Channel Title: The Chemo Tech Channel Description: The Chemo Tech channel is a quick reference for pharmacy technicians. How to videos and full instructions in the description section. <video> Mitomycin bladder irrigation using PhaSeal Optima Description: Mitomycin 40mg/40mL in sterile water using PhaSeal Optima. PhaSeal Bladder Instillation Kit Step 1: Remove navy top from PhaSeal Connector (C35-O) and luer lock to Baxter Catheter Tip and set aside. Step 2: Next, remove clear round top from chemo syringe PhaSeal Injector. Step 3: Holding white part of the PhaSeal Injector (NOT the syringe barrel or plunger) insert the PhaSeal Connector (C35-O) into PhaSeal Injector until it clicks. Step 4: The system is now ready for instillation. Contents of syringe will now flow through catheter when the syringe plunger is depressed. PhaSeal Instillation Kit Step 1: Remove navy top from PhaSeal Connector (C35-O) and luer lock to Baxter Catheter Tip and set aside. Step 2: Next, remove clear round top from chemo syringe PhaSeal Injector. Step 3: Holding white part of the PhaSeal Injector (NOT the syringe barrel or plunger) insert the PhaSeal Connector (C35-O) into PhaSeal Injector until it clicks. Step 4: The system is now ready for instillation. Contents of syringe will now flow through catheter when the syringe plunger is depressed. Mitomycin for Irrigation Possible doses: 40mg in 20mL of Sterile Water OR Sodium Chloride 0.9% (PF) 40mg in 40mL of Sterile Water OR Sodium Chloride 0.9% (PF) </video> <video> Fentanyl PCA Description: </video> <video> NEW MTX Intrathecal w/ sterile pouch Description: Intrathecal how to instructions: Supplies required for: Methotrexate or Cytarabine / Hydrocortisone / Elliott’s B Solution • 1- 1ml syringe • 3- 3ml syringes • 1- 5ml syringe • 1- 10ml syringe • 1- 0.22 micron disk filter • 5- 18 gauge needles • 1- 21 gauge needle • 1- pack luer-tip caps • 1- pair sterile chemo gloves • 1- pair sterile surgical gloves • 1- 5 ¼” x 10” sterilized pouch • 1- sterilized syringe label pouch • 1- sterile pen pouch (if needed to write in custom dose) • 1- ampule Elliott’s B solution • 1- vial Hydrocortisone 100mg powder • 1- vial Methotrexate (Preservative Free) or Cytarabine 2g vial Step 1: Wash hands according to USP 797 cleansing and garbing requirements prior to entering the cleanroom. Clean the interior surfaces of the vertical flow biological safety cabinet (BSC) using standard chemo BSC cleaning procedure. Step 2: Gather all necessary supplies for the preparation of the intrathecal injection. (See supply Note: Supplies may differ depending on the type of IT product you are compounding. Please refer to itemized supply lists at the end of this document. Step 3: replace sterile chemo gloves prior to compounding. Step 4: Remove the medication from its packaging. Place medication, diluent, syringes, alcohol swabs, leur tips, needles, and sterile gloves in the vertical flow BSC. Leave leur tips, the second syringe, and sterile gloves in their original packages. During the process, be sure to attach only one needle to one syringe. Step 5: Allow the vertical BSC to remain undisturbed for approximately three minutes. Step 6: Reconstitute any medication using aseptic technique and withdraw the appropriate dose needed for each medication. Once all items are drawn up, transfer them into the 10mL syringe. After all items are added to the 10mL syringe pull back the plunger to the 10mL mark. (The additional airspace in the syringe is required to help push all the medication through the filter.) Place a 0.22 micron disk filter on the end of the 10mL syringe and apply 18 gauge needle. Place the syringe to the side of the chemotherapy spill pad (standing). Step 7: Aseptically open the package of sterile gloves, the package of leur tips, and the remaining syringe ensuring no physical contact with the sterile gloves. When the items are opened, place them (in their packages) to the side in the BSC. When opening the sterile gloves aseptically open the paper wrap in the center of your compounding area so that use the paper for your sterile field. Step 8: Place a sterile glove over the chemotherapy glove on your dominant hand, ensuring that only the inner portion of the glove comes into physical contact with your hand. This will be your sterile hand throughout the procedure. It is very important not to touch and contaminate the outer portion of the glove. Step 9: Using your sterile hand, remove the sterile syringe from its wrapper, making sure not to touch the wrapper and thus contaminate the glove. Pull back the syringe plunger to the required volume plus an additional 0.2 ml, using only your sterile hand. Step 10: Pick up the syringe containing the medication using your non-sterile hand and allow the needle tip to slide off. Transfer the medication from the non-sterile syringe to the sterile syringe by expressing the medication through the tip. Use aseptic technique to place a leur tip on the sterile syringe. Step 11: Place the final syringe on the paper sterile field. Then aseptically place the other sterile glove on your other hand. Step 12: Now using both sterile hands to peel the correct sterile medication syringe label and place it on the sterile final syringe. (If you have a custom dose you may have to write in the dose using available sterile pens). Step 13: Now using your non dominate hand pick up the - 5 ¼” x 10” sterilized pouch ensuring that the inside of the pouch only comes into physical contact with your sterile hand and the final syringe. Place the sterile syringe in the sterile pouch and secure the end of the pouch with the attached adhesive strip when finished. Step 14: Leave the BSC undisturbed for an additional three minutes. Step 15: Label the pouch with the appropriate label including an antineoplastic or cytotoxic ancillary label and a time/date stamp. The final product is stable for 12 hours. Have the dose double-checked by the pharmacist and co-signed by a second pharmacist. Step 16: Once the final product is checked the final pouch will be placed in an amber “For Intrathecal Use Only” zip bag along with an extra sterilized empty pouch. </video> <video> Chemotherapy Gown Conservation during COVID-19 for Pharmacy Description: Department of Pharmacy Chemotherapy gown Conservation during COVID-19 Safe removal and reuse of chemotherapy gowns for pharmacy • Keeping your inner layer of gloves intact • Untie at the waist • Pull apart Velcro at the neck • Pull gown down at the shoulder one arm at a time, pulling the sleeve inside out. • Hang gown inside out in the anteroom. (Away from non-hazardous gowns and garb.) *Gowns my only be reused if there is no known, or visible soil, holes or breaks in the gown or seams. Do NOT reuse if the gown comes in contact with the floor. </video> <video> APOTECAchemo Doxorubicin Preparation Description: Apoteca Doxorubicin Preparation Apoteca Chemo by: Loccioni group compounding Doxorubicin infusion, while reconstituting a vial of Cyclophosphamide and a vial of Ifosfamide for maximum system efficiency. </video> <video> Mitomycin Ophthalmic 0.3mg/mL dilution Description: 1. Reconstitute one 5mg vial of Mitomycin IV with 12.5mL of sterile water for injection. Using a new 20mL syringe withdraw the entire contents of the 5mg mitomycin vial. Remove the needle and place a filter needle or disk filter to remove any particulates for the solution place a new needle on the end of the disk filter if used. 2. Use a filter needle to vent the vial, then enter an empty 30ml sterile vial with the filter needle pushing all solution through the filter. Finally remove the needle and filter needle. This will provide a stock solution for 0.4mg/mL concentration of mitomycin for ophthalmic solution. Average dosing below. Use the stock vial to withdraw from for the following doses. For a dose of 0.4mg/mL: Draw up 1mL of solution from stock vial and cap with luer tip cap. For a dose of 0.3mg/mL: Draw up 0.75mL of solution from stock vial as well as 0.25mL of Sterile Water (in separate syringes). Using a rapid fill connector (red luer to luer) push 0.25mL of SW into the Mitomycin syringe (Mix gently). Then cap syringe with luer tip cap. For a dose of 0.2mg/mL: Draw up 0.5ml of Mitomycin solution form stock vial as well as 0.5mL of Sterile Water (in separate syringes). Using a rapid fill connector (red luer to luer) push 0.5mL of SW into the Mitomycin syringe (Mix gently). Then cap syringe with luer tip cap. </video> <video> Melphalan compounding using PhaSeal Description: Written instructions coming soon! </video> <video> How to use Snapit Ampule Breaker Description: 1. Snap it should be sprayed with 70% sterile IPA and wiped with a lint free towel prior to placing it in a LAFW or BSC. 2. Swab ampule with alcohol swab. 3. Place the top of the ampule into the bottom of the open as seen in the image to the right. a. If the ampule has a dot on the top align it with the dot and arrows on the Snapit tool. b. If it does not have a dot, this mean that the ampule is scored all the way around. 4. If your ampule has the dot you will turn that away from you and push both thumbs away from you. As seen in the image to the right. Be sure not to block first air when opening the ampule. 5. Once you have opened the ampule, push the plunger of the ampule opener to eject the ampule top. Eject the ampule top directly into a sharps container to avoid any accidental sticks. </video> <video> Embozene Tandem Microspheres in 100mg of Doxorubicin Loading Step 2 Description: Preparation (loading) of Embozene Tandem Microspheres using Doxorubicin HCL 2mg/mL Supplies • 1-Doxorubicin HCL 100mL vial • 1- Embozene Tandem syringe • 2- 5 micron filter needles • 1- Syringe connectors (red) leur to leur • 2- 18 gauge needles (Pink) • 2- Empty viaflex bag (50mL to 150mL) • 1- 10mL syringe • 1- 60mL syringes • 1- tray of rubber syringe caps • 1- pair sterile Bio-gel gloves • 1- sticker strip (to seal final glove transport to patient) Drug Loading: 1. Clean Chemo BSC according to USP 797 IV hood cleaning. 2. Remove Tandem syringe from the box. (Keeping them sealed in the hard plastic tray) then wipe them off with sterile non-shedding wipes and sterile 70% IPA and place the syringe in the Chemo BSC. 3. Place all other items needed to load Tandem microspheres in the Chemo BSC, Making sure that all items are cleaned using sterile non-shedding wipes and sterile 70% IPA. 4. Remove the Tandem syringe from its sterile packing, remove leur lock cap from syringe. Place a 5 micron filter needle on the Tandem syringe. Invert syringe a few times to loosen the microspheres from the sides of the syringe, and then let the beads settle for a few seconds. Using the empty viaflex bag push off the excess saline from the beads (do NOT compress the microspheres!) leave a small air bubble at the top of the syringe. Remove from viaflex bag and place syringe standing up to the side. 5. Using the 60mL syringe draw up 50mL (100mg) of Doxorubicin HCL 2mg/mL solution. 6. Remove PhaSeal injector from the 60mL syringe and place the red syringe connector on the end of the syringe. 7. Now take the filter needle off of the Tandem microsphere syringe and connect to the other end of the red syringe connector. Now push the Tandem microspheres into the 60mL syringe containing the 100mg of doxorubicin. Remove the syringe connector and leave a small air bubble in the syringe and place a black rubber syringe cap on the leur lock. 8. Store loading microspheres in the refrigerator by laying the syringe down to maximize drug absorption, (DO NOT stand the syringe up during loading!) with amber light protect cover over the syringe for at least 4 hours or up to 48 hours. (If a dose is due for a Monday injection microspheres MUST be loaded on Sunday during 1st shift. Once Drug loading is complete: 9. Now that microspheres have been loaded with for at least 4 hours and have not exceeded 48 hours, you will now remove the black rubber syringe cap and place a 5 micron filter needle on the end of the syringe. Invert syringe a few times to loosen the microspheres from the sides of the syringe. Then swab the empty viaflex bag and push off the excess solution (supernatant solution) into the viaflex bag. 10. Now remove the filter needle from the syringe with the microspheres and place an 18 gauge needle on the end of the syringe. *Now you will transfer the microspheres to a final sterile syringe using a sterile surgical glove for transport to IR suite. * 11. Aseptically open the package of sterile gloves, the package of black syringe caps, and the 10mL syringe ensuring no physical contact with the sterile gloves. When the items are opened, place them (in their packages) to the side in the BSC. 12. Place a sterile glove over the chemotherapy glove on your dominant hand, ensuring that only the inner portion of the glove comes into physical contact with your hand. This will be your sterile hand throughout the procedure. It is very important not to touch and contaminate the outer portion of the glove. 13. Using your sterile hand, remove the sterile syringe from its wrapper, making sure not to touch the wrapper and thus contaminate the glove. Pull back the syringe plunger to about 6ml, using only your sterile hand. 14. Pick up the syringe containing the medication using your non-sterile hand and allow the needle tip to slide off. Transfer the Tandem microspheres from the non-sterile syringe to the sterile syringe by expressing the medication through the tip. Use aseptic technique to place a leur tip on the sterile syringe. 15. The remaining sterile glove should be picked up using your non-sterile hand ensuring that the inside of the glove does not come into physical contact with your hand. Place the sterile syringe in the sterile glove and secure the end of the glove by twisting the cuff till a tight seal achieved the secure with a label strip glove when finished. 16. Label the glove with the appropriate label including an antineoplastic or cytotoxic ancillary label and a time/date stamp. Have the dose double-checked by the pharmacist and co-signed by a second pharmacist. </video> <video> EquaShield Syringe Pump dose/ QS’d with solution. Description: EquaShield Syringe dose, QS’d with solution and primmed line. </video> <video> APOTECAchemo Vial Reconstitution Description: Apoteca chemo robot vial reconstitution of Ifosfamide 3g. </video> <video> Mitomycin Ophthalmic 0.4mg/mL final concentration Description: 1. Reconstitute one 5mg vial of Mitomycin IV with 12.5mL of sterile water for injection. Using a new 20mL syringe withdraw the entire contents of the 5mg mitomycin vial. Remove the needle and place a filter needle or disk filter to remove any particulates for the solution place a new needle on the end of the disk filter if used. 2. Use a filter needle to vent the vial, then enter an empty 30ml sterile vial with the filter needle pushing all solution through the filter. Finally remove the needle and filter needle. This will provide a stock solution for 0.4mg/mL concentration of mitomycin for ophthalmic solution. Average dosing below. Use the stock vial to withdraw from for the following doses. For a dose of 0.4mg/mL: Draw up 1mL of solution from stock vial and cap with luer tip cap. For a dose of 0.3mg/mL: Draw up 0.75mL of solution from stock vial as well as 0.25mL of Sterile Water (in separate syringes). Using a rapid fill connector (red luer to luer) push 0.25mL of SW into the Mitomycin syringe (Mix gently). Then cap syringe with luer tip cap. For a dose of 0.2mg/mL: Draw up 0.5ml of Mitomycin solution form stock vial as well as 0.5mL of Sterile Water (in separate syringes). Using a rapid fill connector (red luer to luer) push 0.5mL of SW into the Mitomycin syringe (Mix gently). Then cap syringe with luer tip cap. </video> <video> APOTECAchemo Ganciclovir Preparations Description: Apoteca Chemo preparation of two ganciclovir IV doses. </video> <video> Gemcitabine Bladder Irrigation using PhaSeal Optima. Description: Gemcitabine 1000mg/ 50mL Bladder Irrigation Required Supplies • Gemcitabine 38mg/mL vial (available vial sizes 200mg, 1g, 2g) • 1 or 2- PhaSeal Optima P20-O vial protector(s) • 3- PhaSeal Injectors N35-O • 3- PhaSeal Connectors C35-O • 1- Baxter Rapid Fill Connector (Red luer to leur) • 1- Baxter Sterile Luer lock to Catheter Tip Adapter. • 3- 10mL vials of Sterile Water for Injection • 2- 30mL syringes • 1- 50mL syringe Step 1: Clean Chemo BSC according to your institutions IV hood cleaning policy. Step 2: Wipe down all required items with sterile non-shedding wipes and sterile 70% IPA and place the syringe in the Chemo BSC. Step 3: Don Second pair of chemotherapy gloves, disinfect with a sterile 70% IPA and let dry for at least 10 seconds. Step 4: Using sterile alcohol swabs, swab the vial stoppers of all vials. Let vial stoppers dry for at least 10 seconds before proceeding. Step 5: Place a P20-O vial protector on the Gemcitabine vial(s). Step 6: Using a 30ml syringe and an N35-O PhaSeal injector withdraw 26.3mL of Gemcitabine 38mg/mL and mark the volume with a red sharpie indicating “Gem”. Place this syringe to the side. Step 7: Using the other 30mL syringe and an 18g needle withdraw 23.7mL of sterile water for injection. Remove the 18g needle and place a PhaSeal N35-O injector on the syringe and mark the volume with a red sharpie indicating “SW” Place this syringe to the side. Step 8: Place the last PhaSeal N35-O injector on the 50mL syringe. Step 9: Place a PhaSeal C35-O connector on both luer locks of the Baxter Rapid Fill connector (Red). Step 10: Attach the empty 50mL syringe to one end of the Rapid Fill connector with the PhaSeal C35-O’s attached. Step 11: Attach the 30mL syringe with 23.7mL of sterile water for injection, then push the contents into the contents into the 50mL syringe. Now disconnect PhaSeal from the now empty 30mL syringe. Step 12: Attach the 30mL syringe with 26.3mL of Gemcitabine and push into the 50mL syringe, then push the entire contents of the 30ml into the 50mL syringe. Disconnect the PhaSeal connector for the 50mL syringe. Step 13: Place all items used for compounding into a clear zip bag, seal bag and wipe down with sterile 70% IPA to pass out to the pharmacists for checking. Place patient label “flagged” from the side of the syringe being sure not to cover the syringe calibrations. Place final in a chemo try for checking. Step 14: Remove outer or second pair of chemotherapy gloves as to not spread potential hazardous drug contamination. Step 15: Send final product in a chemotherapy transport bag along with a PhaSeal Connector (C35-O) and the Baxter Sterile Luer lock to Catheter Tip Adapter (Ref: H93813601) for administration. </video> <video> Embozene Tandem Microspheres in 100mg of Doxorubicin Loading Step 1 Description: Preparation (loading) of Embozene Tandem Microspheres using Doxorubicin HCL 2mg/mL Supplies • 1-Doxorubicin HCL 100mL vial • 1- Embozene Tandem syringe • 2- 5 micron filter needles • 1- Syringe connectors (red) leur to leur • 2- 18 gauge needles (Pink) • 2- Empty viaflex bag (50mL to 150mL) • 1- 10mL syringe • 1- 60mL syringes • 1- tray of rubber syringe caps • 1- pair sterile Bio-gel gloves • 1- sticker strip (to seal final glove transport to patient) Drug Loading: 1. Clean Chemo BSC according to USP 797 IV hood cleaning. 2. Remove Tandem syringe from the box. (Keeping them sealed in the hard plastic tray) then wipe them off with sterile non-shedding wipes and sterile 70% IPA and place the syringe in the Chemo BSC. 3. Place all other items needed to load Tandem microspheres in the Chemo BSC, Making sure that all items are cleaned using sterile non-shedding wipes and sterile 70% IPA. 4. Remove the Tandem syringe from its sterile packing, remove leur lock cap from syringe. Place a 5 micron filter needle on the Tandem syringe. Invert syringe a few times to loosen the microspheres from the sides of the syringe, and then let the beads settle for a few seconds. Using the empty viaflex bag push off the excess saline from the beads (do NOT compress the microspheres!) leave a small air bubble at the top of the syringe. Remove from viaflex bag and place syringe standing up to the side. 5. Using the 60mL syringe draw up 50mL (100mg) of Doxorubicin HCL 2mg/mL solution. 6. Remove PhaSeal injector from the 60mL syringe and place the red syringe connector on the end of the syringe. 7. Now take the filter needle off of the Tandem microsphere syringe and connect to the other end of the red syringe connector. Now push the Tandem microspheres into the 60mL syringe containing the 100mg of doxorubicin. Remove the syringe connector and leave a small air bubble in the syringe and place a black rubber syringe cap on the leur lock. 8. Store loading microspheres in the refrigerator by laying the syringe down to maximize drug absorption, (DO NOT stand the syringe up during loading!) with amber light protect cover over the syringe for at least 4 hours or up to 48 hours. (If a dose is due for a Monday injection microspheres MUST be loaded on Sunday during 1st shift. Once Drug loading is complete: 9. Now that microspheres have been loaded with for at least 4 hours and have not exceeded 48 hours, you will now remove the black rubber syringe cap and place a 5 micron filter needle on the end of the syringe. Invert syringe a few times to loosen the microspheres from the sides of the syringe. Then swab the empty viaflex bag and push off the excess solution (supernatant solution) into the viaflex bag. 10. Now remove the filter needle from the syringe with the microspheres and place an 18 gauge needle on the end of the syringe. *Now you will transfer the microspheres to a final sterile syringe using a sterile surgical glove for transport to IR suite. * 11. Aseptically open the package of sterile gloves, the package of black syringe caps, and the 10mL syringe ensuring no physical contact with the sterile gloves. When the items are opened, place them (in their packages) to the side in the BSC. 12. Place a sterile glove over the chemotherapy glove on your dominant hand, ensuring that only the inner portion of the glove comes into physical contact with your hand. This will be your sterile hand throughout the procedure. It is very important not to touch and contaminate the outer portion of the glove. 13. Using your sterile hand, remove the sterile syringe from its wrapper, making sure not to touch the wrapper and thus contaminate the glove. Pull back the syringe plunger to about 6ml, using only your sterile hand. 14. Pick up the syringe containing the medication using your non-sterile hand and allow the needle tip to slide off. Transfer the Tandem microspheres from the non-sterile syringe to the sterile syringe by expressing the medication through the tip. Use aseptic technique to place a leur tip on the sterile syringe. 15. The remaining sterile glove should be picked up using your non-sterile hand ensuring that the inside of the glove does not come into physical contact with your hand. Place the sterile syringe in the sterile glove and secure the end of the glove by twisting the cuff till a tight seal achieved the secure with a label strip glove when finished. 16. Label the glove with the appropriate label including an antineoplastic or cytotoxic ancillary label and a time/date stamp. Have the dose double-checked by the pharmacist and co-signed by a second pharmacist. </video>

Description

The Chemo Tech channel is a quick reference for pharmacy technicians.
How to videos and full instructions in the description section.

Videos from channel