referring more particularly to the drawings , a first form of apparatus in accordance with the invention is indicated generally at 10 in fig1 and 2 . the apparatus includes a novel stand 11 having a base plate 12 and upstanding arms 13 and 14 at its opposite ends . a disposable rack 15 is adapted to be releasably engaged with the upper ends of the arms 13 and 14 by means of headed projections 16 and 17 on the upper ends of the arms which engage in key hole slots 18 and 19 at the opposite ends of the rack 15 . in this connection , the arms 13 and 14 have a normal , upright position with the headed ends engaged in the smaller section of the slots 18 and 19 , to prevent withdrawal of the headed ends through the slots . the arms may be flexed outwardly relative to the rack 15 to align the headed ends 16 and 17 with the larger openings in the slots for removal and / or replacement of the rack on the stand . the rack includes a plurality of upstanding cylindrical walls or cup - shaped formations 20 , 21 , etc . with concentrically disposed openings 22 , 23 , etc . extending through the rack 15 . in a preferred construction , the rack 15 may comprise a plastic material such as rigid pvc , while the arms 13 and 14 may be made of stainless steel or the like . the stand may be secured to a support surface by any suitable means , such as fasteners ( not shown ) extended through openings 24 in the base plate 12 . a plurality of vented spikes 26 , 27 , etc ., corresponding to the number of vials v 1 , v 2 , etc ., each has a piercing end 25 which is inserted upwardly through a respective opening 22 , 23 , etc ., and into the stoppered end of an associated vial placed in the cup - shaped formations 20 , 21 , etc , on top of the rack 15 . a flange 28 on the vented spike engages beneath the rack 15 whereby the vials and vented spike are securely attached to the rack on opposite sides thereof . when the rack is assembled to the stand as shown in fig1 and 2 , the vials are accordingly held in an upright position . a manifold / valve assembly 30 is secured to the plurality of vented spikes 26 , 27 , etc ., and includes a plurality of multi - way valves 31 , 32 , etc ., with each valve being attached to a respective vented spike 26 , 27 , etc . as seen best in fig1 through 13 , each valve 31 , 32 , etc ., comprises a valve body 33 having a tapered male end 34 on one end thereof for attachment to a respective vented spike 26 , 27 , etc ., and a female tapered end 35 on the other end for attachment of a syringe s 1 , s 2 , etc . the ends of the valve body are offset as seen best in fig1 , and a first valve seat 36 is defined therebetween for cooperation with a first check valve 37 . the check valve 37 comprises a flexible disc normally held in closed position against the valve seat 36 by an elongate arm or stop 38 . the side 39 of the valve body opposite the seat 36 is open and a valve seat member 40 is secured thereon by any suitable means such as a sonic weld or the like . the seat member 40 includes an end wall 41 with a plurality of openings 42 formed therethrough . an annular flange or wall 43 defines an annular pocket 44 for receipt of a respective cylindrical projection 45 , 46 , etc . on the manifold 47 . the seat member 40 is secured to the manifold by any suitable means such as a sonic weld or the like , whereby the valves 31 , 32 , etc . form an integral structure with the manifold 47 . with the vented spikes and vials attached to the rack 15 as described above and with the manifold / valve assembly attached to the vented spikes , the apparatus results in a structure wherein each vial is held in aligned relationship with the respective valve and syringe s 1 , s 2 , etc ., so that ready visual reference can be made to the additive which is being withdrawn at a particular time and to the quantity of that additive being withdrawn . as seen best in fig1 , 12 and 13 , the end wall 41 of seat member 40 defines a second valve seat 48 for cooperation with a normally closed flexible valving disc 49 that is secured at its periphery between the manifold 47 and the end wall 41 and has a central opening 50 therethrough so that when fluid pressure deforms the valving disc 49 away from the seat 48 , flow can occur through the openings 42 in end wall 41 and through the opening 50 into the manifold 47 . the valve disc 49 is shown in closed position in full lines in fig1 and in open position in dot and dash lines . in use of the apparatus , a plurality of vials v 1 , v 2 , etc ., are assembled with a rack 15 and vented spikes 26 , 27 , etc ., attached thereto as described previously . the rack is then engaged on the arms 13 and 14 of the stand 11 , and the manifold / valve assembly 30 is attached to the vented spikes . syringes s 1 , s 2 , are attached to the valves 31 , 32 , on the manifold / valve assembly , with the number of syringes corresponding to the number of vials and each syringe being dedicated to a specific vial and held in vertically aligned relationship thereto . the respective syringes s 1 , s 2 , etc . are manipulated in a desired sequence to draw material from the respective vials v 1 , v 2 , etc . through the respective multi - way valves 31 , 32 , etc . and past valve disc 36 into the respective syringe . the syringe is then manipulated in a reverse direction to expel the previously withdrawn material back through the valve 31 , 32 , etc . and past the valve disc 49 into the manifold 47 . from the manifold the material flows through a length of tubing 52 , through a syringe 53 and into a final container 54 for the parenteral nutrition solution to be administered to a patient . the syringes are manipulated in turn as described above to withdraw desired additives from the respective vials through the valves , into the respective syringe and thence back through the associated valve into the manifold and to the container 54 . a container 55 is connected through a length of tubing 56 with a valved fitting 57 connected to the end of the manifold remote from the final container 54 and a syringe pump sp is connected with the conduit to draw a flushing solution , such as normal saline or the like , from the container 55 and force it through the manifold to remove any residual additives left therein following the transfer operation previously described . a suitable clamp 57 is positioned in the length of tubing 56 to interrupt flow therethrough as desired . a first modification of the invention is indicated generally at 60 in fig1 through 17 . in this form of the invention , a vented spike 26 connects with a vial v 1 through the disposable rack 15 , which is supported on the stand 11 as previously described . in this form of the invention , however , a different multi - way valve 61 is used to connect the vented spike 26 to manifold 30 &# 39 ;. the multi - way valve 61 used in this form of the invention is of the type shown and described in applicant &# 39 ; s prior patent no . 4 , 729 , 401 , and includes a pair of normally closed flexible discs positioned to control flow from the vial into a syringe s 1 , and then from the syringe back through the valve and through an elbow fitting 62 into the manifold 30 &# 39 ;. a check ball valve 63 is positioned in the elbow fitting for preventing reverse flow from the manifold 30 &# 39 ; and avoiding cross contamination . the elbow fitting 62 is attached to the manifold 30 &# 39 ; via a female coupling 64 formed integrally with the manifold . except for the modified valve 61 and elbow fitting 62 , this form of the invention is substantially the same as that previously described and functions in essentially the same way . a second modification of the invention is represented generally at 70 in fig1 and 19 . in this form of the invention , a multi - way valve 61 and vented spike 26 of the type shown in fig1 through 17 are used . however , the multi - way valve 61 is connected to a modified manifold 30 &# 34 ; through a valved connection 65 , and the manifold 30 &# 34 ; is carried on one arm of a t - shaped bracket 66 which has its other arm releasably fixed in a slot 67 on a modified stand 11 &# 39 ;. set screws 68 extend through the rack 69 of the stand 11 &# 39 ; into engagement with the arm of the fitting 66 to retain it in the slot 67 . the bracket 69 is permanently affixed to the upper ends of arms 13 &# 39 ; and 14 &# 39 ; which are , in turn , secured at their lower ends to a base 12 &# 39 ;. the vented spike 26 and vials v 1 , v 2 , etc . are carried on the end of an l - shaped bracket 71 extending forwardly from a top edge portion of the bracket 69 . in all other respects this form of the invention is substantially as previously shown and described , and functions substantially identical , to the form of the invention in fig1 and 2 . in fig2 , a further variation of the invention is represented generally at 80 , wherein a plurality of the assemblies shown in fig1 and 2 are connected in tandem for admixing even further additives in producing a parenteral nutrition solution . in this arrangement , a length of tubing 81 connects the outlet end of a first manifold 47 with the inlet end of a second manifold 82 , and the outlet of the second manifold is connected through a length of tubing 52 with the final solution container 54 . the apparatus of the invention provides a fast and efficient method for producing a total parenteral nutrition solution and assures sterile preparation of the final mixture due to the elimination of all vial and needle manipulations . further , the risk of medication dosage error is substantially reduced since the vial and dedicated syringe is always held in aligned relationship for ready visual identification of the additive being selected and the level of that additive . moreover , the apparatus of the invention places the vials , manifold and syringes in the most effective physical position for sterile laminar airflow under the hood of the sterile environment containment device . the apparatus of the invention is also compact in design , saving valuable space for other uses . the combination of multi - way valves and couplings to the manifold are designed such that minimum dead space is created , thus resulting in a minimum amount of residual fluid following a transfer operation . in addition , the flushing assembly attached to the manifold permits any residual fluid which does remain to be flushed into the final container following a transfer operation . still further , the completely closed system approach to the compounding of the numerous additives and their transfer to the final mixture container minimizes or eliminates any breaches in the sterile environment . although the invention has been described with reference to particular embodiments , it is to be understood that these embodiments are merely illustrative of the application of the principles of the invention . numerous modifications may be made therein and other arrangements may be devised without departing from the spirit and scope of the invention .
an apparatus and method for mixing parenteral nutrition solutions from additives in a plurality of vials containing the additives , in which a vented spike is inserted through a disposable rack and into the stoppered end of each vial , with the vials secured on the rack . the rack is engaged on a stand through a quick release fitting , and maintains the vials in a vertical orientation with the labels clearly visible . a dedicated syringe is connected with each vial in aligned relationship therewith through a unique two - way valve which is mounted to a manifold . in one form of the invention , the valve is attached directly on the manifold to reduce dead space volume and consequently reduce residual fluid in the system between purges . a flushing system is attached to one end of the manifold to flush any residual fluids into the final container at the end of a transfer process . the other end of the manifold may be attached in tandem with a further manifold in a further apparatus containing additional vials for admixing even further additives .