in if the doctor recommends it. The entire contents of the bag will mix with your bloodstream, and any excess from the two pools will be stored in the overflow chamber that is your bladder.
Under this configuration a bacterium now has a lot more territory in which to ready itself for action. It’s not just the tip of the needle that could harbor infection; now it is the entire inner surface of the bag and tubes—not to mention the fluid itself—an expanse more than one hundred times larger than that of the syringe alone. Of course this means that the entire apparatus must be kept sterile, but it also means that everything that has ever touched the whole mess, while the medications were added and mixed—and even before that, when the chemical ingredients were synthesized and stored—must be kept sterile at each step along the way.
The great thing about an IV is that it allows your doctor to deliver medicine to your body quickly, and for a sustained period. During cardiac arrest, your brain doesn’t have a couple of hours to wait around for oxygen while your heart stands in a long queue behind your stomach and intestines, hoping for its share of the medication to seep out of the pill you somehow swallowed. So how to combine a liter of fluid with active agents, customized according to the patient’s weight and status, while keeping everything sterile? If this is for the ER or the ICU, we have about ten minutes to make it happen. Fortunately for the patient, there is a sleep-starved teenager apprenticed to a chain-smoking barmaid in the basement who is ready for action.
***
The first step is to create a clean workspace. Although it’s hard to picture, bacteria, yeast, and other tiny things can be removed from air by forcing it through a mesh with holes that are three hundred times smaller than the diameter of a human hair. When I make intravenous medications, I sit in front of a wall that blows air through the mesh and toward me. The area between me and the wall, therefore, is a clean space where sterile items can be opened, mixed, and resealed.
The first thing I do after I pull on gloves is to liberally wash down my entire work area using a spray bottle of isopropanol, bathing the counter and my gloved hands over and over and wiping with tissue after tissue. I leave all surfaces damp with isopropanol, knowing that the sterile air stream will dry them, mainly by blowing it straight into my face.
I go to the Teletype and select a medication order in the form of a two-inch-by-two-inch sticker, upon which is typed the patient’s name, gender, and location and a code that specifies the mixture of medications required. I pick out a sealed bag of fluid, which has the approximate shape and feel of a packaged pork loin, from the pile produced by the tech who is “pumping bags,” filling them by the liter with either normal saline or Ringer’s solution—a weakly sugared saline named after Sydney Ringer, who in 1882 found that he could make a dead frog’s heart beat by repeatedly bathing it in this very formula. Reading the medication order, I pick up the bag, peel the backing off of the sticker, and attach it to the top side such that the text will be upside down when the bag hangs and drips into the patient.
I carry the bag to the stock table and pick up the concentrated drugs that I will need, and I restock my own personal stash of the ones that I use very frequently. These drugs come in little bottles with rubber-stoppered tops, color-coded for quick recognition. The tops are crimped shut with aluminum, and the glass and metal sparkle in the unrelenting brightness of the lit laboratory. Some of the bejeweled bottles are indeed precious, containing only the tiniest drop of liquid protein concentrated from the bodies of heroic human donors or hapless animal subjects. Each of these miniature glittering bottles contains a day, or perhaps a week, of frustration for a ruthless tumor—perhaps just long enough for an
Under this configuration a bacterium now has a lot more territory in which to ready itself for action. It’s not just the tip of the needle that could harbor infection; now it is the entire inner surface of the bag and tubes—not to mention the fluid itself—an expanse more than one hundred times larger than that of the syringe alone. Of course this means that the entire apparatus must be kept sterile, but it also means that everything that has ever touched the whole mess, while the medications were added and mixed—and even before that, when the chemical ingredients were synthesized and stored—must be kept sterile at each step along the way.
The great thing about an IV is that it allows your doctor to deliver medicine to your body quickly, and for a sustained period. During cardiac arrest, your brain doesn’t have a couple of hours to wait around for oxygen while your heart stands in a long queue behind your stomach and intestines, hoping for its share of the medication to seep out of the pill you somehow swallowed. So how to combine a liter of fluid with active agents, customized according to the patient’s weight and status, while keeping everything sterile? If this is for the ER or the ICU, we have about ten minutes to make it happen. Fortunately for the patient, there is a sleep-starved teenager apprenticed to a chain-smoking barmaid in the basement who is ready for action.
***
The first step is to create a clean workspace. Although it’s hard to picture, bacteria, yeast, and other tiny things can be removed from air by forcing it through a mesh with holes that are three hundred times smaller than the diameter of a human hair. When I make intravenous medications, I sit in front of a wall that blows air through the mesh and toward me. The area between me and the wall, therefore, is a clean space where sterile items can be opened, mixed, and resealed.
The first thing I do after I pull on gloves is to liberally wash down my entire work area using a spray bottle of isopropanol, bathing the counter and my gloved hands over and over and wiping with tissue after tissue. I leave all surfaces damp with isopropanol, knowing that the sterile air stream will dry them, mainly by blowing it straight into my face.
I go to the Teletype and select a medication order in the form of a two-inch-by-two-inch sticker, upon which is typed the patient’s name, gender, and location and a code that specifies the mixture of medications required. I pick out a sealed bag of fluid, which has the approximate shape and feel of a packaged pork loin, from the pile produced by the tech who is “pumping bags,” filling them by the liter with either normal saline or Ringer’s solution—a weakly sugared saline named after Sydney Ringer, who in 1882 found that he could make a dead frog’s heart beat by repeatedly bathing it in this very formula. Reading the medication order, I pick up the bag, peel the backing off of the sticker, and attach it to the top side such that the text will be upside down when the bag hangs and drips into the patient.
I carry the bag to the stock table and pick up the concentrated drugs that I will need, and I restock my own personal stash of the ones that I use very frequently. These drugs come in little bottles with rubber-stoppered tops, color-coded for quick recognition. The tops are crimped shut with aluminum, and the glass and metal sparkle in the unrelenting brightness of the lit laboratory. Some of the bejeweled bottles are indeed precious, containing only the tiniest drop of liquid protein concentrated from the bodies of heroic human donors or hapless animal subjects. Each of these miniature glittering bottles contains a day, or perhaps a week, of frustration for a ruthless tumor—perhaps just long enough for an
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