In the Pharmacy: The I.V. Room Quiz

Quiz Answer Key and Fun Facts

1. The hospital pharmacy I.V. room (also known as a "cleanroom") is a place for the sterile preparation of I.V. medications. After scrubbing our hands and arms in the anteroom (like a surgeon would before entering the operating room), we should don some appropriate garb. What are these items of clothing collectively called?

Answer: Personal protective equipment

Drugs that are administered intravenously act quickly, but since their administration bypasses the body's natural defenses against infection (i.e., the skin and digestive system), they must be sterile. A cleanroom is a filtered, pressurized environment in which these drugs can be compounded (mixed) with greatly reduced chances of bacterial, fungal, or viral contamination.

Personal protective equipment (called "PPE") includes gloves, a face mask, a hair covering, shoe covers, and a lint-free smock. PPE isn't really meant to protect the wearer from what he's handling, but it is intended to protect the drug preparations from the microbes that swarm by the millions on every human's body.

2. Smaller hospitals may not have cleanrooms. Instead, they might use a sealed box with heavy-duty gloves fitted to the interior to prevent contamination of the medication being prepared. What is this device called?

Answer: Barrier isolator

Larger hospitals may also use a barrier isolator inside the cleanroom to prepare chemotherapeutic I.V. drugs. Chemotherapy can be very dangerous to healthy individuals, so mixing it in an isolated environment helps protect the pharmacist from being exposed to it.

3. Once inside the cleanroom, pharmacy workers sit or stand at a piece of filtering equipment and prepare I.V. admixtures. What is this piece of filtering equipment known as?

Answer: Laminar airflow hood (LAH)

Laminar airflow hoods use HEPA (high-efficiency particulate air) filters to remove contaminants from the air inside them. The LAH looks like a stainless steel worktable with a grill for the back wall and a horizontal I.V. pole running its length. Pharmacy workers should clean their hood's surfaces often, using sterile water followed by 70% isopropyl alcohol.

While working at the hood, pharmacy personnel practice aseptic technique: a strict set of procedures designed to prevent microbial contamination of medication. The key idea is to position and manipulate objects (needles, vials, I.V. bags, etc.) in such a way that their sensitive surfaces always face the flow of "first air" - the clean air coming out of the LAH's filter.

4. The greater part of an I.V. room worker's job consists of using needles and syringes to extract drugs from vials or ampules, then re-injecting the drug into an I.V. bag or bottle containing the proper volume and type of vehicle (liquid solution). Which of these is NOT a common vehicle for I.V. solutions?

Answer: Dakin's solution

Sterile water is another common vehicle. Dakin's solution is a mild bleach solution used in wound care, NOT to be taken internally.

The choice of vehicle for a particular drug is a question of what pharmacists call "compatibility." Simply put, most drugs are more compatible with some vehicles than they are with others. Drugs mixed in incompatible solutions may react with the vehicle and fail to dissolve or lose their potency. Several references detailing drug and vehicle compatibilities are available to pharmacists.

In medicine, a "percent solution" refers to the number of grams in 100 milliliters of solution. For example, 5 percent dextrose means 5 grams of solid dextrose dissolved in 100 total milliliters of solution (with water as the liquid).

5. Which I.V. delivery method takes the shortest amount of time to administer?

Answer: I.V. bolus

The various delivery methods have as much to do with how long it takes to administer the fluid ("infusion rate") as they do with the amount of fluid given. Larger volume parenteral solutions may be referred to as I.V. drips, and are infused at a continuous rate over a matter of hours (usually 12-24, but variations are common). Volumes can range from 250-1000 milliliters or more. An I.V. bolus is sometimes called an I.V. push because it is "pushed" through a syringe into a patient's vein (directly or indirectly) over a matter of seconds.

This method usually involves only a few milliliters. I.V. piggybacks (or riders) range from 50-100 milliliters, and can run simultaneously with an I.V. drip (i.e., they "ride" or are "piggybacked" on a larger volume infusion).

6. Which of these routes of administration require preservative-free drugs and vehicles?

Answer: Epidural

Drugs given epidurally (usually narcotic painkillers) are injected into the outer layer of the spinal cord. Preservatives in this type of solution can cause serious bodily harm, so these preparations must not contain preservative chemicals.

7. Which of these drugs is LEAST likely to be supplied pre-mixed in an I.V. bag from a manufacturer?

Answer: Insulin drip

Insulin is easy to compound, expires quickly when mixed in an I.V. drip bag, takes up more room in a bag than in a vial, and must be refrigerated, so hospitals usually just compound their own insulin drips. The oxytocin, morphine, and levofloxacin are readily available in pre-mixed bags, and are well worth their purchase cost.

Drug shelf life is one reason hospitals go to all the trouble to compound I.V. admixtures on-site. Another reason is that many drugs are tailored to meet individual patients' requirements; it would be very impractical for manufacturers to make the special combinations and strengths of drugs that certain patients need.

PCA is short for Patient (or Personal) Controlled Anesthesia. In this system, the patient can choose when and how much pain medicine they receive (up to a prescribed limit) by pressing a button that controls an I.V. pump.

8. TPN, or Total Parenteral Nutrition, is for patients who cannot process nutrients / food with their digestive systems. A TPN is a complex mixture of sugars, fats, proteins, vitamins, electrolytes, and minerals that is prepared in the I.V. room. True or False: The order in which the ingredients are mixed is important when making TPNs.

Answer: True

Adding ingredients in the wrong order can lead to precipitation (formation of crystals) in the solution - this is bad!

A completed TPN bag is usually 3-4 liters, white in appearance, and administered with an in-line filter.

9. Which of these is a hypertonic solution?

Answer: Sodium chloride 3 percent

Tonicity refers to how concentrated a solution is in comparison to the concentration of matter in human blood. A 0.9% sodium chloride solution has the same tonicity as blood - it is isotonic. Health care professionals often call it NS, or normal saline. A hypertonic solution is anything with a greater concentration than blood - 3% sodium chloride and 50% dextrose are examples of hypertonic solutions. Hypotonic solutions are less concentrated than blood - two examples are 0.45% sodium chloride (half NS) and sterile water. Pharmacy personnel should be familiar with these different types of solutions.

The tonicity of a solution affects where in the body and how quickly caregivers choose to administer it. Infusing a hypertonic solution too quickly or into too small a vein can cause pain, irritation, and tissue damage.

10. What is the difference between an ampule and a vial?

Answer: An ampule is a single-use, all-glass container

Vials are cylindrical glass or plastic containers of powdered or liquid drug. They have rubber tops, and are designed for either single or multiple uses. Health care workers must use the proper technique when inserting a needle into the rubber to prevent coring - the dislodging of bits rubber that can contaminate an I.V. solution.

Ampules are bullet-shaped glass containers with a narrow neck and a slightly flared top. They contain liquid drugs and are single-use only. Opening an ampule takes practice - one must break the glass where it is scored around the narrowest part of the neck. To prevent glass contamination, a filter needle should be used to withdraw the drug from the ampule OR to inject it into an I.V. bag, but it can't be used to withdraw AND inject, since the glass will be pushed back out of the filter and into the bag.

11. What piece of equipment could you use to reconstitute a powdered drug in a vial and add it to an I.V. bag (using the liquid already in the bag) - in one easy operation?

Answer: Transfer needle

Transfer needles are double-ended needles - one end goes in the vial, the other end goes in the bag. After squeezing liquid from the bag through the transfer needle and into the vial, then swirling the vial to dissolve the drug, the user then squeezes air from the bag into the vial. The resulting pressure will then force the drug solution out of the vial and into the bag. Cool, huh?

Transfer needles aren't as common on the nursing floor these days, due to a recent revolution in hospital pharmacy: the Add-vantage system. This system uses special vials and I.V. bags that allow nurses to mix the powdered drug with the liquid vehicle just before administration, without the solution ever being exposed to the air. Now a common way to supply standard doses of antibiotics, this system has greatly increased the efficiency of medication delivery in hospitals.

Turkey basters, while useful in the kitchen, are not standard cleanroom equipment.

12. Calculations: A pharmacy technician needs to mix an I.V. bag containing 5 mg of a certain drug for every kg of the patient's body weight. If the patient weighs 160 lbs, and the stock solution of the drug comes as 25 mg per ml, how many ml of solution should the technician add to the bag? (Assume that 1 kg = 2.2 lb.)

Answer: 14.5 ml

First, convert 160 lbs to kg: 160 / 2.2 = 72.7 kg. Since we need 5 mg of drug for every kg of body weight, multiply 72.7 by 5 to get 363.5 mg. Finally, set up a proportion to find out how many ml contains 363.5 mg: 363.5mg/xml = 25mg/1ml (where x is the unknown number of ml). To solve for x, cross multiply (363.5 * 1), then divide by 25 to get x alone (363.5 / 25), and your answer is x = 14.5 ml.

Calculations are an important part of pharmacy practice. However, in the real world, calculations are rarely as complicated as this example. Most doses are either standardized or calculated by computer. In any case, calculations should always be double-checked by another person, and signed off by a pharmacist.

As involved as this example was, I could have added another twist. If I had said the dose was to be 5 mg per kg per hour, I could have asked how many ml of drug to add if the bag was to run for 4 hours. This type of calculation is still simple arithmetic, however. Pharmacists may use calculus to determine how much of a drug the body processes, and how quickly.

13. Which of these is an I.V. narcotic?

Answer: Fentanyl I.V.

Fentanyl can be used to manage severe chronic pain, or as an anesthetic in open heart surgery. In addition to the I.V. form, fentanyl is also available as a transdermal patch or as a lollipop. Yes, a narcotic lollipop. Don't get too excited - the amount of pain you would have to suffer before being able to try one of these is almost certainly not worth it.

In case you picked one of the other choices: milrinone is a cardiac drug used in the short term treatment of congestive heart failure, propofol is a nonnarcotic sedative anesthetic, and azithromycin is an antibiotic.

14. Which of these drugs is NOT an I.V. antibiotic?

Answer: Pantoprazole (Protonix)

Antibiotics are one of the most common types of I.V. medications, appearing in a huge variety of classes and uses. The prevention and treatment of hospital-acquired infections is one of the hottest topics in health care today.

Protonix is a proton pump inhibitor used to treat acid reflux and duodenal ulcers, unfortunately common conditions among hospital patients. Some other PPIs you might have heard of are Nexium, Prilosec, Aciphex, and Prevacid. All of these are available in oral form, but as far as I know, only Protonix and Nexium have I.V. forms as well.

15. Which of these injectable drugs could be used to sedate an agitated patient?

Answer: Haloperidol (Haldol)

Administration of drugs via the parenteral route is advantageous in that the drugs act quickly. Few psychiatric drugs are available in injectable form, but some situations call for immediate treatment, such as if the patient poses a danger to himself or others. Haloperidol is an older antipsychotic drug that is available in intramuscular, intravenous, and oral forms. Other injectable drug choices for agitated patients include ziprasidone (Geodon) and olanzapine (Zyprexa). Another fast-acting option is olanzapine orally disintegrating tablets.

In case you picked one of the other choices: ondansetron treats nausea and helps prevent vomiting, amiodarone treats severe cardiac arrhythmia, and norepinephrine is a neurotransmitter produced by the body. Given as an I.V. drug, norepinephrine helps regulate heart rate and blood pressure.

Source: Author celicadriver

This quiz was reviewed by FunTrivia editor crisw before going online.
Any errors found in FunTrivia content are routinely corrected through our feedback system.

Is there really an entire room in some hospital pharmacies just for the preparation of intravenous (I.V.) medications? Yes, there is. Take the quiz and learn about I.V. room equipment, techniques, and drugs. Note: The drug names are U.S. specific.

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