ES2267594T3 - METHOD AND APPLIANCE TO CONTROL THE STRATEGY IN THE PREPARATION OF PHARMACEUTICAL BLENDS. - Google Patents

Abstract

A method and apparatus for controlling the compounding of pharmaceutical parenteral admixtures id disclosed. The apparatus preferably comprises a computer that contains a memory for storing instructions for operating the apparatus and for controlling compounders that prepare a prescription admixture, with the memory including data relating to a plurality of the pharmaceutical components that may be transferred to prepare the prescription admixture, and data concerning the operating characteristics of the compounders that the apparatus is adapted to control. The apparatus determines the order of admixing by general rules of admixing and by categorized compatibility groups of components, so that the number of rinses that must be done are minimized.

Description

Method and apparatus to control the strategy in the preparation of pharmaceutical mixtures.

Field and background of the invention

The present invention generally relates to a method and to an apparatus for preparing and adjusting pharmaceutical mixtures.  More particularly, it refers to strategies to prepare prescriptions of parenteral mixtures, to control the apparatus mixer and to properly adjust the prepared mixture with Strategies implemented in a computer software.

Parenteral pharmaceutical mixtures are a combination of sterile drugs that mix with each other under aseptic conditions and that are planned for infusion intravenous These mixtures can be relatively simple or extremely complex, increasing complexity when included Multiple active ingredients. Mixtures intended for nutrition are an example of complex parenteral mixtures that they frequently prepare at a hospital pharmacy to treat your patients In general, parenteral nutrition blends ("PN") refers to most types of solutions Nutrition for intravenous feeding. Mixtures for Total parenteral nutrition ("TPN") generally refers to those PNs that do not contain lipids as behavior, and mixtures Total nutritional ("TNA") refers to those PN that They contain lipids.

The pharmacy of a hospital, of a center multidisciplinary or a care center prepares or mixes a prescription that is usually determined by a doctor so individually or together with a dietitian, pharmacist or other assistant. The pharmacy may need to mix many PNs daily. The mixing of real PNs is first done in a mixing equipment electromechanical called mixer, which is extremely sophisticated and is adapted to mix many components different in different proportions, as indicated in the pharmaceutical prescriptions

Mixers include large mixers volume, adapted to prepare PNs by transferring those components that are normally found in volumes relatively large in a PN, for example amino acids, water sterile, lipid and dextrose, at a relatively high speed. Such mixers include the AUTOMIX 3 + 3 mixer that manufactures the Clintec Nutrition Division of Baxter Healthcare Corporation.

The mixers also include mixers small volume such as those manufactured by it company, for example a MICROMIX mixer. The MICROMIX mixer It is adapted to accurately transfer those components which are normally found in relatively small volumes in a PN.

It is common for pharmacies to produce a PN prescribed using both a MICROMIX mixer and an AUTOMIX mixer, normally adding large volume components to the container final or final bag with the AUTOMIX mixer and then transferring the final bag to the MICROMIX mixer to transfer the components with a smaller volume. It should be understood that a only mixer can have capacity to transfer both large volume components as small volume components, since either sequentially or at the same time. Alternatively, the single mixer can have both a high volume module and a low volume module that can transfer fluids to a common distributor, to a common transfer tube or to a bag or final container, or to separate containers from a final bag.

To prepare such PNs at an acceptable cost is important that these are mixed in the most effective way possible. Such efficiency is usually achieved by trying to maximize the number. of PNs prepared in a given period of time or "production". However, the complexity of properly preparing a PN It tends to reduce the speed of such production. Can be find complicated parts when determining the proper PN of a prescription given for a particular patient, preparing exactly the PN and adjusting or presenting the same PN. Without However, patient safety is paramount and must be performed. an effective PN preparation with little chance of error.

When preparing an appropriate prescription for a determined patient, the pharmacist must perform several tasks, including evaluation and determination of appropriate components and their corresponding amounts. Specific factors of patient include the type of patient, for example neonatal, and it Will consider your weight. If you improve the pharmacist's ability to make such evaluations and determinations, increase production and The possibility of errors is reduced. With a view to maintaining a registration, it is desirable and sometimes necessary for the pharmacist to write down in a permanent record why the prescription differs from the amounts normally used in the solutions of origin.

As it is well known in pharmacy, the largest part of the complexity involved in preparing PNs results from compatibility factors that refer to the components that They are already in the PN described. Compatibility is defined as the interaction between a drug and all other components with the that the drug comes into contact, including, but not limited to diluents, containers and other drugs that are in the same PN. Compatibility is divided into two subcategories that are physical compatibility and chemical compatibility. Compatibility physics is defined as an incompatibility that alters the appearance physical of the drug, which usually causes a visual change, for example precipitation, a gaseous evolution or a change of color. Chemical incompatibilities cannot be observed visually, but must be analyzed from the point of view analytical. Chemical incompatibilities occur as result of changes in the active drug, for example oxidation or photodegradation Factors that can influence compatibility include, but are not limited to, the total volume of the diluent, concentration levels, mix order and pH.

In the evaluation of compatibility and Parenteral mixtures there are two phases. First, before mixed you have to evaluate the compatibility of the entire PN in the period from the preparation of the mixture until it ends its distribution to the patient. Second, the Mix preparation process should be planned so that There is compatibility in the course of the mixing process. By example, you have to evaluate the compatibility between a solution of origin that is added to the final mixing vessel or to another intermediate mixing vessel and the solution that is present in that vessel In many cases, the source solutions are packaged in concentrations that are incompatible with others solutions, so they have to be diluted before entering contact with each other in such cameras.

As can be seen, the maximum dilution is produced when the greatest amount of diluent fluids is present  in the container to which the solutions are added. For example, the solutions of amino acid or dextrose origin constitute great part of a PN and in addition they are usually compatible with most of the additives. Therefore, it seems that these solutions are transfer first to the final container or to any chamber of intermediate mixture to dilute the source solutions to Add.

Another complication to consider is to avoid contact between incompatible highly concentrated solutions each other that circulate through a common circulation duct of the mixer. In a representative example, although the solutions of origin can circulate through separate tubes, mostly by a transfer conduit, there may be a section of a conduit of common transfer to both incompatible solutions of origin. This common circulation duct can be found in any part of the circulation system, for example in a chamber of intermediate mixing or after the intermediate mixing chamber or after a three way valve.

A method to reduce the possibility of a solution is incompatible with a second solution in a conduit of common circulation consists of blasting said duct After transferring each solution. Such jet cleaning will be performs with a solution compatible with both the previous solution as with the one that is added after cleaning. How can appreciated, frequent jet cleaning dilutes the solutions incompatible making them compatible, but also Decrease production

There must also be a source of fluid for such a jet cleaning program. The source of such solutions cleaning can be a compatible source solution that forms part of the prescription or the solution is present in a downstream chamber such as in a mixture in the container final mix However, in current pharmaceutical practice, the prescribed amount of solutions used as solutions of jet cleaning are normally transferred first to the container final for reasons of convenience and dilution and cannot be used As cleaning solutions. In this case and by default, the solution which is in the final bag has to be compatible with the solution to be used for cleaning, and the cleaning solution is discharge of the final container. Download the cleaning solution of the final bag and take it back to it causes the production. On the other hand, reserve a certain amount of Original diluent solutions for jet cleaning can bring two incompatible solutions into contact in the final mixing chamber without being properly diluted to a compatible concentration.

In an effort to increase efficiency, normally the pharmacist groups solution containers depending on the operating program of the mixer so that the ingredients compatible with each other (at the concentration of original solution) are added together sequentially between the clarified as determined by the pharmacist. After determining the compatibility of the different solutions, the pharmacist can group a set of compatible solutions in stations 1 through 4, a second set of compatible solutions in the stations 5 to 8, etc., determining the rinses after station 4, 8, etc. However, a given mixture may need 5 compatible solutions with each other. As the determination of rinsing requires more time and effort, the pharmacist can place the fifth ingredient in a season that has rinsed before and after instead of adjusting the placement of deposits and the rinse program. However this is not advantageous.

Another factor that has to take into account the pharmacist when preparing multiple prescriptions comprising a mixture of TNA and TPN is lipid clouding, in which Traces of lipids appear in the final solution that should not contain lipids The cloudiness may occur due to lipid amounts as low as one to three parts per million. Normally such cloudiness occurs when a prescription containing lipids mixed immediately before than a prescription that will not contain lipids. In general, it believes that lipid cloudiness does not pose a danger to health, however this cloudiness in a PN to infuse can confused later with a PN that has a precipitation unacceptable due to an error formulating the PN solution compatible, and the cloudy solution may be wrong discarded

When the cloudiness is a factor that the pharmacist tries to avoid, you can jet clean the mixer after mixing each prescription that contains lipids. However, such jet cleaning decreases production and not It is totally effective. To increase production, the pharmacist You can reduce these cleaning by jet by grouping the lipid prescriptions; however this has an impact Negative about flexibility. If lipid cloudiness does not It is a problem, the possibility that it occurs can be communicate to people who mix the solution and manage the PN to the patient to prevent the administrator from creating erroneously that the mixture is unstable.

Other methods that try to avoid lipid clouding involve the use of a conduit of  lipid circulation completely separated until final mixing bowl However, once the lipids are present in the final container, a jet cleaning or a rinsed using a solution of the final container introduces lipids in the circulation duct and can cause clouding by  lipids in a subsequent PN.

In addition to the complication of mixing, the pharmacist has to take into account the limits of accuracy of the mixers so that the prescriptions that consist of ingredients at a volume below the accuracy limit of Mixer can be added by hand using a syringe. Such addition Manual decreases production. They also have to be taken in account of the inefficiencies inherent in the administration of the PN to patient, for example residual volumes in the equipment administration. Considering these complications, it has been proven that involve a waste of time and lead to activities and ineffective practices

With a view to possible refunds and to maintain a record, the prepared mixture has to be checked, which is carried out by transferring information manually or electronically to the health center administration system. The steps the pharmacist has to follow to make sure that a mixture has been perfectly adapted have to be reduced to maximum to increase efficiency.

Brief Description of the Invention

Therefore, it is a main objective of the present invention provide an improved method and apparatus to prepare and adjust parenteral nutrition solutions. Other Aim of the present invention is to provide a method and an apparatus for preparing a parenteral mixture by reducing cases of incompatibility, where a method software program that incorporates many ingredients known assets and other components, which will be checked in several prescribed mixtures. More particularly, it is an associated objective provide strategies to prepare prescriptions for mixtures parenteral, to control the mixing apparatus and to adjust correctly the mixture prepared with the strategies that have been applied by software on a computer.

Another main objective of the present invention is to provide such an improved method and apparatus for prepare a parenteral mixture by increasing the production of a mixer, mainly reducing the number of clarified to be performed.

An object associated with the present invention is to be careful to selectively determine the order or reorder of multiple mixing solutions or groups of compatibility that may appear on a prescription for prepare prescriptions more efficiently, for example maximizing the number of those that can be prepared in a stipulated period of time.

A more detailed object of the present invention is to provide such an improved method and apparatus for control a mixer of the type that uses a mixing chamber intermediate, such as a funnel, to mix components before transfer the contents of the camera to the final mixing chamber, for example a final bag.

Another objective of the present invention is to in the provision of patient-specific data to improve the Pharmacist's ability to formulate effective and safely mix prescription mixes.

Still another objective of the present invention is to provide an improved method and apparatus to allow  to the pharmacist to compensate the limits of precision of the mixer and inefficiencies in the administration of PNs to the patient, for example the fluid that is lost in the equipment of administration.

Still another object of the present invention is to provide an improved method and apparatus that includes a formula with a higher concentration of an ingredient that may substitute for a prescribed formula but determine if the diluent fluid can be provided by other ingredients compatible, so as to minimize the volume of resulting mixture.

Another object of the present invention consists in provide such improved method and apparatus that control the mixture to alert users of when they are not being met recommended limits and such alerts are not ignored unwittingly. An associated object consists of recording and recording the formula when a warning is ignored.

Another objective of the present invention is to in providing a method and apparatus that reduce cases or alert users to the possibility of a lipid clouding and the possibility of such cloudiness is confused with an unacceptable precipitate.

Brief description of the figures

These and other purposes of this invention will be clear to those skilled in the art when reading The following detailed description with reference to the figures that They are accompanied, where:

Figure 1: block diagram illustrating the apparatus of the present invention in the context of a hospital, including the device a central accounting and patient computer networked to the apparatus of the present invention and connected also the device operatively to mixers and printers

Figure 2: perspective view of a mixer representative that can be controlled with the method and apparatus of the present invention, in particular shows the mixer with a funnel or intermediate container in which the components of origin sequentially or at the same time before being transferred To a final bag.

Figure 3: perspective view of a second representative mixer that can be controlled with the method and apparatus of the present invention.

Figures 4a to 4h: together they comprise a Organization chart to control the preparation of a prescribed mixture according to the present invention.

Detailed description of the invention

The present invention provides an apparatus to control the operation of at least one mixer Pharmaceutical according to claim 1 and a method for controlling the operation of at least one pharmaceutical mixer according to the claim 24.

In general, the present invention will be refers to a method and an apparatus for controlling the preparation of pharmaceutical mixtures, the mixture being carried out in one or more mixers that can be located remotely from the computer control or processor that is interconnected with the mixers. Referring to Figure 1, the control computer or controller 10 has enough memory to store pharmaceutical data in a database and to run the software to use for Control the mixers and other peripheral equipment. Preferably the computer 10 is a multi-user computer multitasking with a communication interface to interconnect mixers 12, 14 and 16 and other peripheral equipment such as printers 18 and 20 via communication links 22, which can be wired or wireless, they can be part of a local network, of an expanded network or the Internet or a combination of same. The computer 10 can have a screen 23 and a keyboard 25 in addition to other accessories and other features common to Commercial computers currently available.

Other peripheral equipment may include a 24 console with a keyboard and a screen and other device input such as a laptop 26 or other device laptop adapted to introduce prescriptions and instructions to operate the control computer software. The Mixers can be placed in different locations of a center healthcare such as a hospital, or in different plants from a hospital or even in different hospitals. Mixers 12 and 14 as well as printer 18 and console 24 are in the hospital B of Figure 1, while the rest of the team is found in hospital A. Preferably near each mixer or combination of mixers there is a printer, as shown, to print labels that will be placed in the prescribed mixtures prepared The control computer 10 is preferably interconnected with a general hospital 28 computer that can be used to prepare and record registration instructions, enter Other functions

The present invention is adapted for control mixers such as mixers 12, 14 and 16. The presence of two machines in hospital B is to indicate that You can use two types of blenders combined to prepare prescribed mixtures, for example the mentioned AUTOMIX mixers and MICROMIX. Therefore, the mixer 12 can be a mixer adapted to transfer high volume additives and mixer 14 It can be a mixer adapted to transfer small additives volume. In addition, mixer 16 may be adapted to transfer ingredients in both large and little ones.

Referring to Figure 2, a perspective view of a low volume module mixer adapted to transfer small volumes of components such as micronutrients and other drugs from the containers of Individual origin 30. However, mixtures can be prepared prescribed in a single mixer 16 adapted to transfer large and small volume additives or with multiple mixers attached to a single final bag 46.

In one embodiment, when a large one is needed precision, for example when adding small volume additives to a PN, the fluids from the containers 30 are transferred through separate individual ducts 32 to a single container or intermediate funnel 34, which is suspended from a attached load cell 36. The attached load cell 36 measures the weight total of funnel 34 to generate an output signal indicating the amount of fluid in funnel 36 at any given time. He funnel 34 closes and connects to a pressure conduit 38 connected to a pressure transmitter and an occlusive medium, by example a valve 40. The pressure transmitter is, preferably, a single peristaltic pump that can create from selectively positive and negative funnel pressures 34 to control the direction and flow of fluid entering and leaving of funnel 34. Funnel 34 is also connected to a conduit of exit 42 extending to a second occlusive means 44 interposed between funnel 34 and the final bag or container 46. At selectively operate occlusive means 40 and 44 and the pressure transmitter, fluid can be dragged to the inside the funnel and get it out of there. These same parts of the machine can also control the direction of movement, of so that fluid can be transferred to the final bag 46 and you can take it out in order to clear the funnel 34.

In US Patent 5,228,485 of approximately April 1990 and assigned to the same assignee of the present invention,  the detailed operation of an example of a mixer adapted to transfer small volume components. The MICROMIX mixer that can be obtained commercially in the currently it can include certain improvements when compared to the '485 patent, although it is believed to be similar to that described in the  patent.

The mixer 12 may also include a device that transfers additives using other methods of operation, for example one or more pumping mechanisms and a switching mechanism alone or in combination with other methods of volumetric distribution, which may include calibration, for example the mixing devices that markets BAXA Corporation of Englewood, Colorado.

Referring to Figure 3, another realization of a mixer 50 suitable in particular for transfer large volume additives. The mixer 50 includes several 52 individual fire stations that cooperate with a team of transfer 54 for pumping fluids from containers of individual origin 56 to a final container 58. In the US Patents 4,712,590 and 5,927,349, approximately 1999, assigned to the same assignee of this invention, the operation is described detailed example of a mixer adapted to transfer small volume components The AUTOMIX that is marketed currently it can include certain improvements when compared to '485 and' 349 patents, although it is thought to be similar to what has been described in them.

Prescription Preparation

In an example of a process of using the preferred embodiment of the present invention, a doctor or other toilet or group of toilets determine which are the parenteral nutrition needs of a patient and perform a prescription. A pharmacist will then have to convert the prescription in particular amounts or in concentrations of additives in the PN to be administered at patient. These amounts vary depending on the patient. By For example, the patient may not accept a large amount of parenteral fluid and nutritional needs must be satisfied with a minimum amount of fluid. An example of patient who has to restrict fluids is the neonatal patient To manage the desired amount of a additive in a smaller total volume, the concentration level of additive in the final bag 46 may be higher in the PN than when employs more than one volume of diluent. This higher concentration can increase compatibility issues with others PN additives and may exceed acceptable limits for that patient

Referring to Figure 4A of the embodiment Preferred, the pharmacist enters the data into the controller of patient identification, for example your ID code, using the keyboard 25 (block 70). Then the controller 10 request and accept the patient's specific data (block 72) that they are in a data warehouse such as within the system computer 28 of the equipment and visually displays such information in Screen 23. A type of patient-specific data used preferably by controller 10 in the preferred embodiment is the type of patient, for example if it is premature, neonatal, pediatric or adult, etc. In an alternative embodiment, the health care provider enters patient specific data directly on controller 10 or on a storage device.

The controller 10 also saves in a storage device the preferred ranges of levels of acceptable concentration of the different mixtures in the final bag 46. In one embodiment, the controller 10 can also store concentration ranges of the ingredients of different types of patients and set the range of preferred concentration with a range dependent on the type for that particular patient In another embodiment, the ranges that correspond to patient characteristics, for example their age and weight, can be stored in the storage device of data and the controller can determine the concentration range preferential with the specific proportions for those features.

In another embodiment, the controller may also contain an algorithm to adjust the range of concentrations depending on specific factors of a patient determined such as your age.

Therefore, depending on the specific data of the patient, the controller 10 can assess whether the ranges Preferred are suitable for the specific type of patient and adjust if necessary (block 74).

The toilet can then enter the prescription (block 76), for example using the 25 keypad. introduce the prescription, the toilet sets the levels of concentration of the solutions of the ingredients so that when mixing the PN correspond to such a prescription. The controller 10 allows the prescription to be entered in several different formats As an example, controller 10 can accept the introduction of ingredients in percentages of final solution, in concentration per unit volume or in a amount corresponding to the unit of weight of the patient.

As the sanitary introduces the prescription, the controller 10 checks the concentrations entered against the determined ranges (block 78). If one is entered concentration that is out of range, a error message on screen 23. Also, if the toilet enter an ingredient in an inappropriate format, shown visually an error message or alarm on the screen to let you know An example of inappropriate formatting is when the concentration is entered in units of measure by weight of patient when such weight has not been introduced as part of their specific dates.

In an alternative embodiment, once After entering all the concentrations, the controller 10 can examine the different ingredients and highlight with messages from error those that are outside the range that has been set for that ingredient

In another embodiment, they can be introduced in a memory templates of various prescriptions that correspond to Various types of patients. The pharmacist or the controller 10 can Access the template and accept or adjust the template. Still in another embodiment, a prescription can be stored in a memory previous of the patient. The pharmacist or controller 10 can then access the previous prescription and adjust or accept the previous prescription to use it as the current one.

When an alarm is displayed visually, even when the concentration is out of range, it can be the desired according to the medical judgment of a health worker. He controller 10 can then, in certain cases, allow the sanitary cancel the alarm (block 82). The controller 10 allows the cancellation if one of certain factors occurs or a combination thereof. One factor is whether the toilet that enter the prescription you are authorized to cancel the alarm particular. Each alarm may need a different level of accreditation before the cancellation is accepted. Some alarms They cannot be canceled.

The identity and authorization level of the sanitary can be set using a single password of access requested by controller 10 and entered in a determined moment, for example when the prescription is introduced or when an alarm appears (block 84). Others are also contemplated methods to establish the identity of the toilet, for example key cards, retina scanners or the like.

In addition to establishing the authorization of the health, to verify that it recognizes and understands the message error and to save it, controller 10 may require the introduction of a rational explanation to proceed to the cancellation in a note shown on screen 23. In some alarm situations, controller 10 does not allow any cancellation even if such explanation is introduced (block 86).

Group Compatibility

The preferred embodiment of the present invention evaluates the compatibility of ingredients and solutions with which the ingredient comes in contact during mixing process and also the solution of the final bag 46 Once the mixture is complete.

In current practice, the evaluation of the PN final prepared is a process that normally performs a pharmacist. The pharmacist compares the components of the mixture final prepared with that literature that contains information About compatibility. Many times, literature is not what specific enough for the exact type of ingredients that they are prepared in the mixture, which requires the pharmacist use your professional judgment to decide if the resulting mixture It will be compatible.

According to the present invention, the entire evaluation of compatibility for complex mixtures focuses a priori on mixtures for parenteral nutrition, which, in general, It includes investigating the PN and the solubility of calcium phosphate.

Preferably, the process comprises a first phase of study in which all the additives of the PN up to the limits established by controller 10, being able to include the phases of setting the limits of the ranges of Preferred concentration as already described.

A second phase comprises comparing the final concentration of amino acids, dextrose and lipid components  with the database of mixtures already analyzed. Comparisons of Amino acids have a specific brand. In the course of analysis of mixtures and also in the published literature have compiled databases about it. The database for mixtures preferably comprises the concentrations of mixtures both stable as unstable, along with an annotation of the conditions of study, for example time and temperature. Preferably, the database includes mixtures whose components of origin have been identified, for example named amino acids commercial.

In the second phase, the prescribed mixture is Compare with the database. Preferably, the comparison is perform first with mixtures that have source components identified. If the prescribed mixture falls within the range of one stable mixing, the present invention proceeds to the next step without generate any notice to the pharmacist. The range can be set in various quantities, for example by a percentage established amounts or concentration levels of base components corresponding to a stable mixture.

However, the blends that fit (or matches of stable and unstable mixtures) with a formulation unstable contained in the database (preferably with more or minus a set of established variations of the amounts of base components) and have already passed the first phase of analysis They can be considered as potentially unstable.

In an embodiment of the present invention, if the prescribed mixture fits with an unstable mixture, you can perform another phase such as the analysis of whether the conditions of Study of the matching mixture is equivalent to the current ones. The The present invention warns the pharmacist that the mixture is equivalent to a potentially unstable mixture under those conditions of study.

In another embodiment, they are reassessed those mixtures that do not conform to any stable mixture or unstable database. In this case, the brand of the amino acid and the mixture is compared with the entire database. The results of this comparison are manipulated following the same phases that have been previously described. Preferably, at pharmacist is given a warning to ignore the amino acid brand from the mix database. If the mixture does not fit the base of data after reassessing the entire database, the This invention generates a warning to the pharmacist that it has not been previously analyzed no similar PN.

With respect to the study of solubility of calcium phosphate, the solubility of calcium salts and of phosphate in the same solution depends on many variables that include, but are not limited to, concentration, temperature, form of salt, mix order, pH, amino acid concentration, others Additives and time. In the state of the art it is a practice common for the pharmacist to compare both the final concentration of calcium salts such as phosphate salts with a solubility curve specific for a given amino acid brand and at a concentration final.

In the present invention, the study of solubility of calcium phosphate in a complex mixing process is performed by controller 10, comparing the concentration end of calcium and phosphate salts with a matrix of known compatibility. The matrix can be introduced by the pharmacist in a storage device or be previously in the database. The present invention employs the matrix to classify compatibility depending on the brand of amino acids and the final concentration. For example, the matrix of Calcium phosphate solubility for an amino acid brand specific may contain compatible concentrations of salts of calcium and phosphate for a final amino acid concentration of 1%, 2% and 4%. The present invention determines the solubility limits that have been exceeded and notify the pharmacist if this happens.

In another embodiment, controller 10 may generate and display on the screen 25 the graph of a curve that represents the solubility of calcium phosphate for an amino acid determined and also the denomination of the prescribed mixture that corresponds to such a solubility curve to help the pharmacist to Make a compatible prescription.

However, in addition to determining whether the prescription present in the final bag is compatible, you have to assess compatibility during the mixing process. For example, the compatibility of a solution with a Second solution at the time of contact. The second fluid is you will find in a common duct, in an intermediate mixing chamber or in a final bag.

To eliminate this possible problem, the Pharmacist can adopt obvious rules of mixing processes. For example, it is a common practice to first add all diluent volumes to the final bag so that the additives present in it are diluted to the maximum at the moment in which add another ingredient to such final bag. However, this practice reduces the rinse capacity of such diluent during the mixing process

According to an important aspect of this invention, the control computer 10 can use the known compatibilities for the components in order to allow simultaneous mixing of such compatible components in the final bag or in an intermediate mixing chamber. In addition, the rinsing can be done with a compatible source solution with the solutions that circulate through the part cleared before and after rinsing. Therefore, additives can be transferred from large volume to the final container or bag or to a chamber intermediate mixture at the same time as small volume additives or be used as rinsing fluids. Such compatibility analysis and Simultaneous mixing allows the present invention to maximize the speed with which the mixtures are prepared, which gives as result in more effective use of mixers and computer control.

According to an important aspect of this invention, the analysis of the components that present compatibility features is used to create a base of data that includes multiple groups, which represent the compatibility based on concentration based on the analysis of the components. In one example, there are seven component groups identified in Table 1, shown below, which have Based on current information. It should be understood that you can define many more groups as added information in reference to the compatibility characteristics of the different ingredients required, even to the point of having a group for each individual component or even separate groups for the same component in different concentrations.

TABLE 1 Group Compatibility

Group Compatible Incompatible one 1, 2, 3, 6 4, 5, 7 2 1, 2, 3, 4, 6, 7 5 3 1, 2, 3, 4, 6 5, 7 4 2, 3, 4, 6 1, 5, 7 5 6 1, 2, 3, 4, 5, 7 6 1, 2, 3, 4, 5, 6, 7 - 7 2, 6, 7 1, 3, 4, 5

The compatibility of the groups can be known based on the results of the analyzes and these are found in the control computer database so that the process Mixing can be done with the information in the database. It is preferred that the database be located only in the control computer instead of in several places so you can control, manage and modify easily, as information additional, and thus obtain information from the records, analysis continuous and addition of other drugs and components to the base of data.

In a preferred embodiment of the present invention, based on the database, the controller groups of Logically the fluids in the original containers 30 (Figure 2) in the compatibility groups regardless of their physical location in one of the mixers 12, 14, 16.

In another embodiment of the present invention, the controller calculates, for a given prescription, the number of groups present and their classification into groups of groups of compatibility between which a rinse is needed, reducing thus to a minimum the total number of rinses.

Still in another embodiment of the present invention, the controller uses other inputs such as physical limitations of the system to determine the sequence of proper mixing in order to more effectively use the solutions of origin as rinses as opposed to rinses on the stock market final. Examples of physical limitations may include volume of an intermediate chamber or funnel 34 and the rinse volume for that camera.

In one example, the intermediate chamber has a 60 ml volume funnel and a rinse volume demand of 30 ml If the prescription requires 5 ml of group 1, 20 ml of the group 2.20 ml of group 3, 55 ml of group 4 and 40 ml of group 6, the controller 10 can adopt the mix order of group 1, group 2, group 3, group 6 and group 4 instead of a sequence upward.

If funnel 34 is partially filled only with groups 1, 2, 3 and with 10 ml of group 6, and then the partially filled funnel before adding the rest of group 6, to less 30 ml of group 6 fluid left after first filling funnel 34 and this group 6 fluid can serve as a rinse thus eliminating the need to clarify the final bag.

The controller can define and apply others examples of classification relationships or algorithms to satisfy  the needs of the users, for example distribute the volume of a group to other compatible groups to minimize the number of emptyings of the chamber or funnel 34.

In this aspect and emphasizing the explained previously, although in Table 1 seven groups are included separated, more groups are expected to be defined, which can be based in more sophisticated information and analysis. The exact number of groups ultimately depends on the complexity of the information in compatibility with respect to the other components that are use, being expected to define a number considerably larger groups.

This makes the control computer can control more precisely the mixing phases, which gives as result even greater increase in efficiency and speed mixing In addition, the database can be patented since its sophistication increases and the control of the database in a single placement is an important protection that would not be present, for example, if the database were distributed to the processor of Each mixer

Mixing Strategies

In another embodiment of the present invention, in Figures 4b to 4h show a strategy or method of mixing that recognizes the possibility of clouding of liquids and of preferably use fewer rinses for the bag Finally, these illustrate the preferred embodiment of a method for define the operation of at least one mixer to Provide a mixture of nutritional formula. The beginning (block 100) of the method or process is shown in Figure 4b and occurs after having entered the prescriptions in the computer of control.

In an alternative embodiment of the present invention, the controller 10 first analyzes the prescriptions by one or more methods of those described.

The next phase is to decide the strategy of mixture (block 102), which partly depends on the type of equipment present mix.

In this regard, and as mentioned, a hospital or other health center or pharmacy can have only one high volume module mixer 12 (Figure 1) adapted for transfer a large flow of high volume fluids. But nevertheless, in the event that the health center also has a mixer 12 low volume module, then you can transfer a small solution flow, which usually allows to add to the bag very small volumes or quantities of a component. Therefore in those cases where large volume mixers are used and small particularly adapted, the controller that decides the Mixing strategy (block 2) determines which strategy to use. The program is adapted to control high flow rates (block 104) which would control, for example, a high module mixer volume, low flow rates (block 106) that you would control, for example, a low volume module mixer, or high and low flow rates (block 108) that would be the result of using both machines or a single mixer 16 suitable for transferring, for example, both large volumes as small.

Referring in principle only to flows high, the controller performs initial mixing calculations to operate the mixer only with high flow (block 104), which includes several calculations that the program executes for each large volume component that will be part of the bag final. This includes a calculation based on specific gravity to convert a volume measure to a weight measure, if the transfer is done using the weight of a component that is transfers instead of volume. Regarding this, you can write a prescription using measures that are entered in grams or milliliters or percentages of the final solution and can be ordered to the software that transforms the measurements into weight, if the mixers transferred based on the detected weight of the transferred component. For example, the high volume module mixer 14 and the low volume module mixer 12 mix using the weight or the change of weight of an intermediate or final container.

Once the calculations are done, line 110 is extends to Figure 4c, where it is determined whether the prescription which contains lipids you have to first transfer the lipids to the final bag (block 112), which is a user parameter. With Regarding this, the user may wish that the lipids are in first or at the end of the whole in the final bag, which is strictly an option that the user can specify. Such specification is preferably based on the criteria that has been determined at the beginning, before the mixer begins to function in the health center.

This implies the classification of all additives in compatibility groups and this is done by grouping common compatibility components as shown in the Table 1 previous If lipids are first transferred to the final bag, they determines the number of compatibility metagroups and the number of clarified N needed (block 114) and then the program specify a large volume transfer sequence first with lipids Once the sequence is determined, line 118 is extends to Figure 4d, where the instructions to make it work (block 120).

Alternatively, the controller 10 can transfer fluids using other user parameters, including those that reflect the general mixing rules for TPN's (blocks 116, 124). With respect to the general rules of mixture of fully parenteral nutrients, these include:

one.

Add phosphate salts before salts of calcium

2.

The Determination of the solubility of calcium phosphate must be do based on the volume of the solution in the TPN bag at the moment when calcium is added.

3.

TO unless lipids are needed as a final additive, calcium has that always be the last element that is added to the TPN bag, supporting a rinse, if possible.

Four.

The compatibility groups are numbered in order to match mix order, unless exceptions are identified specific.

If mixer 14 has separate ducts to the final bag for each of the original solutions, the controller 10 sets the pumping order to ensure that it add the fluid to the final bag, the primary determination of pumping order is compatibility with the fluid present in the bag of fluid entering it.

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Going back to Figure 4c, if the lipids are not the first to enter the final bag, the number of compatibility groups as well as the number of clarifications needed (block 122) and the sequence of transfers and rinsed with lipids in the end is determined by applying one or more of the mixing methods that are executed and the final phase shown with line 126 that extends to Figure 4d results in  the transfer of instructions to the mixer (block 120).

Changing now to the case of only low flows, which begins with the beginning of the mixing calculations just to low flow rates (block 106), this can be used to prepare mixing prescriptions that would be made, for example, with a low volume module mixer. Even if it was probable that a low volume mixer existed in the same area, is common choose the low volume mixer if the volume to be add to the final bag is relatively low, as it would happen for a neonatal prescription or for a very small infusion.

First, it is determined whether the final bag It already contains lipids (block 130). The reason for this is that it can have a prescription that has been mixed in two phases with high volume fluid components that have already been transferred to a bag and this is then placed in the low volume module to transfer micronutrients in it. If there are already lipids in the bag, there will be differences in reference to how many rinses are made since the final bag inside the funnel or mixing chamber intermediate that may be present in a module mixer low volume.

From the prescription, the program determine if there are lipids in the bag and in that case all  the mix prescription to determine if they are already or will be in The final bag. If there are already lipids, information is requested if user cares about possible lipid cloudiness in the following mixing prescription (block 132). This is due to fact that when any rinse is done using fluid from the final bag some lipids will remain in the funnel. These lipids can be transferred to several of the following bags in one enough to visibly cloud the solution. If the present bag is made with lipids and the next does not contain them and no surface rinse occurs that come into contact with the contents of both bags, there is the possibility of lipids clouding the next bag, in particularly if the previous one uses a rinse from the bag final. In the event that the health center does not want such lipid clouding, the mixture is not prepared at that time, but remains on hold to be prepared later (block 134). If the hospital accepts lipid cloudiness, the printer prints a warning notice (or the warning is displayed visually) indicating that there is the possibility of a lipid cloudiness in the funnel (block 136).

When the final bag does not contain lipids (block 130) or contains them regardless of possible cloudiness (block 136), the solubility and compatibility tables are used and the mixture is calculated taking into account those rinses that come from the final bag (block138). Purpose of this phase is to perform calculations designed to minimize the number of cleared in order to maximize effectiveness and can use One of the methods described. When this is done, line 140 is extend to Figure 4d and then the instructions are sent transfer to the mixer (block 142).

Returning now to the flow section highs and lows shown in Figure 4b, in the initial phase start the preparation of the mixture (block 108), which requires the conversion calculations that have been described with respect to the high flow only routine (block 104) and line 144 is extended to Figure 4c, where the number of groups of compatibility and rinsing (block 146). Basically, it is a determination of whether there will be a problem with the prescription if Mix in the way described.

It is determined if lipids are included in the bag final (block 152). If lipids are needed, it is determined whether they are they will be transferred first, in the end or they will be optimized (block 154). The presence of lipids at the beginning, at the end or if they are going to optimize is a user preference programmed in the sense that this one defines it once and from here it does not depend of the prescription. Optimization usually implies that Lipids are transferred first. Therefore, the criterion of mix that the user sets first determines the cycle of The decided phases. If they are transferred first or optimize, line 156 extends to Figures 4d and 4c until a phase that will be described later. If lipids are not included in the final bag, line 158 extends to Figures 4d and 4e to some phases that will be described later. If it is necessary that lipids are transferred at the end, line 160 extends until the Figure 4d and determine if the prescription is stable without the lipid volume (block 162).

If the prescription is not stable without the volume of lipids, the program warns the user that the prescription does not it can be mixed if the lipids are transferred at the end and that can verification by a pharmacist is necessary (block 164). The program then determines if lipids can be transferred to the final bag (block 166) and, if not, the result is that the mixture is not prepared (block 168). If lipids can be transfer first, line 170 extends to Figure 3d, where the number of rinses will be transferred including the lipid volume and lipids first to the final bag (block 172).

Going back to block 162, if the prescription is stable without including lipid volume, the program calculate all solubilities including lipid volume and Lipids are transferred to the final bag last (block 174) (Figure 4d). The calculation of solubilities without including the lipid volume (block 174) is made to calculate the solubility of calcium phosphate based on a volume possibly smaller than what was included in the original study. Therefore for example, if there were 50 milliliters of lipids in 200 milliliters of Total volume of PN, phosphate solubility evaluation of Calcium would be made over 150 milliliters.

Once the compatibility of groupings and rinses (blocks 172 and 174), the program determines if the total volume, excluding lipids, is greater than the funnel volume (block 176). If so, line 178 is extends to Figure 4f where the program determines if lipids are the first (block 180) and, if so, the program determines whether the number of rinses can be maintained from a Rinsing base source for rinsing according to a sequence acceptable (block 182). If you can, the program starts with the compatibility groups and continue mixing with the rinses required from the selected container of origin (block 184) and the instructions are transferred to the mixer (block 186). As described, the phases described in the blocks 182 and 184, although they are identified as separate phases in the Organization chart, they are actually interrelated. This is because the number of rinses is a function of the compatibility groups and these compatibility groups should be determined to identify where rinses should be produced as described previously.

If the total volume, excluding lipids, does not is greater than the funnel volume, the mixture is completed using the low volume module and can be done in the mixer funnel of low volume module The program determines if you can book a source rinse volume of a component solution for a final rinse (block 188) and, if so, is reserved when mix the source rinse volume of a base component and all other ingredients in the funnel and transferred to the final bag, and the funnel is then cleared with the reserve base (block 190) with the rinse that is transferred to the final bag and send transfer instructions to the mixer (block 192).

To determine if a volume can be reserved source rinse is necessary to analyze the fluid present during the mixture in the funnel without the diluting effect of the rinse to see if it is maintained, that is, if the resulting mixture is going to be stable. In addition, the funnel capacity is important in relation to volume that you can maintain to perform a complete rinse. By example, if the funnel capacity is 50 milliliters and only 30 milliliters can be reserved, the funnel is not completely cleared and the decision of whether this is appropriate or not can be taken by the Username. It is also contemplated that in the rinse method can perform the final rinse with a component of origin as sterile water, dextrose or amino acids and that can be made intermediate rinses using solutions from the final bag along with the clarified source of a volume of components reserved for the final rinse, so that the funnel is cleaned to the maximum possible.

If there is not enough volume of source rinse, the program determines if a volume amount can be reserved source rinse for a final rinse (block 194), if possible it's done, and all the other ingredients are mixed in the funnel and this is clarified with the reserve base (block 196). The transfer instructions are then sent to the mixer (block 198).

If you cannot reserve any amount of source rinse for the final rinse, all ingredients in the funnel without rinsing (block 200) and sent instructions to the mixer (block 202).

It should be borne in mind that if the response of the block 152 is that there are no lipids in the final bag, the line that crosses the flowchart that assumes that the total volume exceeds funnel volume results in determination of whether lipids are the first in block 180, which in reality cannot be applied since there are no lipids present. In In this case, phases 182 and 184 can be performed with the rinse source that comes from the original container and / or the final bag. As already described, the controller preferably uses the clarified sequence and mixture that eliminates the need for a rinse coming from the final bag.

Returning now to block 204, if the answer it is no, or if the mixture contains lipids, the lipids are going to transfer first and a rinse from the bag is needed final (block 182), the program determines if lipids can be transfer at the end (block 206), if the answer is no, the program ask if lipid cloudiness is acceptable (block 208), and if the answer is no, the result is that the mixture does not continue (block 210). If acceptable, the program warns of a lipid clouding (block 212).

If lipids can be transferred at the end, the program determines whether the number of rinse levels of the rinse source for a rinse and if you can perform a acceptable sequence with a rinse from the final bag (block 214). If possible, the prescription is analyzed for groups of compatibility and mixing with rinses is continued produced at certain times, preferably from next rinsed until the final rinse with the final bag and all others with the source components (block 216). In this way, at rinse with the contents of the final bag, the ingredients that are present in it are diluted to the maximum, allowing a final rinse of the original container. The instructions are transferred to the mixer (block 218).

If the answer to block 214 is no, the line 220 that continues until Figure 4g ends in the program that determines whether the number of rinse levels can be kept at least 2 (N - 2) times the rinse of source components for a rinse in an acceptable sequence, two rinses being determined from the final bag (block 222). If the answer is yes, the compatibility group phase is executed again (block 224) and instructions are transferred to the mixer (block 226). If the answer is no, another determination of the number of clarified minus 3 (N - 3), performing an analysis of compatibility if the answer is yes (block 230) and sending instructions to the mixer (block 232). If the answer is no, it will make another determination with respect to N - 4 (block 234). If the answer of block 234 is yes, an analysis of compatibility (block 236) and the instructions are sent to mixer (block 238). If the answer is no, on line 240 the program determines whether a source rinse can be maintained for a final rinse (block 242). If the answer is yes, it is done once again a compatibility analysis (block 244) and they are sent mixing instructions (block 246).

If the answer is no, the program determines if you can keep an amount of source solution to create the volume required, excluding lipids, less than the volume of funnel (block 248). If the answer is yes, that volume is reserved suitable and the ingredients are mixed in the funnel and the component base that has been maintained is used to clear the funnel (block 250) and transfer instructions are sent to the mixer (block 252). If the answer is no, the program determines if there is lipids in the prescription (block 254) and, if not, the program mixes all the rinses originated in the final bag (block 256) and the instructions are sent to the mixer (block 258), but if lipids are present, the program determines whether worrying about lipid cloudiness (block 258). If that is not the case, a warning is issued (block 260) and if it does concern, the mixture (262). Once the notice is issued, mixing continues with all rinses from the final bag (block 256), what which results in sending instructions to the mixer (block 258).

By sending the instructions to the mixer (blocks 192, 186, etc.), the mixer and the controller can use various methods and transformations to develop the mixture. For example, controller 10 can send instructions to a controller that is part of the mixer 12, 14, 16 or the controller can directly operate the mixer or any combination or similar method.

In addition to the mixing strategies that performed in the manner described in relation to the organizational charts of the Figures 4a to 4h, there are other functions performed by this invention. In this aspect, the control computer 10 is adapted to examine the composition of each mixture prescribed in a queue of prescribed mixtures, for which they are sent instructions to the mixer that will prepare the mixture. To the examine the components of each prescribed mixture of the glue to determine those that contain lipids, for example, those that do they contain lipids can be grouped together so that the lipid cloudiness do not worry until the last mixture that does contain lipids.

As described in US Patent 4,653,010, the prescribed glue mixtures can be classified and grouped into common components. In one embodiment of the invention, they can be similarly determine other mix groupings desired, for example, depending on the type of patient. Such rearrangement of the prescribed glue mixtures may have the effect of increasing the number due to the needs and requirements of a center sanitary.

Another important aspect of the present invention implies that the computer 10 can adjust, for a user, the defined fill volume by increasing the volume of each of the components to be added to the prescribed mixture in a determined amount, which allows to obtain a mixture of equal prescription although with a slightly larger volume, compensating thus the volume necessary to prime the administration team or take into account aspects of precision when the prescription requires extremely small concentrations of a mixture of so that the correct amount is actually administered to the patient of component at the desired concentration.

Still another important aspect of this invention involves the ability of computer 10 to receive a user activatable option that, when activated, allows replace a diluted high concentration ingredient with a prescribed ingredient at lower concentration. In many cases in that the patient is not prohibited from fluids, dilute a solution of a higher concentration with a compatible rinse solution, for example with sterile water, it makes the prescribed mixture have a minimum amount of potential instability. In another embodiment of the present invention, in particular when the patient is prohibit fluids, the stability of the mixture in reference to the elimination or reduction to the maximum of the diluent solution considering other ingredients as diluent fluids is determined by controller 10, which can use one of the methods described to determine stability during or after mix.

In another embodiment of the method of the present invention, a mixing strategy can be carried out to fill the final bag 46. As already described, the filling can be suitable to compensate for the amount of mixture that cannot be administered due to the administration system. For example, a part of the solution may be retained in a final bag even after administration.

According to one aspect of the present invention, you can set the desired method in particular to Determine the filling. As an example, the fill volume is can set in absolute quantities, in percentage or in a manner that the final bag has a specific desired volume. When preparing such prescription, the method calculates the new amounts of necessary ingredients to obtain a substantially mixed equivalent to the prescribed mixture, although with a slightly volume higher.

When determining the appropriate amounts of ingredients among these, the controller 10 can check the resulting mixture according to several criteria to determine if this It can be administered. For example, for a patient who is ban fluids, a filler can generate a mixture with a amount of fluid that exceeds the allowed. You can activate a alarm and visually show the user an error message.

In another embodiment, controller 10 may adjust or recommend mixing volume adjustment to avoid an amount of one or more ingredients less than one level default such as the one that corresponds to the minimum quantity precise recommended for a mixer 12, 14, 16. As an example, the quantity of a component can be 90% of the minimum quantity suggested. The controller can then increase the total volume of the mixture so that the quantity of the component reaches the quantity minimum suggested and indicate to the user that they are only going to administer to the patient a part of the resulting mixture.

It should be understood that the order of the phases of the different preferred embodiments of the present invention may vary. For example, the stability of the final mixture is can determine before or after determining the strategy of proper mix.

Notification

The mixer 12, 14, 16 can communicate with the 10 controller during and after the mixing process. By example, if a sensor like the one described in U.S. Pat. 5,927,349 detects that an incorrect source solution is circulating through one of the ducts 32, an alarm can be activated. By way of similar, during or after mixing, can be transmitted to controller 10 the exact amounts of the ingredients that are transferred to final bag 46.

Upon receiving the controller 10 the amounts of ingredient transferred during mixing, it can show the data regarding the cost to the pharmacist or communicating them to the system 28 of the hospital. The controller 10 can adjust the cost data to reflect the actual cost of provision of the mixture. As an example, some ingredients may come in containers that can be accessed only once before discarded. Thus, if such an ingredient is used in an amount smaller than the one in the container, the controller 10 indicates the cost of the entire container instead of the cost of that part of the ingredient used in the mixture.

From the above, we can appreciate that it has described an improved method and apparatus for controlling the preparation of parenteral mixtures ensuring this method and this faster and more effective preparation thereof without sacrifice safety at all. In addition, several of the Features add protection. The present invention employs a extensive analysis of the mixing components and uses the known characteristics of such components in a novel way to control the mixers so that such mixtures prescribed can be prepared accurately and safely without violating known rules of preparation, and also in a way that matches with certain preferences defined by the user.

Although several are shown and described embodiments of the present invention, other modifications, substitutions and alternatives are obvious to any expert Medium in the matter.

Claims (31)

1. Apparatus for controlling the operation of at least one pharmaceutical mixer adapted to transfer selectively prescribed amounts of components pharmacists from individual containers of origin, through a hollow transfer means, to a final container for preparing a prescribed mixture, said apparatus comprising: a computer with memory to store instructions for the operation of the device and to control the minus a mixer when preparing a prescribed mix, including said memory data relating to multiple of the components Pharmacists that can be transferred to prepare the mixture prescribed and data referring to the characteristics of operation of at least one mixer; said computer including at least one port communication to establish a communication link with the less a mixer; said computer being adapted to receive a prescribed mixture, identify the pharmaceutical components of the same, to determine the compatibility of the components pharmacists with each other, to determine the order in which they are transferred the components during the preparation of the mixture prescribed and to communicate the preparation instructions of the mixture prescribed at least to a mixer to be used for its preparation, characterized in that the compatibility of the pharmaceutical components with each other comprises the compatibility depending on the concentration. 2. Apparatus according to claim 1, characterized in that said computer is adapted to convert the quantity of each component to a measure in which at least one mixer to prepare the prescribed mixture can be transferred. 3. Apparatus according to claim 2, characterized in that said computer is adapted to convert quantities of defined component volumes established in a prescribed mixture to a weight measurement by multiplying the specific gravity of the component by the volume defined in the prescribed mixture. 4. Apparatus according to claim 1, characterized in that said data referring to the multiple pharmaceutical components comprises a database that includes multiple compatibility groups, each group containing at least one of said pharmaceutical components, said database also having data specifying the compatibility and / or incompatibility of each group with respect to other groups. 5. Apparatus according to claim 4, characterized in that at least a first compatibility group of said compatibility groups comprises components including lipids, and a second compatibility group of said compatibility groups comprises a component that is sterile water. 6. Apparatus according to claim 4, characterized in that said computer determines the order in which the components are transferred with which the order obeys a set of general rules for determining the mixing order, the general rules comprising: add phosphate salts before salts of calcium; check the solubility of calcium phosphate based on the volume of solution of the mixture prescribed at the time in which calcium is added; Y Calcium is the last thing added to the mixture prescribed. 7. Apparatus according to claim 6, characterized in that said computer determines how many rinses and when they are to be done during the order of transfer of components, the rinsing being a cleaning of at least a part of the elongated hollow transfer means near the final container with a solution compatible with the next component to be transferred to the final container. 8. Apparatus according to claim 6, characterized in that said cleaning solution is obtained from one of the individual original containers or the final container. 9. Apparatus according to claim 4, characterized in that said computer includes at least one port for receiving input data in order to select whether a pharmaceutical component that includes lipids will determine the order of transfer so that the lipid-containing component is transferred first or lastly depending on the other pharmaceutical components. An apparatus according to claim 1, characterized in that said communication link can comprise at least one internet connection, a local network connection or a wireless connection. 11. Apparatus according to claim 1, characterized in that said apparatus is adapted to be used by users in at least two locations, where each location can have at least one mixer and a printer for printing labels, a terminal with a screen and a input device to introduce prescribed mixtures and selectable parameters related to the operation of the device and the mixers. 12. Apparatus according to claim 11, characterized in that said computer is adapted to control two mixers in each of its locations, a mixer being adapted to transfer a flow of components significantly higher than the other mixer. 13. Apparatus according to claim 9, characterized in that said computer is adapted to examine the prescribed mixture and determine if the lipid components are part of it, to determine if the user objects to whether the next prescribed mixture to be prepared can present a cloudy appearance due to the presence of a lipid component in the prescribed mixture being prepared, to finish the preparation of the prescribed mixture in case the user indicates an objection and warn with an alarm the possibility of such clouding in case that the user does not indicate any objection. 14. Apparatus according to claim 9, characterized in that said computer is adapted to receive multiple prescribed mixtures and order them in a queue for preparation, said computer being adapted to examine each mixture of the queue and determine the similarity of the predetermined components of the same and to reorder the prescribed mixtures in said glue in order to group together those prescribed mixtures that have said similarity of predetermined components. 15. Apparatus according to claim 1, characterized in that said computer is adapted to extract data corresponding to the profile of a patient for whom a prescribed mixture is to be prepared, wherein the data of the patient profile includes at least its name, its age and its weight, said computer being adapted to extract data referring to multiple categories of patients, each category containing predetermined limits of specific mixing components of each category, said computer being adapted to compare the quantities of the components of a prescribed mixture for a patient in one of said categories and provide a signal when a component is outside the limits determined for said component of the prescribed mixture. 16. Apparatus according to claim 15, characterized in that said categories of patients comprise adult, pediatric, neonatal and premature patients. 17. Apparatus according to claim 15, characterized in that said signal is adapted to prevent the prescribed mixture from being prepared. 18. Apparatus according to claim 15, characterized in that said patient profile data also includes a history of the patient's weight and mixing prescriptions for a certain period of time, said processor being adapted to prepare a report concerning the patient that includes a prognosis of the patient's weight at a certain time in the future. 19. Apparatus according to claim 1, characterized in that said computer is adapted to extract data referring to the profile of a patient for whom a prescribed mixture is to be prepared, wherein the patient profile data includes at least its name, age and weight , said computer being adapted to extract data referring to the limits of the quantities of the mixture components that can be added to a prescribed mixture to a given patient, said computer being adapted to compare the quantities of components that are in a mixture prescribed for a patient and requires an authorized entry of data explaining the reason for exceeding one or more such limits. 20. Apparatus according to claim 19, characterized in that an authorized data entry is a data entry made by at least one doctor or a pharmacist. 21. Apparatus according to claim 19, characterized in that the absence of data necessary to explain the reason for exceeding one or more such limits causes the computer to complete the preparation of said prescribed mixture. 22. Apparatus according to claim 1, characterized in that said memory includes data concerning the amount of fluid that is needed to prime the at least one mixer from a source vessel, through the elongated hollow transfer means, to the final vessel, said processor being adapted to increase the amount of a component in that which is necessary to prime the at least one mixer. 23. An apparatus according to claim 1, characterized in that said processor is adapted to receive an activatable input relative to the preparation of a mixing prescription that requires a certain amount for a first component, an amount of diluent for such first component and relatively small amounts of one or more additional components, where the total mix prescription is going to be a certain total amount, said computer being adapted to use relatively small amounts of volume of one or more of said additional components as substitutes for the same volume of diluent with the in order not to exceed the total amount determined. 24. Method to control the operation of at least one pharmaceutical mixer adapted to transfer selectively prescribed amounts of components pharmacists from individual containers of origin, through elongated hollow transfer means, to a final container, to prepare a prescribed mixture, using the method a computer with memory to store instructions for operation of the apparatus and for the control of at least one mixer, for prepare a prescribed mix, including data memory related to multiple pharmaceutical components that can be transfer to prepare the prescribed mixture and data to be refer to the operational characteristics of the at least one mixer adapted to the device for control, including the computer as minimum one communication port to establish a link communication with the at least one mixer, comprising the method the phases of: Receipt of a prescription mix in the computer; identification and determination of the amount of the pharmaceutical components of the prescribed mixture; determination of the compatibility of pharmaceutical components with each other; determination of the order in which they are transferred the components during the preparation of the prescribed mixture; Y communication of instructions to prepare the mixture prescribed at least to a mixer to be used to prepare the prescribed mixture, characterized in that the compatibility of the pharmaceutical components with each other comprises the compatibility depending on the concentration. 25. Method according to claim 24, characterized in that the phase of identification and determination of the quantities includes in turn the phase of converting the quantity of each component to a measure in which the at least one mixer to prepare the prescription of Mix is able to transfer. 26. Method according to claim 24, characterized in that the data relating to multiple pharmaceutical components comprise a database of pharmaceutical components classified into multiple groups, the components of each group having common compatibility characteristics, said database having data specifying the compatibility and / or incompatibility of each group in correspondence with the other groups, said compatibility determination step also comprising: examine the mix prescription for identify the particular groups of components that are present in it and the compatibility features of each group in correspondence with the other groups identified. 27. A method according to claim 26, characterized in that said order determination phase also comprises: determining the mixing order so that the components that are in compatible groups are added simultaneously or sequentially to the final container according to the rules of known general mix. 28. Method according to claim 27, characterized in that said general known mixing rules comprise: the addition of phosphate salts before calcium salts; establish the solubility of calcium phosphate based on the volume of solution in the mixture prescribed at the time in which calcium is added; Y adding calcium last after A prescribed mixture. 29. Method according to claim 26, characterized in that said order determination phase also comprises: determining the mixing order to which the components that are in compatible groups are added sequentially to the final container, so that the maximum number of rinses, rinsing being performed to clean the hollow transfer medium near the final container due to the incompatibility of a component of a first group in correspondence with a component of another group that is the next in order to transfer. 30. A method according to claim 24, characterized in that said phase of identification and determination of the quantity of the pharmaceutical components further comprises identifying the lipids as a component of the prescribed mixture and providing the user with the option of being able to complete the preparation of the prescribed mixture. If you decide so. 31. Method according to claim 30, characterized in that an alarm is generated in case the preparation of a prescribed mixture containing lipids has not been completed, said alarm informing that a prescribed mixture to be prepared afterwards may have a cloudy appearance. due to the presence of lipids.