IV Room Workflow and Aseptic Technique Review Guide

Introduction to IV Room Operations

The intravenous (IV) room is one of the most critical areas in a hospital pharmacy. Sterile products prepared here are administered directly into patients' bloodstreams, making contamination potentially fatal. Pharmacy technicians who work in the IV room must demonstrate competence in aseptic technique, understand proper workflow procedures, and maintain strict adherence to USP 797 standards.

Working in the IV room requires specialized training, ongoing competency assessment, and meticulous attention to detail. Every step in the compounding process, from hand hygiene to final product verification, must be performed correctly to ensure patient safety.

Garbing Procedures

Proper garbing is the first defense against contamination. USP 797 specifies a specific garbing order that must be followed before entering the clean room:

• Remove personal items: All jewelry, watches, and visible piercings must be removed. No makeup, artificial nails, or nail polish are permitted.
• Don shoe covers: Place one shoe cover on each foot before stepping over the line of demarcation in the ante-room.
• Don hair cover and face mask: Hair cover must completely contain all head and facial hair. Face mask must cover both nose and mouth.
• Perform hand hygiene: Wash hands and forearms to the elbows for at least 30 seconds with antimicrobial soap. Dry with lint-free towels.
• Don sterile gown: A non-shedding, disposable gown is donned in the ante-room after hand hygiene.
• Apply sterile alcohol-based hand rub: After entering the buffer room, apply sterile 70% isopropyl alcohol (IPA) to hands and allow to dry.
• Don sterile gloves: Sterile, powder-free gloves are the last item donned. Gloves must be sprayed with sterile 70% IPA before beginning work and periodically throughout the compounding session.

Primary Engineering Controls

Laminar Airflow Workbench (LAFW)

The horizontal laminar airflow workbench draws room air through a prefilter, then pushes it through a HEPA filter that delivers unidirectional ISO Class 5 air across the work surface toward the operator. Key operating principles include:

• The LAFW must run for at least 30 minutes before use to purge particles
• All work must be performed at least 6 inches inside the outer edge of the hood opening
• Nothing should be placed between the HEPA filter and the critical site to avoid disrupting airflow (no upstream contamination)
• Arrange supplies to avoid blocking airflow to critical sites
• All items entering the LAFW must be wiped with sterile 70% IPA

Biological Safety Cabinet (BSC)

Biological safety cabinets provide both product and personnel protection and are required for compounding hazardous drugs. Class II Type B2 BSCs are recommended for hazardous drug compounding because they exhaust 100% of air externally rather than recirculating it into the room.

Aseptic Technique Fundamentals

Critical Sites

Critical sites are any surfaces or openings that are at risk of direct contact with the sterile product. These include:

• Syringe tips and needle hubs
• Vial tops (rubber stoppers) after being swabbed
• IV bag additive ports
• Ampule necks after breaking

Critical sites must never be touched, breathed on, or placed in the path of non-HEPA-filtered air. Maintaining the sterility of critical sites is the fundamental principle of aseptic technique.

Proper Manipulation Techniques

Essential techniques for maintaining sterility include:

• Swabbing vials: Wipe rubber stoppers with sterile 70% IPA and allow to dry for at least 10 seconds before puncturing
• Breaking ampules: Swab the neck with an alcohol swab, wrap in gauze or use an ampule breaker, snap away from the HEPA filter, and use a filter needle or filter straw to withdraw contents
• Needle handling: Never touch the needle shaft. Use a scoop technique for recapping when necessary. Change needles after puncturing rubber stoppers to maintain sharpness and remove cored rubber particles.
• Coring prevention: Insert the needle into the vial stopper at a 45-degree angle with the bevel up, then straighten to 90 degrees once through the stopper to minimize coring

IV Room Workflow Steps

Order Verification

Before compounding begins, the order must be reviewed and verified by a pharmacist. The technician should review the verified order for the medication name, dose, diluent, volume, rate, and beyond-use date. Any questions or concerns must be addressed before compounding begins.

Supply Gathering

Gather all necessary supplies before entering the clean room: medications, diluents, syringes, needles, IV bags, labels, and any other required materials. Check all items for expiration dates, particulate matter, and package integrity. Remove outer packaging in the ante-room and wipe items with sterile 70% IPA before placing them in the LAFW.

Compounding

Compound the preparation using proper aseptic technique, following the verified order precisely. Measure volumes carefully, verify concentrations, and maintain awareness of critical site protection throughout the process.

Labeling

Apply a complete label that includes the patient name, medication name and concentration, total volume, diluent, infusion rate, beyond-use date and time, storage requirements, and any auxiliary labels.

Final Verification

The completed product undergoes pharmacist verification, which may include visual inspection for particulate matter, leaks, and color abnormalities, as well as verification of the label against the original order.

Competency Assessment

USP 797 requires initial and ongoing competency assessment for all personnel who compound sterile preparations. This includes media fill testing (aseptic technique qualification), gloved fingertip sampling, and written knowledge assessments. Failure to pass competency assessments results in removal from sterile compounding duties until remediation and successful retesting.

PTCB Exam Tips

Sterile compounding and aseptic technique are heavily tested on the PTCB exam. Ensure you understand garbing order, LAFW principles, critical site protection, and USP 797 requirements. Practice with our PTCB practice questions and review key concepts using our pharmacy flashcards.