when performed accurately aseptic
0:05
technique minimizes contamination and
0:07
spills in this section we'll review the
0:09
proper handling and use of needles
0:11
syringes and filters first let's discuss
0:14
needles there are three main parts of a
0:17
needle the shaft the hub and the bevel
0:20
the shaft is usually metal and
0:22
lubricated with a sterile silicon
0:23
coating the larger end is called the hub
0:26
the hub attaches the needle to the
0:28
syringe and is often color-coded to
0:30
designate the needles diameter or gauge
0:32
will discuss gauge in a moment notice
0:36
how the tip of the needle shaft is
0:37
slanted to form a point the slant is
0:40
called the bevel and the point is called
0:41
a bevel tip the opposite end of the
0:43
slant is called the bevel heel needles
0:46
are commercially available in many sizes
0:47
described by two numbers gauge and
0:50
length the gauge of the needle
0:52
corresponds to the diameter of its bore
0:54
which is the diameter of the inside of
0:56
the shaft the larger the gauge the
0:58
smaller the needle bore for example the
1:01
smallest needles have a gauge of 30
1:03
while the largest needles have a gauge
1:05
of 13 the length of a needle shaft is
1:08
measured in inches and usually ranges
1:10
from 3/8 of an inch to 3 and a half
1:12
inches some needles are designed with
1:15
unique characteristics for example
1:17
needles for batch filling have built-in
1:19
vents to release pressure that might
1:21
form in the vial another unique design
1:23
equips needles with built-in filters
1:25
intended for products or preparations
1:27
requiring frequent filtering in order to
1:30
open needle packages correctly follow
1:32
these steps
1:33
position the packaged needle six inches
1:36
inside the hood without blocking airflow
1:38
tilt the needle hub toward the back wall
1:41
of the hood to make sure the airflow is
1:42
surrounding the needle hold the needle
1:45
in the middle of the cap and pull
1:46
packaging from the top toward you make
1:49
sure you never touch the shaft that will
1:51
be in contact with the drug then without
1:54
moving the needle outside of the hooded
1:55
area discard the packaging into the
1:57
waste container beside the workstation
1:59
when dealing with small volumes it is
2:01
important to account for the volume of
2:03
the solution left in the hub of the
2:05
needle it may be necessary to dilute the
2:07
product to increase volume or provide
2:09
overfill consult the institution's
2:12
policies and procedures for
2:13
guidance next let's talk about syringes
2:17
syringes are made of either glass or
2:19
plastic some medications react with
2:22
plastic potentially altering the potency
2:24
or stability of the final preparation so
2:26
glass syringes are used for some drugs
2:28
however disposable plastic syringes are
2:31
most frequently used in preparing
2:32
sterile preparations because they are
2:35
inexpensive durable and are usually in
2:37
contact with substances only for a short
2:39
time your institution will have a clear
2:42
policy on which syringes are used with
2:44
which drugs composed of a barrel and
2:46
plunger syringes provide the suction
2:48
power to both drying and expel fluid
2:50
through an attached needle the barrel
2:52
holds the drug the plunger provides the
2:55
pressure the plunger fits inside the
2:57
barrel and has a flat lip at one end and
2:59
a rubber piston at the other the top
3:02
collar the barrel prevents the syringe
3:03
from slipping during manipulation the
3:06
tip is where the solution is drawn in
3:07
and ejected from and where the needle or
3:10
other attachments is main to maintain
3:12
sterility of the preparation do not
3:14
touch the tip of the syringe or the
3:16
plunger many syringes have a locking
3:19
mechanism at the tip such as the luer
3:21
lock which secures the needle within a
3:23
threaded ring some syringes such as a
3:25
slipped tip syringes do not have a
3:27
locking mechanism in that case friction
3:30
holds the needle on the syringe syringes
3:32
are available in numerous sizes ranging
3:34
from 0.5 to 60 milliliters graduated
3:38
marks on the outside of the syringe
3:39
barrel represent different increments of
3:41
capacity depending on the size of the
3:43
syringe notice the measures on the side
3:45
of the large syringe in comparison to a
3:47
small one you can see that the volume of
3:49
the liquid held between the markings in
3:51
the small syringe is much less than the
3:53
volume of liquid held in the larger
3:54
syringe usually the larger the syringe
3:57
capacity is the larger the interval
3:59
between graduation lines for example
4:01
each line on the ten milliliter syringes
4:04
represents 0.2 milliliters
4:06
but each line on the 30 milliliters
4:08
syringes represents one milliliter
4:11
syringes are accurate to one half of the
4:13
smallest increment marking on the barrel
4:15
for example a 10 milliliter syringe with
4:18
0.2 milliliter markings is accurate to
4:21
0.1 milliliters and can be used to
4:23
measure 3.1 milliliters accurately a 30
4:27
milliliter syringe
4:28
with one milliliter markings however is
4:30
only accurate to 0.5 milliliters and
4:32
should not be used to measure a volume a
4:34
3.1 milliliters ideally the volume of
4:38
solution should take up only one-half to
4:40
two-thirds of the syringe capacity which
4:42
avoids inadvertent touch contamination
4:44
caused when the syringe plunger is
4:46
pulled all the way back when measuring
4:48
with a syringe the final edge of the
4:50
plunger piston should be lined up to the
4:52
graduation mark on the barrel that
4:53
corresponds to the required volume for
4:57
maximum accuracy the smallest syringe
4:59
that can hold a required amount of
5:01
solution should be used syringes are
5:03
packaged to keep them sterile and ready
5:05
for safe use the sterility of the
5:07
contents is guaranteed as long as the
5:09
outer package remains intact
5:11
therefore packages should be inspected
5:13
and if found to be damaged discarded
5:16
immediately in order to maintain
5:18
sterility the syringe package should be
5:20
opened within the hood if you are
5:23
working with syringes in an isolator
5:25
there are a few things to keep in mind
5:27
if the syringe does not have a
5:28
protective cap the package should be
5:30
opened inside the isolator otherwise the
5:33
outer packaging should be peeled apart
5:35
inside the antechamber not ripped or
5:37
torn to minimize the introduction of
5:39
particles syringes may come from the
5:42
manufacturer with a needle attached or
5:44
with a protective cover over the syringe
5:46
tip the syringe tip protector should be
5:49
left in place until it is time to attach
5:51
the needle for attaching needles to lure
5:53
lock type syringes a quarter turn is
5:55
usually sufficient to secure the needle
5:57
to the syringe as you are setting out
5:59
your supplies before compounding inspect
6:02
the needle package to make sure it is
6:03
not open or damaged a damaged package
6:06
should be thrown in the special sharps
6:08
container reserved for needles and
6:09
syringes let's discuss the standard
6:12
procedure for opening a syringe without
6:15
blocking air flow place the syringe six
6:18
inches inside the hood workspace and
6:19
remove the package whole syringe by the
6:22
barrel never by the luer lock tip or
6:25
plunger angle the barrel tip toward the
6:27
back wall of the hood and the flowing
6:29
air grasp the top of the packaging with
6:32
the other hand peel the packaging down
6:34
from the tip and discard wrap in the
6:37
waste container beside the workstation
6:39
do not use the same syringe more than
6:41
time's for a single compounded dose
6:43
choose the appropriate needle for the
6:45
syringe by comparing the needle size in
6:47
relation to the size of the syringe
6:48
usually these rules apply when using a
6:51
one milliliter three milliliter or five
6:53
milliliter syringe use a 20 gauge one
6:56
inch needle when using a 10 20 30 or 60
6:59
milliliter syringe use an 18 gauge
7:01
one-and-a-half inch needle or admixture
7:04
needle when compounding large volumes or
7:06
viscous drugs use a 16 gauge one and a
7:09
half inch needle when compounding
7:11
requires the contents of a glass ampule
7:13
use a filter needle please note that the
7:15
use of large gauged needles may present
7:17
the risk of coring the increased
7:20
diameter of the kneel increases the risk
7:22
of slicing or coring off a portion of
7:25
the containers stopper membrane whenever
7:27
you use a large gauge or admixture
7:29
needle be sure to inspect the solution
7:32
container at eye level for debris that
7:34
could have been pushed inside the
7:35
container undetected particles left in
7:38
the solution due to coring cause
7:40
contamination in the stare compound
7:42
which can be detrimental or even fatal
7:44
to the patient let's discuss how to
7:46
connect needles to syringes place a
7:49
packaged needle and packaged syringe at
7:52
the correct location under the hood to
7:54
ensure proper air flow for the sterile
7:56
environment point the needle and syringe
7:58
toward the back wall of the hood where
8:00
air flows place the needle and syringe
8:03
at least six inches inside the hood at
8:06
the centre of the work surface position
8:09
hands so as not to block airflow remove
8:13
the packaging from the needle inside the
8:14
hooded workspace keep hands angle to the
8:17
side in front of items that will be
8:18
manipulated to keep the airflow from the
8:21
back wall blowing freely toward the
8:23
needle and syringe hold the needle at
8:25
midpoint on top of the packaging pull
8:28
the packaging down from the top to the
8:30
center toward you
8:32
hold the needle by the capped area only
8:35
lay the capped unwrapped needle pointing
8:38
toward the back wall discard the needle
8:41
wrapper in the workstations waste
8:42
container
8:44
now remove the syringe from the package
8:47
six inches inside the hooded work space
8:49
without blocking airflow hold the
8:51
syringe by the barrel tilt the barrel
8:53
tip toward the back wall of the hood
8:55
where
8:55
air is flowing grasp the top of the
8:58
packaging with the other hand peel the
9:01
packaging down from the top and angle
9:03
towards you discard the wrapper in the
9:05
waste container besides the work station
9:08
attach the needle to the syringe six
9:10
inches inside the hood without blocking
9:12
air flow keep the syringe in one hand
9:15
and point the tip toward the back wall
9:17
where Eric flow originates with the
9:20
other hand pick up the needle at the
9:22
midsection of the needle cap insert the
9:25
needle hub onto the tip of the syringe
9:27
being careful to position both hands
9:29
away from air flow the needle may be
9:32
held on by friction or by a locking
9:34
mechanism the finger should be held well
9:36
back from the point of the needle
9:37
syringe attachment pull the cap straight
9:40
off then lay the cap inside the hooded
9:42
work space with the opening facing the
9:44
back wall until it is needed to recap
9:46
the needle for disposal now let's talk a
9:50
little about working with syringes and
9:51
needles one of the most common problems
9:54
encountered when withdrawing medication
9:56
from a container is that air bubbles may
9:58
also be drawn into the syringe
10:00
preventing accurate measurement of the
10:02
solution to remove air bubbles hold the
10:05
syringe in a vertical position so that
10:07
the needle is pointing upward pull the
10:10
plunger back a short distance so that
10:12
some air enters a syringe and solution
10:14
is drawn in from the needle firmly tap
10:17
the barrel of the syringe so that air
10:18
bubbles cling to the side float to the
10:20
top of the syringe expel all the air in
10:23
the syringe by slowly pushing in the
10:25
plunger until the solution fully Prime's
10:27
the attached needle then read the volume
10:30
of solution by aligning the pointed end
10:32
of the plunger with the graduation marks
10:34
on the barrel of the syringe syringes
10:37
and uncap needles should be discarded in
10:39
puncture resistant sealable containers
10:41
often called sharps containers if the
10:44
pharmacist needs the syringe to verify
10:46
the amount of drug added to the
10:47
admixture institutions may allow needles
10:50
used in compounding to be recapped for
10:52
removal and disposal when a syringe is
10:55
used to verify the amount of drug added
10:57
the plunger is drawn back to the
10:58
graduation mark to indicate amount and
11:01
along with the drug placed next to the
11:03
completed and labeled preparation for
11:05
the pharmacist to verify as required by
11:07
OSHA and this
11:09
DC most institutions have policies
11:11
against recapping needles to decrease
11:13
the risk of needle stick injuries
11:16
contaminated uncap needles and syringes
11:18
must be disposed of in puncture
11:20
resistant containers if recapping is
11:22
required a one-handed scoop method
11:24
should be used for worker safety
11:27
two-handed recapping is never an
11:29
acceptable practice let's discuss the
11:31
precautions for safely recapping and
11:33
discarding a used needle and syringe
11:35
position the syringe cap on the hoods
11:38
work surface at a left-right angle so
11:40
that the needle can slip inside without
11:42
hands blocking airflow coming from the
11:44
back wall of the hood remove your hand
11:47
from the position cap using the one
11:49
handed method aim the needle toward the
11:51
opening of the cap and move the needle
11:53
inside now using your other hand hold
11:56
the cap and continue moving the needle
11:58
cap opening toward the needle hug twist
12:02
the cap on the hub sharply to lock in
12:04
place remove the used recap needle on
12:08
the syringe then dispose of the cap
12:11
needle in the sharps container or safe
12:13
to be placed in a bin for the pharmacist
12:15
to check later these procedures help to
12:18
guard you against injuries such as
12:19
needle sticks there are two types of
12:22
needle sticks when the needle has never
12:24
been used and when the needle has been
12:26
used for compounding or to inject drugs
12:28
into a patient both accidents need to be
12:31
reported OSHA requires that everyone be
12:34
aware of the proper procedure in case of
12:36
needle stick accidents if the injury is
12:38
from an unused needle inform a manager
12:41
within 24 hours of the incident complete
12:45
a record of occupational injury illness
12:48
have the injury examined by qualified
12:50
medical personnel if the injury is from
12:54
a used needle inform a manager
12:56
immediately complete a record of
12:59
occupational injury illness form have
13:03
the injury examined by qualified medical
13:05
personnel if recommended return for a
13:08
follow-up visit remember it is your
13:11
responsibility to report such incidents
13:13
to your employer proper aseptic
13:16
technique is an acquired skill
13:18
pharmacists and technicians must be
13:20
trained and demonstrate competence and
13:22
septic technique before they are allowed
13:24
to work in a compounding environment
13:26
some of the most common manipulations
13:29
that you perform in compounding involves
13:31
syringes just a safe technique can
13:33
prevent needle stick injuries proper
13:35
aseptic technique is one of the most
13:37
effective ways to minimize a risk of
13:39
exposing the preparation to
13:40
microorganisms