Patent Publication Number: US-11642284-B2

Title: Carousel for automatic drug compounder

Description:
CROSS REFERENCE TO RELATED APPLICATIONS 
     This application is a divisional application of U.S. patent application Ser. No. 17/093,438, filed Nov. 9, 2020, which issued as U.S. Pat. No. 11,241,363 on Feb. 8, 2022, which is a divisional application of U.S. patent application Ser. No. 15/781,074, filed Jun. 1, 2018, which issued as U.S. Pat. No. 10,842,716 on Nov. 24, 2020, which is the National Stage Entry of PCT/US16/64347, filed Dec. 1, 2016, which claims priority from U.S. Provisional Application No. 62/263,576, filed Dec. 4, 2015, the entirety of each of which is incorporated herein by reference. 
    
    
     TECHNICAL FIELD 
     The present disclosure generally relates to an apparatus that reconstitutes, mixes, and delivers a drug from a vial to a receiving container. Specifically, the present disclosure relates to a replaceable carousel that holds an array of cartridges each with multiple flow paths to allow reconstitution of a drug, delivery of diluents from hung diluent bags and diluent vials to medication vials, filling of a receiving container, and removal of waste to a waste container. The replaceable carousel is capable of holding the cartridges and managing the tubes used to fill the receiving containers from the cartridges. 
     BACKGROUND 
     Pharmaceutical compounding is the practice of creating a specific pharmaceutical product to fit the unique need of a patient. In practice, compounding is typically performed by a pharmacist, tech or a nurse who combines the appropriate ingredients using various tools. One common form of compounding comprises the combination of a powdered drug formulation with a specific diluent to create a suspended pharmaceutical composition. These types of compositions are commonly used in intravenous/parenteral medications. It is vital that the pharmaceuticals and diluents are maintained in a sterile state during the compounding process, and there exists a need for automating the process while maintaining the proper mixing characteristics (i.e. certain pharmaceuticals must be agitated in specific ways so that the pharmaceutical is properly mixed into solution but the solution is not frothed and air bubbles are not created). There exists a need for a compounding system that is easy to use, may be used frequently, efficiently, is reliable, and reduces user error. 
     SUMMARY 
     In accordance with one or more embodiments, a compounder system is provided that includes a carousel hub having a shape; a carousel that includes a plurality of cartridge pockets each configured to receive a pump cartridge and a central opening having a shape that corresponds to the shape of the carousel hub; and a vial and carousel drive assembly configured to rotate the carousel hub to rotate the carousel to move a selected one of the pump cartridges to a position adjacent to a pump head assembly of the compounder system. 
     In accordance with one or more embodiments, a method of operating the compounder system is provided, the method comprising inserting a cartridge and backpack assembly in each cartridge pocket of the carousel; and placing the carousel with the inserted cartridge and backpack assemblies onto the carousel hub. 
    
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
       The accompanying drawings, which are included to provide further understanding and are incorporated in and constitute a part of this specification, illustrate disclosed embodiments and together with the description serve to explain the principles of the disclosed embodiments. In the drawings. 
         FIG.  1    illustrates a front perspective view of an example of an exemplary embodiment of a compounding system in accordance with aspects of the present disclosure. 
         FIG.  2    illustrates a front perspective view of the compounding system of  FIG.  1    with a transparent housing in accordance with aspects of the present disclosure. 
         FIG.  3    illustrates a side view of the compounding system of  FIG.  1    with the housing removed in accordance with aspects of the present disclosure. 
         FIG.  4    illustrates a perspective view of an exemplary embodiment of a pump drive mechanism in accordance with aspects of the present disclosure. 
         FIG.  5    illustrates an exploded view of the pump drive mechanism of  FIG.  4    in accordance with aspects of the present disclosure. 
         FIG.  6    illustrates a perspective view of an example of an exemplary embodiment of a motor mount in accordance with aspects of the present disclosure. 
         FIG.  7    illustrates a rear perspective view of the motor mount of  FIG.  6    in accordance with aspects of the present disclosure. 
         FIG.  8    illustrates a perspective view of the motor mount of  FIG.  6    in accordance with aspects of the present disclosure. 
         FIG.  9    illustrates a perspective view of an exemplary embodiment of a cam housing in accordance with aspects of the present disclosure. 
         FIG.  10    illustrates a rear perspective view of the cam housing of  FIG.  9    in accordance with aspects of the present disclosure. 
         FIG.  11    illustrates a rear perspective view of the cam housing of  FIG.  9    with the gears removed in accordance with aspects of the present disclosure. 
         FIG.  12    illustrates a perspective view of an exemplary embodiment of a pump head assembly in accordance with aspects of the present disclosure. 
         FIG.  13    illustrates a perspective view of the pump head assembly of  FIG.  12    with an exemplary embodiment of a gripping system and vial puck in accordance with aspects of the present disclosure. 
         FIG.  14    illustrates a perspective view of the pump head assembly, gripping system and vial puck of  FIG.  13    in accordance with aspects of the present disclosure. 
         FIG.  15    illustrates a rear perspective view of the pump head assembly, gripping system and vial puck of  FIG.  13    in accordance with aspects of the present disclosure. 
         FIG.  16    illustrates a perspective view of an exemplary embodiment of a gripping system in accordance with aspects of the present disclosure. 
         FIG.  17    illustrates a rear perspective view of the gripping system of  FIG.  16    in accordance with aspects of the present disclosure. 
         FIG.  18    illustrates a side perspective view of the gripping system of  FIG.  16    in accordance with aspects of the present disclosure. 
         FIG.  19    illustrates a top plan view of the gripping system of  FIG.  16    in accordance with aspects of the present disclosure. 
         FIG.  20    illustrates a top plan view of the gripping system of  FIG.  16    in accordance with aspects of the present disclosure. 
         FIG.  21    is a flow chart illustrating an exemplary embodiment of the steps of a process in accordance with aspects of the present disclosure. 
         FIG.  22    illustrates a perspective view of an exemplary embodiment of a cartridge in accordance with aspects of the present disclosure. 
         FIG.  23    illustrates a perspective view of an exemplary embodiment of a carousel with a cover in accordance with aspects of the present disclosure. 
         FIG.  24    illustrates a front perspective view of another exemplary embodiment of a compounding system in accordance with aspects of the present disclosure. 
         FIG.  25    illustrates another front perspective view of the compounding system of  FIG.  24    in accordance with aspects of the present disclosure. 
         FIG.  26    illustrates a front perspective view of the compounding system of  FIG.  24    with portions of the housing removed in accordance with aspects of the present disclosure. 
         FIG.  27    illustrates a rear perspective view of the compounding system of  FIG.  24    with portions of the housing removed in accordance with aspects of the present disclosure. 
         FIG.  28    illustrates an exploded perspective view of the compounding system of  FIG.  24    in accordance with aspects of the present disclosure. 
         FIG.  29    illustrates a perspective view of the compounding system of  FIG.  24    with various components shown in enlarged views for clarity in accordance with aspects of the present disclosure. 
         FIG.  30    illustrates a perspective view of the carousel of  FIG.  23    with the cover removed in accordance with aspects of the present disclosure. 
         FIG.  31    illustrates a bottom perspective view of the carousel of  FIG.  23    in accordance with aspects of the present disclosure. 
         FIG.  32    illustrates a perspective view of the carousel of  FIG.  23    with only one cartridge attached in accordance with aspects of the present disclosure. 
         FIG.  33    illustrates a bottom perspective view of the carousel of  FIG.  23    with only one cartridge attached in accordance with aspects of the present disclosure. 
         FIG.  34    illustrates a bottom perspective view of the carousel of  FIG.  23    with only one cartridge attached in accordance with aspects of the present disclosure. 
         FIG.  35    illustrates a top perspective view of the cartridges in  FIG.  23    with the carousel frame removed in accordance with aspects of the present disclosure. 
         FIG.  36    illustrates a bottom perspective view of the cartridges in  FIG.  23    with the carousel frame removed in accordance with aspects of the present disclosure. 
         FIG.  37    illustrates a perspective view of an exemplary embodiment of a cartridge with a backpack attachment in accordance with aspects of the present disclosure. 
         FIG.  38    illustrates a perspective view of the cartridge of  FIG.  37    with a transparent backpack attachment in accordance with aspects of the present disclosure. 
         FIG.  39    illustrates a perspective view of an exemplary embodiment of a carousel with cartridges including backpacks in accordance with aspects of the present disclosure. 
         FIG.  40    is a top plan view of the carousel of  FIG.  39    in accordance with aspects of the present disclosure. 
         FIG.  41    illustrates a perspective view of a cartridge with a spool retractor attached in accordance with aspects of the present disclosure. 
         FIG.  42    illustrates a perspective view of the spool retractor of  FIG.  41    in accordance with aspects of the present disclosure. 
         FIG.  43    illustrates a perspective view of the screw of  FIG.  42    inside a spool in accordance with aspects of the present disclosure. 
         FIG.  44    illustrates a perspective view of an exemplary embodiment of a carousel with an array of cartridges of  FIG.  43    in accordance with aspects of the present disclosure. 
         FIG.  45    illustrates a cross sectional view of an exemplary embodiment of a carousel with a tube retraction mechanism in accordance with aspects of the present disclosure. 
         FIG.  46    illustrates a view of the bottom portion of the carousel of  FIG.  45    in accordance with aspects of the present disclosure. 
         FIG.  47    illustrates a perspective view of a vial and carousel drive assembly for a compounding system in accordance with aspects of the present disclosure. 
         FIG.  48    illustrates an exploded perspective view of the vial and carousel drive assembly of  FIG.  30    in accordance with aspects of the present disclosure. 
         FIG.  49    illustrates a pump head assembly of a pump drive in accordance with aspects of the present disclosure. 
         FIG.  50    illustrates a cross-sectional view of an embodiment of a carousel having cartridges disposed thereon in accordance with aspects of the present disclosure. 
         FIG.  51    illustrates a perspective view of the carousel of  FIG.  50    in accordance with aspects of the present disclosure. 
         FIG.  52    illustrates a cross-sectional perspective view of a portion of the carousel of  FIG.  50    showing backpack engagement features of the carousel in accordance with aspects of the present disclosure. 
         FIG.  53    illustrates a perspective view of a mounting member for a cartridge and backpack assembly in accordance with aspects of the present disclosure. 
         FIG.  54    illustrates a cross-sectional perspective view of the carousel and backpack of  FIG.  50    showing tube management features of the backpack in accordance with aspects of the present disclosure. 
         FIG.  55    illustrates a cross-sectional perspective view of a cartridge and backpack showing tube management features of the backpack in accordance with aspects of the present disclosure. 
     
    
    
     DETAILED DESCRIPTION 
     The detailed description set forth below describes various configurations of the subject technology and is not intended to represent the only configurations in which the subject technology may be practiced. The detailed description includes specific details for the purpose of providing a thorough understanding of the subject technology. Accordingly, dimensions may be provided in regard to certain aspects as non-limiting examples. However, it will be apparent to those skilled in the art that the subject technology may be practiced without these specific details. In some instances, well-known structures and components are shown in block diagram form in order to avoid obscuring the concepts of the subject technology. 
     It is to be understood that the present disclosure includes examples of the subject technology and does not limit the scope of the appended claims. Various aspects of the subject technology will now be disclosed according to particular but non-limiting examples. Various embodiments described in the present disclosure may be carried out in different ways and variations, and in accordance with a desired application or implementation. 
     The present system comprises multiple features and technologies that in conjunction form a compounding system that can efficiently reconstitute pharmaceuticals in a sterile environment and deliver the compounded pharmaceutical to a delivery bag for use on a patient. 
       FIG.  1    illustrates a compounder system  10  according to an embodiment.  FIG.  2    illustrates the system  10  with a transparent outer housing  12  and  FIG.  3    illustrates the system with the housing removed. The system comprises a carousel assembly  14  that contains up to 10 individual cartridges  16 . The carousel  14  can hold more or less cartridges  16  if desired. The cartridges  16  are disposable and provide unique fluid paths between a vial  18  containing a powdered drug (or concentrated liquid drug), multiple diluents, and a receiving container. The cartridges  16  may, if desired, also provide a fluid path to a vapor waste container. However, in other embodiments, filtered or unfiltered non-toxic waste may be vented from the compounder to the environment reducing or eliminating the need for a waste port. Each cartridge contains a piston pump and valves that control the fluid intake, outtake, and fluid path selection during the steps of the compounding process as the fluid moves through the cartridge and into a receiving container. 
     The carousel assembly  14  is mounted on the apparatus such that it can rotate to bring different cartridges  16  into alignment with the pump drive mechanism  20 . The carousel  14  is typically enclosed within a housing  12  that can be opened in order to replace the carousel  14  with a new carousel  14  after removing a used one. As illustrated, the carousel  14  can contain up to 10 cartridges  16 , allowing a particular carousel to be used up to 10 times. In this configuration, each carousel assembly can support, for example, 10 to 100 receiving containers, depending on the type of compounding to be performed. For example, for hazardous drug compounding, a carousel assembly can support compounding to ten receiving containers. In another example, for non-hazardous drug compounding such as antibiotic or pain medication compounding, a carousel assembly can support compounding to 100 receiving containers. The housing  12  also includes a star wheel  22  positioned underneath the carousel  14 . The star wheel  22  rotates vials  18  of pharmaceuticals into position either in concert with, or separate from, the specific cartridges  16  on the carousel  14 . The housing  12  may also include an opening  24  for loading the vials  18  into position on the star wheel  22 . 
     Each one of the cartridges  16  in the carousel  14  is a disposable unit that includes multiple pathways for the diluent and vapor waste. Each cartridge  16  is a small, single disposable unit that may also include a “backpack” in which a tube for connection to the receiving container (e.g., an IV bag, a syringe, or an elastomeric bag) may be maintained. Each cartridge  16  also may also include a pumping mechanism such as a piston pump for moving fluid and vapor through the cartridge  16  as well as a duel lumen needle in a housing that can pierce a vial puck  26  on top of a vial  18  once the vial  18  has been moved into position by the pump drive mechanism  20 . For example, the needle may pierce the vial puck  26  via the compressive action of the vial puck  26 , which is moved towards the needle. Each cartridge  16  also includes a plurality of ports designed to match up with the needles of a plurality of diluent manifolds. Each cartridge  16  also includes openings to receive mounting posts and a locking bayonet from the pump head assembly  28 . Although a locking bayonet is described herein as an example, other locking mechanisms may be used to retrieve and lock a cartridge to the pump head (e.g., grippers, clamps, or the like may extend from the pump head). Each cartridge  16  also includes openings allowing valve actuators from the pump motor mechanism to interact with the valves on each cartridge  16 . 
     Adjacent the housing  12  that holds the vials  18  and the carousel  14  is an apparatus  30  for holding at least one container  32 , such as an IV bag  32  as shown in the figures. The IV bag  32  typically has two ports such as ports  34  and  36 . For example, in one implementation, port  34  is an intake port  34  and port  36  is an outlet port  36 . Although this implementation is sometimes discussed herein as an example, either of ports  34  and  36  may be implemented as an input and/or outlet port for container  32 . For example, in another implementation, an inlet  34  for receiving a connector at the end of tubing  38  may be provided on the outlet port  36 . In the embodiment, shown, the IV bag  32  hangs from the holding apparatus  30 , which, in one embodiment is a post with a hook as illustrated in  FIGS.  1 - 3   . One or more of the hooks for hanging containers such as diluent containers, receiving containers, or waste containers may be provided with a weight sensor such as a load cell that detects and monitors the weight of a hung container. The holding apparatus  30  can take any other form necessary to position the IV bag  32  or other pharmaceutical container. Once the IV bag  32  is positioned on the holding apparatus  30 , a first tube  38  (a portion of which is shown in  FIG.  1   ) is connected from a cartridge  16  on the carousel  14  to the inlet  34  of the IV bag  32 . For example, the first tube may be housed in a backpack attached to the cartridge and extended from within the backpack (e.g., by an operator or automatically) to reach the IV bag  32 . A connector  37  such as a Texium® connector may be provided on the end of tube  38  for connecting to inlet  34  of receiving container  32 . 
     On the opposite side of the compounder  10  is an array of holding apparatuses  40  for holding multiple IV bags  32  or other containers. In the illustrated version of the compounder  10 , five IV bags  42 ,  44  are pictured. Three of these bags  42  may contain diluents, such as saline, D5 W or sterile water, although any diluent known in the art may be utilized. An additional bag in the array may be an empty vapor waste bag  44  for collecting waste such as potentially hazardous or toxic vapor waste from the mixing process. An additional bag  44  may be a liquid waste bag. The liquid waste bag may be configured to receive non-toxic liquid waste such as saline from a receiving container. Liquid waste may be pumped to the waste bag via dedicated tubing using a mechanical pump. In operation, diluent lines and a vapor waste line from the corresponding containers  42  and  44  may each be connected to a cartridge  16  through a disposable manifold. 
     The compounding system  10  also includes a specialized vial puck  26  designed to attach to multiple types of vials  18 . In operation, the vial puck  26  is placed on top of the vial  18  containing the drug in need of reconstitution. Once the vial puck  26  is in place, the vial  18  is loaded into the star wheel  22  of the compounder  10 . Mating features on the vial puck  26  provide proper alignment both while the vial puck  26  is in the star wheel  22  and when the vial puck  26  is later rotated into position so that the compounder  10  can remove it from the star wheel  22  for further processing. 
     The pump drive mechanism  20  is illustrated in  FIG.  4   , and in an exploded view in  FIG.  5   , according to an embodiment. In the embodiment shown in  FIGS.  4  and  5   , the pump drive mechanism  20  comprises a multitude of sections. At one end of the pump drive mechanism  20  is the rotation housing  46 , which holds the drive electronics and includes locking flanges  94  on its housing  96  for flexible tubing  50  which may run from one or more diluent containers and/or waste containers to one or more corresponding manifolds. The rotation housing  46  is capable of rotating around its axis to rotate the rest of the pump drive mechanism  20 . The rotation housing  46  includes bearing ribs  52  on its ends which allow it to rotate. For example, the pump drive mechanism may be configured to rotate through any suitable angle such as up to and including 180.degree., or more than 180.degree. 
     Next to the rotation housing  46  is the motor mount  54 , which is shown alone from various angles in  FIGS.  6 - 8   , according to an embodiment. In the embodiment shown in  FIGS.  4 - 8   , the cam housing  56 , shown in further details from various angles  FIGS.  9 - 11   , is connected to the motor mount  54 , which includes cams and gears that control the rotary motion of the motors and the axial motion of the pump drive mechanism  20  as it moves into position to pick up a cartridge  16  and a vial  18 . 
     The compounder system also includes a diluent magazine (not shown) that mounts in a slot  60  located on the side of the pump drive mechanism. The diluent magazine may be a disposable piece configured to receive any number of individual diluent manifolds operable as diluent ports. The diluent manifolds (not shown) may be modular so they can easily and removably connect to each other, the magazine, and/or connect to the pump drive mechanism  20 . 
     The final portion of the pump drive mechanism  20  is the pump head assembly  28 . The pump head assembly  28  includes the vial grasping arms  76 , the vial lift  78 , the pump cartridge grasp  80 , the pump piston eccentric drive shaft  82  with arm  222 , the valve actuation mechanisms  84 , as well as the motors that allow the pump drive mechanism  20  to move forward and back and to rotate in order to mix the pharmaceutical in the vial  18  once the diluent has been added to it. The compounder  10  may also include an input screen  86  such as a touch screen  86  as shown in the figures to provide data entry by the user and notifications, instructions, and feedback to the user. 
     The operation of the compounder system  10  will now be generally described in the flowchart illustrated at  FIG.  21   , according to an embodiment. In the first step  88 , a user inserts a new diluent manifold magazine having a plurality of manifolds (e.g., diluent manifolds and waste manifolds) into the slot  60  on the side of the pump head assembly  28 . Manifolds may be loaded into the magazine before or after installing the magazine in the slot  60 . The manifolds maintain needles inside the housing of the manifold until the cartridge  16  is later locked in place. The magazine may contain any number of diluent manifolds and vapor waste manifolds. In one illustrative system, there may be three diluent manifolds and one vapor waste manifold. In the next step  92 , diluent tubing is connected to corresponding diluent bags. The tubes may be routed through locking flanges on a surface (e.g., the front surface) of the compounder frame to hold them in place. For example, in the illustrated embodiment of  FIG.  24   , the tubes are held in place with locking flanges  2402  on the frame of the compounder. Alternatively, other types of clips or locking mechanisms known in the art may be used to hold the tubes securely in place. In the illustrated embodiment of  FIG.  4   , the additional flanges  94  positioned on the outside housing  96  of the pump drive mechanism  20  are provided for securing internal wiring of the compounder. In the next step  98 , waste tubing may be connected to the vapor waste bag  44 . In other embodiments, tubing may be pre-coupled between the manifolds and associated containers such as diluent containers and/or waste containers and the operations of steps  92  and  98  may be omitted. 
     If desired, in the next step  100 , a new carousel  14  may be loaded into a carousel mounting station such as a carousel hub of the compounder system. The carousel  14  may contain any number of disposable cartridges  16  arranged in a generally circular array. In the next step  110 , a vial puck  26  is attached to the top of a vial  18  of a powdered or liquid pharmaceutical for reconstitution and the vial  18  is loaded into the star wheel  22  under the carousel  14  in the next step  112 . Step  110  may include loading multiple vials  18  into multiple vial puck recesses in star wheel  22 . After one or more vials are loaded into the star wheel, the vials are rotated into position to enable and initiate scanning of the vial label of each vial. In one embodiment, the user will be allowed to load vials into the star wheel until all vial slots are occupied with vials before the scanning is initiated. A sensor may be provided that detects the loading of each vial after which a next vial puck recess is rotated into the loading position for the user. Allowing the user to load all vials into the star wheel prior to scanning of the vial labels helps increase the efficiency of compounding. However, in other implementations, scanning of vial labels may be performed after each vial is loaded or after a subset of vials is loaded. Following these setup steps, the next step  114  is for a user to select the appropriate dosage on the input screen. 
     After the selection on the input screen  86 , the compounder  10  begins operation  116 . The star wheel  22  rotates the vial into alignment  118  with the vial grasping calipers  76  of the pump head assembly  28 . The vial puck  26  includes, for example, gears that interface with gears coupled to a rotational motor that allow the vial  18  to rotate 120 so that a scanner (e.g., a bar code scanner or one or more cameras) can scan  122  a label on the vial  18 . The scanner or camera (and associated processing circuitry) may determine a lot number and an expiration date for the vial. The lot number and expiration date may be compared with other information such as the current date and/or recall or other instructions associated with the lot number. Once the vial  18  is scanned and aligned, in the next step  124  the pump drive mechanism  20  moves forward into position to grip the vial  18  with the calipers  76 . The forward movement also brings the mounting posts  130  and locking bayonet  128  on the front of the pump head assembly  28  into matching alignment with corresponding openings on a cartridge  16 . In the next step  126  the cartridge  16  is locked in place on the pump head assembly  28  with the locking bayonet  128  and the calipers  76  grip  132  the vial puck  26  on the top of the vial  18 . The calipers  76  then remove  132  the vial  18  from the star wheel  22  by moving backward, while at the same time pulling  134  the cartridge  16  off of the carousel  14 . 
     In some embodiments, the cartridge  16  includes a backpack that includes a coiled tube. In this embodiment, in step  136  the pump drive mechanism  20  tilts the cartridge  16  toward the user to expose the end of the tube and prompts  138  the user to pull the tube out of the backpack and connect it to the receiving bag  32 . In an alternative embodiment, the tube  38  is exposed on the side of the carousel  14  once the cartridge  16  is pulled away from the carousel  14 . In another alternative embodiment, the tube  38  is automatically pushed out (e.g., out of the backpack) thus allowing the user to grab onto the connector located at the end of the tube and connect to the receiving container. The system prompts  138  the user to pull the tube out from the carousel  14  and connect it to the input  34  of the IV bag  32 . Once the tube  38  is connected, in step  140  the user may notify the compounder  10  to continue the compounding process by interacting with the input screen  86 . 
     At step  142 , the vial  18  is pulled up towards the cartridge  16  so that one or more needles such as a coaxial dual lumen needle of the cartridge  16  pierce the top of the vial puck  26  and enter the interior of the vial  18 . Although the example of  FIG.  21    shows engagement of the needle with the vial puck after the user attaches the tube from the cartridge to the receiving container, this is merely illustrative. In another embodiment, steps  138  and  140  may be performed after step  142  such that engagement of the needle with the vial puck occurs before the user attaches the tube from the cartridge to the receiving container. 
     Diluent is pumped at step  144  into the vial  18  through the cartridge  16  and a first needle in the proper dosage. If necessary, a second or third diluent may be added to the vial  18  via a second or third diluent manifold attached to the cartridge  16 . Simultaneously, vapor waste is pumped  144  out of the vial  18 , through a second needle, through the cartridge  16  and the vapor waste manifold, and into the vapor waste bag  44 . The valve actuators  84  on the pump head assembly  28  open and close the valves of the cartridge  16  in order to change the fluid flow paths as necessary during the process. Once the diluent is pumped into the vial  18 , the pump drive mechanism  20  agitates the vial  18  in the next step  146  by rotating the vial lift  78  up to, for example 180 degrees such that the vial  18  is rotated between right-side-up and upside-down positions. The agitation process may be repeated for as long as necessary, depending on the type of pharmaceutical that is being reconstituted. Moreover, different agitation patterns may be used depending on the type of drugs being reconstituted. For example, for some drugs, rather than rotating by 180 degrees, a combination of forward-backward, and left-right motion of the pump head may be performed to generate a swirling agitation of the vial. A plurality of default agitation patterns for specific drugs or other medical fluids may be included in the drug library stored in (and/or accessible by) the compounder control circuitry. Once the agitation step is complete, the pump drive mechanism rotates the vial to an upside down position or other suitable position and holds it in place. In some embodiments, a fluid such as a diluent already in the receiving container  32  may be pumped (e.g., through the cartridge or via a separate path) into a liquid waste container to allow room in the receiving container for receiving the reconstituted medicine. 
     In the next step  148 , the valve actuators  84  reorient the valves of the cartridge and the pumping mechanism of the cartridge  16  is activated to pump  150  the reconstituted drug into the receiving bag  32  through the attached tube. Once the drug is pumped into the receiving bag  32 , in the next step  152  the pump drive mechanism  20  clears the tube  38  by either pumping filtered air or more diluent through the tube  38  into the receiving bag  32  after another valve adjustment to ensure that all of the reconstituted drug is provided to the receiving bag  32 . In some scenarios, a syringe may be used as a receiving container  32 . In scenarios in which a syringe is used as the receiving container  32 , following delivery of the reconstituted drug to the syringe, a vacuum may be generated in tube  38  by pump drive mechanism  20  to remove any air or other vapors that may have been pushed into the syringe so that, when the syringe is removed from tube  38 , the reconstituted drug is read for delivery to a patient and no air or other unwanted gasses are present in the syringe. 
     The system then prompts  154  the user to remove the tube  38  from the receiving container  32 . The user may then insert the connector (e.g., a Texium® or SmartSite® connector) into its slot in the backpack or carousel and an optical sensor in the pump head may sense the presence of the connector and automatically retract the tube into either the carousel or the backpack. The tube is pulled back into either the carousel  14  or the backpack, depending on which type of system is in use. In the next step  156 , the compounder  10  rotates the vial  18  back into alignment with the star wheel  22  and releases it. The used cartridge  16  may also be replaced on the carousel  14 . The used cartridge may be released when a sensor in the pump drive determines that the tube has been replaced in the cartridge (e.g., by sensing the presence of a connector, such as a Texium® connector, at the end of the tube in the backpack of the cartridge through a window of the cartridge). The carousel  14  and/or star wheel  22  then may rotate 158 to a new unused cartridge  16  and/or a new unused vial  18  and the process may be replicated for a new drug. In some circumstances (e.g., multiple reconstitutions of the same drug), a single cartridge may be used more than once with more than one vial. 
     The cartridges  16  are designed to be disposable, allowing a user to utilize all the cartridges  16  in a given carousel  14  before replacing the carousel  14 . After a cartridge  16  is used, the carousel  14  rotates to the next cartridge  16 , and the system software updates to note that the cartridge  16  has been used, thus preventing cross-contamination from other reconstituted drugs. Each cartridge  16  is designed to contain all the necessary flow paths, valves, filters and pumps to reconstitute a drug with multiple diluents if necessary, pump the reconstituted drug into the receiving container, pump vapor waste out of the system into a waste container, and perform a final QS step in order to make sure that the proper amount of drug and diluent is present in the receiving container. This complete package is made possible by the specific and unique construction of the cartridge  16 , its flow paths, and its valve construction. 
     An embodiment of a cartridge  16  is illustrated in  FIG.  22   . As shown in  FIG.  22   , cartridge  16  may include a cartridge frame  160 , a cartridge bezel  164 , as well as a piston pump  166 , a needle housing  168  and a needle assembly  170 . The cartridge frame  160  provides the main support for each cartridge  16  and includes diluent chambers, a vapor waste chamber, a pumping chamber, a hydrophobic vent, an exit port, and/or other features as described hereinafter that can be connected to a tube that connects to the receiving container  32 . 
     The frame  160  of the cartridge  16  also includes locating features that allow each cartridge  16  to be removably mounted to the pump head assembly  28 . These features include, for example, three openings  198  to receive mounting posts  130  from the pump head assembly  28 , and a keyhole  210  that allows a locking bayonet  128  to be inserted therein and turned to lock the cartridge  16  to the pump head assembly  28  for removal from the carousel  14 . An outlet port extension  220  may be present in some embodiments. The piston pump  166  is mounted within a chamber with a rod  194  positioned within a silicone piston boot. Furthermore, the bezel  164  includes openings  228  in which the valves  190  of the sealing membrane are located and be accessed by the valve actuators  84 . Moreover, the bezel  164  includes openings  230  that allow a fluid manifold to be connected to the diluent and vapor waste chambers in the cartridge  16 . Bezel  164  may also include an opening that facilitates the detection of a connector (e.g., a Texium® or SmartSite® connector) when the user inserts the connector into the provided slot when compounding is complete. In operation, the needles of the fluid manifold enter through the openings  230  in the bezel  164  and pierce the sealing membrane to gain fluidic access to the diluent and vapor waste chambers defined in the cartridge  16  between the sealing membrane and the cartridge frame  160 . Further details of various embodiments of the cartridge  16  will be discussed hereinafter. 
     Referring to  FIG.  23   , an exemplary embodiment of a carousel  14  removed from the compounder  10  is illustrated, according to an embodiment. The carousel  14  of  FIG.  23    includes an array often cartridges  16  in this embodiment, but it should be understood that more or fewer cartridges  16  can be present on the carousel  14 , leaving some of the carousel  14  pockets  500  empty, or the frame  510  of the carousel can be designed to have more or fewer cartridge pockets  500 . The carousel  14  also includes a cover  511  that prevents a user from accessing the tubes coupled to each of the cartridges  16  directly. The cover  511  may be removed if necessary to access the backs of the cartridges  16 . In the example implementation of  FIG.  23   , a connector such as a Texium® attachment  548  is disposed adjacent each cartridge  16 , the attachment  548  being attached to the tube  38  that runs from the extension  220  on each cartridge  16 . 
       FIGS.  24 - 29    show the compounder  10  according to another embodiment. As shown in  FIG.  24   , holding apparatus  40  may be implemented as an extended arm providing support for mounting devices for each of containers  42  and  44 . Holding apparatus  40  and holding apparatus  30  may each include one or more sensors such as weight sensors configured to provide weight measurements for determining whether an appropriate amount of fluid has been added to or removed from a container or to confirm that fluid is being transferred to and/or from the appropriate container (e.g., that the appropriate diluent is being dispensed). A scanner  2404  may be provided with which each diluent container and/or the receiving container can be scanned before and/or after attachment to compounder  10 . As shown in  FIG.  24   , a carousel cover  2400  and tube management structures  2402  may also be provided on compounder  10  in various embodiments. For example, tubes connected between containers  42  and/or  44  and corresponding manifolds can each be mounted in a groove of tube management structure  2402  to prevent tangling or catching of the tubes during operation of compounder  10 . 
     As shown in  FIG.  25   , an opening  2502  may be provided by which vials  18  can be installed in the star wheel. Additionally, an exterior pump  2500  may be provided for pumping non-toxic liquid waste from, for example, receiving container  32  to a waste container  44  (e.g., for pumping a desired amount of saline out of receiving container  32  quickly and without passing the liquid waste through a cartridge and/or other portions of the compounder). 
     A fluidics module  2504  may be provided that includes several container mounts  2506 . Container mounts  2506  may be used for hanging diluent and waste containers and may include sensor circuitry for sensing when a container has been hung and/or sensing the weight of the container. In this way, the operation of compounder  10  can be monitored to ensure that the correct diluent contain has been scanned and hung in the correct location and that the waste is being provided in an expected amount to the appropriate waste container. 
     As shown in  FIG.  26   , pump  2500  and display  86  may be mounted to a chassis  2600 . Pump drive  20  may be mounted partially within the chassis  2600  with pump head assembly  28  extending from the chassis to a position which allows the pump head assembly to rotate (e.g., to turn over or agitate a vial). Carousel  14  is also shown in  FIG.  26    without any cartridges mounted therein so that cartridge mounting recesses  500  can be seen. 
     Star wheel  22  (sometimes referred to herein as a vial tray) is shown in  FIG.  26    with several empty vial puck recesses  2604 . Vial tray  22  may be rotated and an actuating door  2608  may be opened to facilitate loading of vials  18  into the vial puck recesses  2604  in vial tray  22 . In some embodiments, door  2608  may be closed before rotation of vial tray  22  to ensure that the operator&#39;s fingers are not in danger of injury from the rotating tray. However, this is merely illustrative. In other embodiments a sensor such as sensor  2650  (e.g., a light curtain) may be provided instead of (or in addition to) door  2608  to sense the presence of an operator in the vicinity of tray  22  and prevent rotation of the tray if the operator or any other obstruction is detected. 
     Similarly, a lid may be provided for carousel  14  to prevent contamination of cartridges  16  loaded therein, and to prevent injury to an operator due to rotation of the carousel. A lid sensor (not shown) may also be provided to detect the position (e.g., an open position or a closed position) of the lid. Rotation of carousel  14  may be prevented if the lid is not detected in a closed position by the lid sensor. 
     Each vial  18  that is inserted may be detected using a sensor such as sensor  2652  (e.g., a load sensor or an optical sensor) when placed in a vial puck recess  2604 . When detected, the inserted vial may be moved to a scanning position by rotating vial tray  22  and then the inserted vial  18  may be rotated within its position in vial tray  22  using a vial rotation motor  2602  to allow the vial label to be scanned. 
     A reverse perspective view of compounder  10  is shown in  FIG.  27    in which scanning components can be seen. In particular, a camera  2700  is mounted in an opening in chassis  2600  and configured to view a vial  18  in a scanning position. Motor  2602  may rotate vial  18  through one or more full rotations so that camera  2700  can capture images of the vial label. In some embodiments, an illumination device  2702  (e.g., a light-emitting diode or other light source) may be provided that illuminates vial  18  for imaging with camera  2700 . 
     As shown in  FIG.  27    one or more gears  2704  coupled to motor  2602  may be provided that engage corresponding gears on a vial puck  26  to which a vial  18  is attached at the scanning position. The vial tray  22  may be rotated so that the vial puck gears engage the rotation motor gears so that when the motor  2602  is operated the vial  18  is rotated. 
       FIG.  27    also shows how a magazine  2706  containing one or more manifolds may be mounted in a recess in pump head assembly  28 . A magazine slot in magazine  2706  for the vapor waste manifold may be keyed to prevent accidental connection of a diluent manifold in that slot (or a waste manifold in a diluent slot in the magazine). Other diluent slots in magazine  2706  may have a common geometry and thus any diluent manifold can fit in the magazine diluent slots. One or more manifold sensors such as manifold sensor  2750  (e.g., an optical sensor) may be provided in the manifold recess in pump head assembly  28 . Manifold sensor  2750  may be configured to detect the presence (or absence) of a manifold in a manifold recess (slot) in magazine  2706  to ensure that an appropriate manifold (e.g., a diluent manifold or waste manifold) is loaded at the expected position for compounding operations. In this way, the pump head may detect a manifold presence. The pump head and/or manifold sensors may communicate with the diluent load sensors to ensure proper positioning of the diluent manifolds. Various operational components  2708  such as valve actuators, needle actuators, mounting posts, a locking bayonet, and a drive pin can also be seen extended from pump head assembly  28  which are configured to secure and operate a pump cartridge  16  (e.g., as described above in connection with  FIG.  4   ). 
     An exploded view of various components of compounder  10  is shown in  FIG.  28   . Components discussed above such as display  86 , pump  2500 , dose hanger  30 , fluidics module  2504 , pump drive  20  with pump head assembly  28 , camera  2700 , and lighting device  2702  are shown. Additional components such as a chassis base  2810  and chassis housing  2812  of chassis  2600  are also shown in  FIG.  28   . A rear panel  2802  having an electronics assembly  2803  can be mounted to chassis housing  12  and pump drive  20  may be seated in an opening  2808  in chassis housing  2812  that allows pump head assembly  28  to protrude from chassis housing  2812 . Processing circuitry for managing operations of compounder system  10  may be included in electronics assembly  2803 . 
     A vial tray and carousel drive assembly  2800  is also shown in which actuating door  2608  and a carousel hub  2814  can be seen. Carousel  14  may be placed onto carousel hub and rotated by vial tray and carousel drive assembly  2800  operating to rotate hub  2814  to move a selected cartridge in the carousel into position to be retrieved and operated by pump drive  20 . Vial tray and carousel drive assembly  2800  may include separate drive assemblies for the vial tray and for the carousel such that vial tray  22  and carousel  14  may be rotated independently. 
       FIG.  29    shows another perspective view of compounder  10  highlighting the locations of various particular components such as the carousel  14  with cartridges  16  mounted therein, a cartridge  16  having a backpack  2900 , a vial puck  26  for mounting vials  18 , and pump head assembly  28  with a diluent magazine  2706  containing a plurality of manifolds  2906  in accordance with an embodiment. Further features of the carousel will be described hereinafter in connection with  FIGS.  30 - 57   . 
     Turning now to  FIG.  30   , the carousel  14  of  FIG.  23    is shown with the cover  511  removed. In the example of  FIG.  30   , the carousel  14  comprises a frame  510  to support the cartridges  16  in pockets  500  around the outside of the frame  510 . As described in further detail hereinafter, these pockets  500  are designed such that the individual cartridges  16  may slide into the pockets  500  and lock in place. Typically, the cartridges  16  are not removed by a user, but the pockets may include a release mechanism so that individual cartridges  16  can be removed and replaced with fresh ones. 
     Referring to  FIGS.  30 - 36   , various views of the carousel  14 , cartridges  16  and frame  510  are illustrated in accordance with one or more embodiments. The frame  510  includes an outer wall  512 , an inner wall  514 , pocket walls  516 , side walls  518 , a support ring  520  and support posts  522  in  FIGS.  32 - 34   . In an alternative embodiment shown in  FIGS.  30  and  31   , the carousel  14  includes an outer wall  512 , an inner wall  514 , pocket walls  516  and a support floor  542  with openings  544  defined therein. 
     Referring to  FIGS.  30 ,  31 ,  45  and  46   , an embodiment of the carousel  14  and frame  510  is illustrated. This embodiment includes an outer wall  512 , an inner wall  514 , pocket walls  516  and a support floor  542  with a plurality of openings  544  defined therein. The outer wall  512  includes a cartridge opening  524  at each position where a cartridge  16  is mounted. This cartridge opening  524  allows the extension  220  of the cartridge  16  to protrude into the interior of the frame  510  of the cartridge  16 , through the cartridge pocket  500 . The outer wall  512  also includes mounting posts  522  on the front  530  of the outer wall  512  that are inserted into openings on the back of the cartridge  16  to hold the cartridge  16  in place while also allowing easy removal of the cartridge  16  from the carousel  14  by the pump head assembly  28  when the cartridge  16  is in use. A pair of pocket walls  516  extend from the back of the outer wall  512  and connect to front  534  of the inner wall  514  to form each pocket  500 . The inner wall  514  is generally concentric with the outer wall  512 . The inner wall  514  has an opening  536  defined therein allowing the extension  220  of each cartridge  16  to protrude into the interior of the carousel  14 . The inner wall  514  also includes an opening  546  near the bottom side of the inner wall  514 . This opening  546  provides a mounting point for a connector such as a Texium® attachment  548  that are each attached to the tube  38  that runs from the extension  220  on each cartridge  16 . The Texium® attachment  548  can be pulled out by a user when the specific cartridge  16  is ready for use. A support floor  542  is connected to the back  550  of the inner wall and extends across the interior of the carousel  14 . This support floor  550  is positioned between the cartridge openings  524  and the inner wall openings  536 . Extension  220  may be provided as a tube management structure and may include an opening  1801  through which a tube (e.g., a tube from outlet port  180 ) can be fed to prevent tangling or other interference between tubes of various cartridges. In operation, a support tube  38  may be routed through each extension  220  and routed through a support floor opening  544  and attached to the Texium® attachment  548 . In this way, the tubes  38  are kept separate from each other to prevent kinking and tangling, but a user may freely pull out the attachment  548  and the tube  38  from the carousel  14 .  FIGS.  35  and  36    show the array of cartridges  16  and Texium® attachments  548  without the frame  510  attached for clarity. 
     Referring to the illustrated embodiment in  FIGS.  32 - 34   , the outer wall  512  forms the outside surface of the frame  510  of the carousel  14 . The outer wall  512  includes a cartridge opening  528  at each position where a cartridge  16  is mounted. This cartridge opening  528  allows the extension  220  of the cartridge  16  to protrude into the interior of the frame  510  through the cartridge pocket  500 . The outer wall  512  also includes mounting posts  522  on the front  530  of the outer wall  512  that are inserted into openings on the back of the cartridge  16  to hold the cartridge  16  place while also allowing easy removal of the cartridge  16  from the carousel  14  by the pump head assembly  28  when the cartridge  16  is in use. A pair of pocket walls  516  extend from the back of the outer wall  512  and connect to front  534  of the inner wall  514  to form each pocket  500 . The inner wall  514  is generally concentric with the outer wall  512 . The inner wall  514  has an opening  536  defined therein that allows the extension  220  of each cartridge  16  to protrude into the interior of the carousel  14 . At each point  538  where the outer wall  512 , inner wall  514  and pocket wall  518  intersect, a side wall  520  extends towards the middle  540  of the carousel  14 . These side walls  520  connect to a supporting ring  520  in the middle  540  of the carousel  14  and provide extra support for the carousel  14  while also keeping the tubes  38  from each cartridge  16  separate. A support post  522  extends between each side wall  518  for additional support. 
     An embodiment of the cartridge  16  utilizing a tube management structure implemented as a “backpack” to retain the flexible tubing  38  is illustrated in  FIGS.  37 - 40   . The backpack  298  is attached to the back  200  of the cartridge frame  16  and one end of the flexible tube  38  is attached to the outlet port  180  on the back  200  of the cartridge frame  16 . The backpack  298  comprises a housing with an opening for a Texium® attachment  300  attached to the tube  38  from the outlet port  180  on the cartridge  16  so a user can pull the Texium® attachment  300  out of the backpack  298 , pull tubing  38  from within the backpack and attach it to the receiving container  32 . 
       FIGS.  39  and  40    illustrate a carousel  14  with an implementation of a backpack tube management feature of the cartridges  16  installed. This embodiment also includes an outer wall  512 , an inner wall  514 , pocket walls  516  and a support floor  542  with a plurality of openings  544  defined therein. The outer wall  512  includes a cartridge opening  524  at each position where a cartridge  16  is mounted. In this embodiment, the cartridge opening  524  is large enough to allow the backpack  298  to protrude into the interior of the carousel  14 . The support floor  542  extends from the back  550  of the inner wall  514  and may be positioned such that the backpack  298  is supported thereon in one embodiment. In some embodiments, backpack  298  may be configured to snap or otherwise be guided into and secured in a corresponding slot in carousel  16 . In these embodiments, when the cartridge  16  is pulled out of the carousel  14  by the pump head assembly  28 , the backpack  298  is accessible by a user and the user may pull the Texium® attachment  300 , along with associated tubing, out of the backpack  298  to connect it to the receiving container  32 . 
       FIGS.  41 - 44    illustrate another alternative embodiment of a retraction mechanism for tube management and the associated carousel  14 . In this embodiment, a screw  312  is enclosed in a screw chamber  314 . The screw chamber  314  is generally cylindrical and has an opening  552  on the side to allow a tube  38  to coil into the threads of the screw  312 . As the screw  312  rotates, the tube  38  is drawn along the threads of the screw to retract the tube  38 . A gear  554  is defined on one end of the screw chamber  314 . A gear  556  is also defined on a post extending from the screw  312 . The screw chamber  314  also includes an opening  560  at an end thereof such that when the screw  312  is inserted into the screw chamber  314 , the gear  556  on the screw  312  extends out through the opening  560 . As illustrated in  FIG.  41   , the screw chamber  314  is mounted on the back of the frame  160  of a cartridge  16  with the gear  556  on the screw  312  extending through the cartridge  16  and protruding out of the front of the cartridge  16 . 
     Another embodiment of a retraction mechanism and the associated carousel  14  is illustrated in  FIGS.  45  and  46   . In this embodiment, a bottom support  562  is defined near the bottom of the carousel  14 . The bottom support  562  is defined as an annular ring that matches the inside dimensions of the inner wall  514  of the carousel  14  and includes an opening  564  defined therein. Texium® attachments  548  are mounted in the openings  546  near the bottom sides of the inner wall  514 . Tubes  38  running from the outlet port  180  through extension  220  on each cartridge  16  are attached to each Texium® attachment  548 . A gearing mechanism  566  is mounted on the bottom support  562  behind each Texium® attachment  548 . The gearing mechanism  566  is comprised of two gears  568  mounted on the bottom support  562  such that rotation of the carousel  14  causes the gears  568  to rotate as well. Each gear  568  has an extension  570  with concave sides mounted on a post  572  that extends through the gear  568  and through a panel  574  on top of the extension  570 . A locking post  576  is positioned on top of each post  572  on top of the panel  572  to maintain the position of the post  572  while allowing it to rotate freely. In operation, each tube  38  is threaded through the two extensions  570  and then attached to the Texium® attachment  548 . 
     Turning now to  FIG.  47   , a perspective view of a vial and carousel drive assembly  3000  is shown, according to an embodiment. In the example, of  FIG.  47   , vial tray  22  has been rotated so that a vial  18  is in an imaging position  3001  at which the label on the vial may be imaged. In the imaging position  3001 , gears  3002  of the vial puck that is attached to the vial  18  are engaged with gears  2704  of motor  2602 . In this way, motor  2602  can be operated to rotate vial  18  while vial  18  is in the vial recess of vial tray  22  at the imaging position. While motor  2602  rotates vial  18 , a camera such as  2700  (see, e.g.,  FIGS.  27  and  28   ) may capture images of the label on vial  18 . A light source such as light source  2702  may be operated to illuminate at least a portion of the label while the images are captured. Light source  2702  may be a line-wise light source configured to illuminate a vertical line on the vial so while the vial is rotated so that each captured image includes an image of a vertical line on the vial. The vertical line images may be combined using processing circuitry associated with the camera and/or processing circuitry such as one or more processors for the compounder system to form a rectilinear image of the entire vial label. 
       FIG.  48    shows an exploded perspective view of the vial and carousel drive assembly  3000 . As shown in  FIG.  48   , assembly  3000  may include a carousel support frame  3100  having legs  3106  on which the carousel hub  2814  and vial spin drive  2602  are mounted. Assembly  3000  may also include a drive mechanism having one or more additional motors such as motor  3108  configured via a plurality of gears and/or belts to actuate door  2608 , rotate vial tray  22 , and/or rotate carousel hub  2814  to rotate a carousel of cartridges mounted thereon. As shown, vial tray  22  may be disposed at least partially between carousel support frame  3100  and drive mechanism  3104 . 
     As shown in  FIGS.  47  and  48   , carousel hub  2814  may have a polygonal shape. Carousel  14  may be provided with a central opening having a corresponding polygonal shape so that, when carousel  14  is placed onto carousel hub  2814  and carousel hub  2814  is rotated, the carousel is correspondingly rotated. However, this is merely illustrative. Carousel hub  2814  may be provided with other shapes such as a “D” shape or any other suitable shape that corresponds to the shape of the central opening in carousel  14  such that, when carousel  14  is placed onto carousel hub  2814  and carousel hub  2814  is rotated, the carousel is correspondingly rotated. As shown in  FIG.  48   , drive mechanism  3104  may have an extension  3114  that extends into carousel hub  2814  to rotate hub  2814  responsive to operation of a motor of drive mechanism  3104 . 
       FIG.  49    shows another embodiment of the pump head assembly  28 . As shown, in the embodiment of  FIG.  49   , pump head assembly  28  includes vial grasping arms  76 , vial lift  78 , pump piston eccentric drive shaft  82 , valve actuation mechanisms  84 , as well as the motors (not explicitly shown) that allow the pump drive mechanism  20  to move forward and back and to rotate in order to mix the pharmaceutical in the vial  18  once the diluent has been added to it. As shown in  FIG.  49   , bayonet  128  may include an end portion  4900  that forms the top of a T-shaped bayonet. In this embodiment, the end portion  4900  may be rotated to actuate a release mechanism of a cartridge backpack to release the backpack and cartridge from the carousel and to simultaneously bear against a ramp portion of the cartridge to lift and pull the cartridge and backpack from the carousel. Further details of the cartridge/backpack release mechanism and the ramp portions of the cartridge are discussed hereinafter in connection with  FIGS.  50 - 55    in accordance with one or more embodiments. 
     As shown in  FIG.  49   , pump head assembly  28  may include other devices and structures such as a pressure sensor  4904  configured to sense the pressure in a fluid pathway in a pump cartridge, an air-in-line sensor  4906  configured to receive an air-in-line fitment of a pump cartridge, and a connector sensor  4902  configured to view a connector such as a Texium® connector in a backpack of a pump cartridge for determining whether the connector has been placed into the backpack to determine whether to release the cartridge and backpack from the pump head assembly and back into the carousel (e.g., by turning bayonet  128  in a direction opposite to the direction the bayonet was turned to lift and pull the cartridge from the bayonet). 
       FIG.  50    shows a cross sectional view of a carousel  14  having a plurality of cartridge and backpack assemblies  3203  mounted in corresponding cartridge pockets  500  in accordance with one or more embodiments. As shown in  FIG.  50    a connector  4002  such as a Texium® connector may be disposed in an opening in each backpack  3202  of each cartridge and backpack assembly  3203 . The connector  4002  may be disposed at an end of tubing  4000  (e.g., an implementation of tubing  38  of  FIG.  1   ) that extends from the connector into the internal cavity of each backpack  3202  and connects to an output port of the cartridge  16  attached to that backpack. A perspective view of carousel  14  is shown in  FIG.  51   . As shown in  FIG.  51   , cartridge and backpack assemblies  3203  may be disposed around the circumference of carousel  14  and carousel  14  may include recesses  4009  in an upper surface  4013  for accommodating tubing  4000  and connector  4002  of each cartridge and backpack assembly  3203 . Carousel  14  may also include a bottom surface  4015  having a plurality of extensions  4017  that each extends downward therefrom and each has a recess  4011  that accommodates needle housing  168  of a corresponding cartridge and backpack assembly  3203 . Extensions  4017  may have a protective bottom surface  4019  that runs underneath a needle housing  168  of an installed cartridge and prevents actuation of the needle housing that could expose an operator to the needle assembly therein. Protective bottom surface  4019  may also serve as a surface for collecting any small amount of drug that may inadvertently drip from the needle (or needle housing) of the cartridge  16 ). A handle  4026  may be provided that facilitates user installation of a new carousel of cartridges onto carousel hub  2814  and removal of a carousel with used cartridges from the carousel hub. 
     A central opening  4005  can also be seen in the cross-sectional view of  FIG.  50   . As shown, central opening  4005  may be a substantially cylindrical opening with a portion having slatted planar walls that together for a polygonal pattern  4007  that corresponds to the polygonal shape of carousel hub  2814 . 
       FIG.  52    is a cross-sectional perspective view of a portion of a cartridge and backpack assembly  3203  that is mounted to carousel  14 . As shown in  FIG.  52   , carousel  14  may include an extended portion  4102  of top surface  4013  that extends over cartridge and backpack assembly  3203  in cartridge pocket  500  and includes a recess  4100  on an inner surface that is configured to receive protrusion  3206  of structure  3200  of cartridge and backpack assembly  3203  to secure cartridge and backpack assembly  3203  within pocket  500 . Carousel  14  may also include structural members in pocket  500  such as a bumper member  4103  configured to help hold cartridge and backpack assembly  3203  in place when cartridge and backpack assembly  3203  is mounted in pocket  500 . When it is desired to remove cartridge and backpack assembly  3203  from pocket  500  of carousel  14 , protrusions  3206  may be lowered and thereby removed from recesses  4100  to allow cartridge and backpack assembly  3203  to move out of pocket  500 . Protrusions  3206  may be lowered by deforming structure  3200  using, for example, bayonet  128 . 
       FIG.  53    shows a perspective view of structure  3200 . As shown in  FIG.  53   , structure  3200  may be a patterned structure (e.g., a molded resiliently deformable plastic structure) having various features for facilitating mounting and removal of cartridge and backpack assembly  3203  to and from carousel  14 . For example, structure  3200  may include a central opening  4202  configured to receive a portion of the bayonet that extends from the pump drive assembly through cartridge  16 . When the bayonet is turned, portions of the bayonet may simultaneously bear against an upper structure  4204  and a lower structure  4210  of structure  3200 . When the bayonet bears downward against lower structure  4210 , lower structure  4210  may be moved downward and/or rotated by the bayonet such that lower structure  4210  pulls correspondingly downward on protrusions  3206  in order to lower protrusions  3206  (e.g., in direction  4220  of  FIG.  53   ). When the bayonet simultaneously bears upward on upper structure  4204 , upper structure  4204  may pull, via arms  4206  and  4212 , correspondingly upward on latch structure  4216  (e.g., to raise the latch structure in direction  4218  of  FIG.  53    and out of a corresponding recess in a bottom surface of the carousel). 
     In this way, protrusions  3206  and latch structure  4216  may be simultaneously retracted toward the center of structure  3200  (e.g., out of recess  4100  of cartridge  14 ) in order to release cartridge and backpack assembly  3203  from carousel  14 . Latch structure  4216  may, for example, extend through an opening in backpack  3202  to engage a corresponding recess in cartridge pocket  500  when the cartridge and backpack assembly  3203  is mounted in the pocket. 
     Structure  3200  may also include a recess  4200  that forms a portion of opening  3120  to facilitate viewing of a connector  4002  stored within backpack  3202  as discussed herein. An opening  4208  may be formed in structure  3200  between arm  4206  and upper structure  4204 . An opening  4214  may be formed in structure  3200  that extends from arm  4212  along lower structure  4210 . Openings  4208  and  4214  may be a connected single opening that is patterned to form structures  4210 ,  4204 ,  4206  and  4212  that actuate protrusions  3206  and latch structure  4216  when structure  3200  is deformed. 
       FIG.  54    is a cross-sectional perspective view of another portion of a cartridge and backpack assembly  3203  that is mounted to carousel  14 . As shown in  FIG.  54   , backpack  3202  may include a roller assembly  4300  that can be turned to actively drive tubing  4000  into or out of backpack  3202 . For example, roller assembly  4300  may be turned in a first direction to extend tubing  4000  from within cavity  3300  or turned in an opposite second direction to retract tubing  4000  into cavity  3300 . Roller assembly  4300  may be turned by an operator or automatically by a drive mechanism that extends from the pump drive assembly through cartridge  16  to backpack  3202 . Roller assembly may be operated to retract tubing  4000  into the backpack when the connector  4002  is detected in the opening in backpack  3202 . Cartridge and backpack assembly  3203  may also be released back into the carousel  14  when the connector  4002  is detected. Releasing cartridge and backpack assembly  3203  back into carousel  14  may include moving pump drive mechanism  20  forward toward the carousel until protrusion  3206  of the cartridge and backpack assembly is aligned with recess  4100  of carousel  14 , turning bayonet  128  to raise protrusions  3206  into the recesses  4100 , and moving the pump drive mechanism backward to withdraw the bayonet from opening  210  of the cartridge and backpack assembly. Ramp portion  5499  of cartridge  16  (e.g., within opening  210 ) can also be seen in  FIG.  54    against which bayonet  128  may be rotated in a first direction to lift and pull the cartridge and backpack assembly  3203  from carousel  14  while bearing against structure  3200  in opening  4202 . Turning the bayonet in an opposite, second direction may release the cartridge and backpack assembly and raise protrusions  3206 . 
     As shown in  FIG.  54   , backpack  3202  may also include internal structures for managing the insertion and removal of tubing  4000 . For example, a strain relief structure  4304  may be provided that at least partially covers a bottom portion of tubing  4000  so that a pull against tubing  4000  from outside of backpack  3202  will result in tubing  4000  bearing against strain relief structure  4304  rather than resulting in a pull along the length of the tubing that could undesirably detach the tubing from cartridge  16 . Strain relief structure  4304  may, for example, be an integrally formed internal extension that extends from a sidewall of interior compartment  3300  in a direction substantially perpendicular to the direction in which tubing  4000  exits backpack  3202 . Backpack  3202  may also include a guide structure  4302  having a curved internal surface  4306  that forms a curved surface against which tubing  4000  can be coiled. 
       FIG.  55    is a cross-sectional top perspective view of cartridge and backpack assembly  3203  showing how a plurality of coil ramp extensions  4400  can be formed on a bottom surface of internal cavity  3300  to form a ramp that encourages coiling of tubing  4000  when tubing  4000  is inserted into cavity  3300 . As shown, each ramp extension  4400  may each have a height. The height of each ramp extension may increase with distance from strain relief structure  4304  to form the desired coil ramp. Thus, when the tubing is retracted into the backpack, the tubing is stored in such a way that the tubing of various cartridge and backpack assemblies in a carousel do not become tangled or otherwise interfere with themselves or each other. 
     The subject technology is illustrated, for example, according to various aspects described above. Various examples of these aspects are described as numbered concepts or clauses ( 1 ,  2 ,  3 , etc.) for convenience. These concepts or clauses are provided as examples and do not limit the subject technology. It is noted that any of the dependent concepts may be combined in any combination with each other or one or more other independent concepts, to form an independent concept. The following is a non-limiting summary of some concepts presented herein: 
     Concept 1. A carousel for a compounder system, the carousel comprising: a cartridge pocket configured to receive a pump cartridge for the compounder system; a top surface having a plurality of extensions configured to extend over the pump cartridge; a bottom surface having an extension with a recess, the bottom surface recess configured to receive a needle housing of the pump cartridge; and a recess in the top surface configured to receive a protrusion that extends from a top surface of a backpack coupled to the pump cartridge to secure the pump cartridge in the cartridge pocket. 
     Concept 2. The carousel of Concept 1 or any other Concept, further comprising an additional recess in the top surface configured to accommodate a connector and tubing of the pump cartridge. 
     Concept 3. The carousel of Concept 2 or any other Concept, further comprising a central opening with a polygonal inner surface, wherein the polygonal inner surface has a shape that corresponds to a carousel hub of the compounder system. 
     Concept 4. The carousel of Concept 3 or any other Concept, further comprising a handle disposed over the central opening. 
     Concept 5. The carousel of Concept 3 or any other Concept, wherein the bottom surface recess has an additional bottom surface configured to prevent actuation of the needle housing of the pump cartridge and to collect any drug that may drip from the needle housing. 
     Concept 6. The carousel of Concept 1 or any other Concept, further comprising a plurality of additional cartridge pockets disposed about the periphery of the carousel. 
     Concept 7. The carousel of Concept 1 or any other Concept, wherein the cartridge pocket and the plurality of additional cartridge pockets comprises at least ten cartridge pockets disposed about the periphery. 
     Concept 8. A method, comprising: providing a carousel having a plurality of cartridge pockets disposed about a periphery of the carousel; providing a cartridge and backpack assembly in each cartridge pocket of the carousel; and providing the carousel having the cartridge and backpack assemblies onto a carousel hub of a compounder system. 
     Concept 9. The method of Concept 8 or any other Concept, further comprising retrieving a selected one of the cartridge and backpack assemblies from the carousel by extending a bayonet of a pump drive mechanism of the compounder system into an opening in the selected cartridge and backpack assembly and rotating the bayonet. 
     Concept 10. The method of Concept 9 or any other Concept, wherein rotating the bayonet comprises rotating a portion of the bayonet against a ramp structure disposed on a surface of an opening in a pump cartridge of the selected cartridge and backpack assembly to lift and pull the selected cartridge and backpack assembly from the carousel. 
     Concept 11. The method of Concept 10 or any other Concept, wherein rotating the bayonet further comprises rotating an additional portion of the bayonet against a deformable structure disposed between the pump cartridge and a backpack of the selected cartridge and backpack assembly and wherein rotating the additional portion of the bayonet against the deformable structure retracts latching structures of the deformable structure to release the selected cartridge and backpack assembly from the carousel. 
     Concept 12. The method of Concept 11 or any other Concept, further comprising rotating the carousel to align the bayonet of the pump drive mechanism of the compounder system with the opening in the selected cartridge and backpack assembly. 
     Concept 13. The method of Concept 12 or any other Concept, further comprising pumping a reconstituted drug through at least one controllable fluid pathway in the pump cartridge of the selected cartridge and backpack assembly and to a receiving container via tubing that extends from the pump cartridge through the backpack of the selected cartridge and backpack assembly. 
     Concept 14. A compounder system comprising: a carousel hub having a shape; a carousel comprising: a plurality of cartridge pockets each configured to receive a pump cartridge; and a central opening having a shape that corresponds to the shape of the carousel hub; and a vial and carousel drive assembly configured to rotate the carousel hub to rotate the carousel to move a selected one of the pump cartridges to a position adjacent to a pump head assembly of the compounder system. 
     Concept 15. The compounder system of Concept 14 or any other Concept, further comprising the pump cartridges in the cartridge pockets. 
     Concept 16. The compounder system of Concept 15 or any other Concept, wherein each cartridge pocket of the carousel is further configured to receive a backpack attached to the pump cartridge in that pocket. 
     Concept 17. The compounder system of Concept 14 or any other Concept, further comprising a pump drive mechanism having the pump head assembly, wherein the pump head assembly comprises a plurality of operational components operable to pump a fluid through the selected one of the pump cartridges. 
     Concept 18. The compounder system of Concept 17 or any other Concept, wherein the pump head assembly further comprises a bayonet rotatable to release the selected pump cartridge with the attached backpack from the cartridge pocket. 
     Concept 19. The compounder system of Concept 18 or any other Concept, wherein the carousel further comprises: a top surface having a plurality of extensions; and at least one recess in each extension configured to receive a latching mechanism formed on a structure disposed between each cartridge and the backpack attached to that cartridge to secure the pump cartridge and backpack in the cartridge pocket. 
     Concept 20. The compounder system of Concept 19 or any other Concept, wherein the carousel further comprises a bottom surface having a plurality of extensions each having a recess configured to receive a needle housing of one of the pump cartridges. 
     The present disclosure is provided to enable any person skilled in the art to practice the various aspects described herein. The disclosure provides various examples of the subject technology, and the subject technology is not limited to these examples. Various modifications to these aspects will be readily apparent to those skilled in the art, and the generic principles defined herein may be applied to other aspects. 
     One or more aspects or features of the subject matter described herein may be realized in digital electronic circuitry, integrated circuitry, specially designed ASICs (application specific integrated circuits), computer hardware, firmware, software, and/or combinations thereof. For example, infusion pump systems disclosed herein may include an electronic system with one or more processors embedded therein or coupled thereto. Such an electronic system may include various types of computer readable media and interfaces for various other types of computer readable media. Electronic system may include a bus, processing unit(s), a system memory, a read-only memory (ROM), a permanent storage device, an input device interface, an output device interface, and a network interface, for example. 
     Bus may collectively represent all system, peripheral, and chipset buses that communicatively connect the numerous internal devices of electronic system of an infusion pump system. For instance, bus may communicatively connect processing unit(s) with ROM, system memory, and permanent storage device. From these various memory units, processing unit(s) may retrieve instructions to execute and data to process in order to execute various processes. The processing unit(s) can be a single processor or a multi-core processor in different implementations. 
     A reference to an element in the singular is not intended to mean “one and only one” unless specifically so stated, but rather “one or more.” Unless specifically stated otherwise, the term “some” refers to one or more. Pronouns in the masculine (e.g., his) include the feminine and neuter gender (e.g., her and its) and vice versa. Headings and subheadings, if any, are used for convenience only and do not limit the invention. 
     The word “exemplary” is used herein to mean “serving as an example or illustration.” Any aspect or design described herein as “exemplary” is not necessarily to be construed as preferred or advantageous over other aspects or designs. In one aspect, various alternative configurations and operations described herein may be considered to be at least equivalent. 
     As used herein, the phrase “at least one of” preceding a series of items, with the term “or” to separate any of the items, modifies the list as a whole, rather than each item of the list. The phrase “at least one of” does not require selection of at least one item; rather, the phrase allows a meaning that includes at least one of any one of the items, and/or at least one of any combination of the items, and/or at least one of each of the items. By way of example, the phrase “at least one of A, B, or C” may refer to: only A, only B, or only C; or any combination of A, B, and C. 
     A phrase such as an “aspect” does not imply that such aspect is essential to the subject technology or that such aspect applies to all configurations of the subject technology. A disclosure relating to an aspect may apply to all configurations, or one or more configurations. An aspect may provide one or more examples. A phrase such as an aspect may refer to one or more aspects and vice versa. A phrase such as an “embodiment” does not imply that such embodiment is essential to the subject technology or that such embodiment applies to all configurations of the subject technology. A disclosure relating to an embodiment may apply to all embodiments, or one or more embodiments. An embodiment may provide one or more examples. A phrase such an embodiment may refer to one or more embodiments and vice versa. A phrase such as a “configuration” does not imply that such configuration is essential to the subject technology or that such configuration applies to all configurations of the subject technology. A disclosure relating to a configuration may apply to all configurations, or one or more configurations. A configuration may provide one or more examples. A phrase such a configuration may refer to one or more configurations and vice versa. 
     In one aspect, unless otherwise stated, all measurements, values, ratings, positions, magnitudes, sizes, and other specifications that are set forth in this specification, including in the claims that follow, are approximate, not exact. In one aspect, they are intended to have a reasonable range that is consistent with the functions to which they relate and with what is customary in the art to which they pertain. 
     It is understood that the specific order or hierarchy of steps, or operations in the processes or methods disclosed are illustrations of exemplary approaches. Based upon implementation preferences or scenarios, it is understood that the specific order or hierarchy of steps, operations or processes may be rearranged. Some of the steps, operations or processes may be performed simultaneously. In some implementation preferences or scenarios, certain operations may or may not be performed. Some or all of the steps, operations, or processes may be performed automatically, without the intervention of a user. The accompanying method claims present elements of the various steps, operations or processes in a sample order, and are not meant to be limited to the specific order or hierarchy presented. 
     All structural and functional equivalents to the elements of the various aspects described throughout this disclosure that are known or later come to be known to those of ordinary skill in the art are expressly incorporated herein by reference and are intended to be encompassed by the claims. Moreover, nothing disclosed herein is intended to be dedicated to the public regardless of whether such disclosure is explicitly recited in the claims. No claim element is to be construed under the provisions of 35 U.S.C. .sctn. 112 (f) unless the element is expressly recited using the phrase “means for” or, in the case of a method claim, the element is recited using the phrase “step for.” Furthermore, to the extent that the term “include,” “have,” or the like is used, such term is intended to be inclusive in a manner similar to the term “comprise” as “comprise” is interpreted when employed as a transitional word in a claim. 
     The Title, Background, Summary, Brief Description of the Drawings and Abstract of the disclosure are hereby incorporated into the disclosure and are provided as illustrative examples of the disclosure, not as restrictive descriptions. It is submitted with the understanding that they will not be used to limit the scope or meaning of the claims. In addition, in the Detailed Description, it can be seen that the description provides illustrative examples and the various features are grouped together in various embodiments for the purpose of streamlining the disclosure. This method of disclosure is not to be interpreted as reflecting an intention that the claimed subject matter requires more features than are expressly recited in each claim. Rather, as the following claims reflect, inventive subject matter lies in less than all features of a single disclosed configuration or operation. The following claims are hereby incorporated into the Detailed Description, with each claim standing on its own as a separately claimed subject matter. 
     The claims are not intended to be limited to the aspects described herein, but is to be accorded the full scope consistent with the language claims and to encompass all legal equivalents. Notwithstanding, none of the claims are intended to embrace subject matter that fails to satisfy the requirement of 35 U.S.C. .sctn. 101, 102, or 103, nor should they be interpreted in such a way.