
Make 1 gentle stroke across area toward side or front of hood
Use unused portion of swab with each pass
Allow alcohol to dry fully before each use

20. Manipulation (cont’d)
Proper use of alcohol pad (cont’d)
Swabbing
Removes physical contaminants such as dust
Disinfects as alcohol evaporates (desiccation)

21. Manipulation (cont’d)
Using syringes
Available in various volumes ( mL)
Use smallest syringe that will hold desired amount
20% rule: total volume must be ≥20% of syringe volume
Don’t touch tip or plunger of syringe

22. Manipulation (cont’d)
Using syringes (cont’d)
Single-use only; dispose of in sharps container
Open syringe within clean air space in PEC
Be familiar with Luer-lock vs. slip tip

23. Manipulation (cont’d)
Using needles
Available in different sizes & lengths
Gauge: width of needle
Larger the gauge, smaller the bore
Standard gauge needle in pharmacy: G
Handle needle only by protective cover
Avoid touching hub

24. Manipulation (cont’d)
Using vials
Date all vials before bringing them into hood
Discard single-dose vials at end of shift
Multiple-dose vials
May be reused
Follow storage instructions on package insert
Note date & time opened & your initials on label

25. Manipulation (cont’d)
Using vials (cont’d)
To prevent coring
Insert needle into stopper with bevel tip up
Apply slight lateral & downward pressure to insert

26. Manipulation (cont’d)
Using vials (cont’d)
Pressure issues
Vials are closed-system containers
Positive pressure can cause spraying or leaking
Removing air can create vacuum
Replace volume of fluid to be removed with air

27. Withdrawing From a Vial
Dress, wash hands, & gather all materials
Swab rubber top with alcohol & allow to dry
Make sure needle is firmly attached to syringe
Pull plunger back to slightly less than amount needed

28. Withdrawing From a Vial (cont’d)
Remove cap, place needle, bevel end up, on center of stopper
Hold needle at 45º angle & insert
Gently push air from syringe into vial
Insert vial & release plunger
Remove any air bubbles by tapping on syringe
Withdraw needle & carefully recap

29. Straight Draw
FIGURE 5-3 (A) Straight draw

30. Straight Draw (cont’d)
FIGURE 5-3 (B) Straight draw (cont’d)

31. Straight Draw (cont’d)
FIGURE 5-3 (C) Straight draw (cont’d)

32. Straight Draw (cont’d)
FIGURE 5-3 (D) Straight draw (cont’d)

33. Straight Draw (cont’d)
FIGURE 5-3 (E) Straight draw (cont’d)

34. Straight Draw (cont’d)
FIGURE 5-3 (F) Straight draw (cont’d)

35. Straight Draw (cont’d)
FIGURE 5-3 (G) Straight draw (cont’d)

36. Straight Draw (cont’d)
FIGURE 5-3 (H) Straight draw (cont’d)

37. Straight Draw (cont’d)
FIGURE 5-3 (I) Straight draw (cont’d)

38. Straight Draw (cont’d)
FIGURE 5-3 (J) Straight draw (cont’d)

39. Reconstituting a Powdered Vial
Dress, wash hands, & gather all materials
Swab all rubber tops with alcohol & allow to dry
Make sure needle is firmly attached to syringe
Draw up correct amount of diluent needed
Pull back plunger to clear neck; remove needle & replace with vented needle

40. Reconstituting a Powdered Vial (cont’d)
Add diluent to powered vial
Gently shake or swirl to dissolve
Change back to regular needle & withdraw fluid
Remove any air bubbles
Withdraw needle & recap

41. Removing Air Bubbles Pull back plunger to allow more air in syringe
Rotate large air bubble around syringe to pick up small ones
Tap syringe to dislodge smaller air bubbles
Hold syringe upright; pull plunger back another 0.2 mL to clear hub

42. Removing Air Bubbles (cont’d)
Push plunger up to remove air
Make sure desired amount is left in syringe

43. Using Transfer Needles
Double-ended
Used to transfer entire contents of vial to an IVPB

44. Using Transfer Needles (cont’d)
To use
Swab appropriate areas
Place longer of two ends in additive port of IVPB
Place shorter end in desired vial
Gently squeeze IV bag & IV fluid will fill vial
Hold IV bag so that air floats to top & squeeze
Air will move into vial & create pressure in vial

45. Opening Ampules Dress, wash hands, & gather all materials
Remove fluid from neck of ampule
Swab neck with alcohol
Hold ampule at 20º angle toward side of hood
Using thumbs, apply pressure toward neck

46. Opening Ampules (cont’d)
Using filter needle, withdraw fluid
Remove any air bubbles
Change to regular needle before injecting in bag
Insert needle in additive port of IV bag & inject

47. Opening an Ampule
FIGURE 5-7 (A) Opening an ampule

48. Opening an Ampule (cont’d)
FIGURE 5-7 (B) Opening an ampule (cont’d)

49. Opening an Ampule (cont’d)
FIGURE 5-7 (C) Opening an ampule (cont’d)

50. Opening an Ampule (cont’d)
FIGURE 5-7 (D) Opening an ampule (cont’d)

51. Opening an Ampule (cont’d)
FIGURE 5-7 (E) Opening an ampule (cont’d)

52. Opening an Ampule (cont’d)
FIGURE 5-7 (F) Opening an ampule (cont’d)

53. Opening an Ampule (cont’d)
FIGURE 5-7 (G) Opening an ampule (cont’d)

54. Opening an Ampule (cont’d)
FIGURE 5-7 (H) Opening an ampule (cont’d)

55. Preparing a Sterile Dosage Form
Assemble all materials within PEC
Clean injection surfaces with a 70% alcohol swab
Place syringes with needles capped on hood
Check base solution & place next to syringe

56. Preparing a Sterile Dosage Form (cont’d)
Don’t puncture bag when inserting needle in port
Keep water & potassium chloride in hood
Position injection port of bag toward HEPA filter
Withdraw drug fluid with appropriate size syringe
Properly label & inspect CSP for cores & matter