Compounding Question
I have a pharmacist that insists that it is necessary to use empty containers to make compounds that go on pumps in order to avoid any potential error from the overfill in a pre-manufactured fluid container. Other pharmacists are ok with removing a specified volume from a 250 or 500ml bag to achieve the final volume, as long as the over-fill is accounted for. Would anyone be willing to comment on their policy on their methods for preparing these types of compounds?
Submitted By: Connie Sullivan, R.Ph., Infusion Director, Heartland I.V. Care
Response Summary
There were 3 Listserv responses to Connie’s question:
Barry Stenberg RPh, Sacred Heart Home Infusion, Eugene, Oregon, replied:
Because of the batch-to-batch variation in bag fill volumes, this becomes a QA issue. What we have done is empty and tare one bag from each batch, then weigh the bags to determine the bag volumes based on the specific gravity of the diluents. That way you can be assured of the correct original fill volume and amount to withdraw to achieve the desired diluent volume for the compound. If you have an accurate repeater pump the volumes can be easily and quickly withdrawn by programming the pump in reverse to pull fluid, again weighing the emptied bags to verify resulting volume.
Jerry Ewancio, P.D., Director of Pharmacy , American HomePatient of Delmarvastated:
When absolute correct concentration is THE critical issue, we always hand fill everything starting with empty containers. This however only becomes critically important with chemotherapy, inotropic and pain management. When we are compounding a continuous antibiotic, i.e. Zosyn, Nafcillin, Unasyn, etc which is given as a 24 hour continuous infusion, this issue isn't quite as critical and we use Prefilled bags.
Thomas L. McCormick, President & CEO, Coventry Diagnostics LLC, Western Slope Laboratory LLC, 1197 Rochester Road, Suite K, Troy, Michigan 48083responded with: We have found inaccuracies in compounding caused by several factors as we verify for our customers as they comply with 797. This might be one of them.
Rock-Pond Analysis
Pre-filled solution bags do have an overfill volume. Check with the individual manufacturer to determine what that amount might be. Jerry Ewancio makes a very good point when he states, “When absolute correct concentration is THE critical issue, we always hand fill everything starting with empty containers”. When utilizing an infusion pump, one must be aware of the administration set volume as well as filtration reservoir prior to calculating the finished compounded solution. As mentioned above, what type of drug is you compounding and is this an adult or pediatric patient. As always, industry standards of practice need to be evaluated at all times.