Now it is time to actually prepare the product. Aseptic technique is more critical
during this stage than at any other time. This is where the materials, especially the
solutions, can become contaminated. Once a sterile product enters a patient's body, it
cannot be retrieved as an oral dose may be. If it is administered intravenously, it has
also bypassed a number of the body's natural defenses.
a. The first step is to disinfect all stoppers and entry ports. This is accomplished
using alcohol swabs. Use a dabbing or patting motion with the swab to reduce the
chances of leaving fibers of the swab on the stopper or entry port.
b. Attach needles to syringes using aseptic technique. Care should be taken
here as it is very easy to contaminate the shaft or the inside of the needle hub and the
syringe hub. This can occur when removing the items from their packages or when
attaching them. Today, many syringes and needles are packaged in plastic containers.
When opening the container, the cap has to be "snapped" off. If the cap does not
"snap," assume that the sterility of the contents has been compromised and should not
be used. After use, both syringes and needles should be destroyed to prevent their
c. When several additives are to be added it may be necessary to add them in a
specific order to prevent precipitation. The order in which they are to be added will be
determined by the ingredients and local policy. To draw up the drug, place the beveled
edge of the needle perpendicular to the stopper. Place slight back pressure on the
shaft of the needle by pushing the syringe body in the direction of the bevel. This
causes the tip of the needle to go through the rubber stopper without "coring" the
stopper. Coring is when the needle cuts out a portion of the stopper on its way through.
This stopper fragment will then contaminate the fluid. If a glass ampule must be used,
use a filter needle to draw up the fluid. This will filter out glass particles. If a filter
needle is unavailable, place the bevel of the needle against the interior wall of the
ampule when drawing up the liquid. This causes the glass particles to be trapped
between the bevel and the wall of the ampule. Always draw up more additive than is
required. This excess fluid is then expelled, which aids in eliminating air from the
d. Once the required amount of additive is drawn into the syringe, it is ready to
be added to the base or parent solution. Again, take care not to core the stopper. If the
parent solution is in a vacuum bottle, the contents of the syringe will empty into the
bottle with little or no pressure on the plunger. If the solution is in a plastic IV bag, lift
the bag so the liquid is away from the entry port. After the additive has been added to
the base solution, they must be thoroughly mixed. Check materials used again to
insure the correct ingredients in the correct amounts were used, and inspect the
solution for visible particulate matter.