NUR 113 - Welcome to SKILL 22-1 Preparing Injections: Ampules & Vials – along with a brief description on mixing insulin. PARENTERAL MEDICATIONS. Before we begin, Let’s review some things about Parenteral Medications
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Failure to inject a medication correctly result sin complications such as inappropriate drug response (e.g., too rapid or too slow), nerve injury with associated pain, localized bleeding, tissue necrosis, and sterile abscess.
Over 16 billion preventive and curative injections are administered each year.
Prevent Contamination of Solution: Ampules should not sit open and medication should be removed quickly.
Prevent Needle Contamination: Avoid letting needle touch contaminated surface (e.g., outer edges of ampule or vial, outer surface of needle cap, you hands, countertop, or table surface).
Avoid touch the length of the plunder or inner part of the barrel. Keep tip of syringe covered with a cap or needle.
Prepare the Skin: Wash skin soiled with dirt, drainage or feces with soap and water. Use friction and a circular motion while cleaning with an antiseptic swab. Swab from center of site and move outward in a 5 cm (2 inch) radius.
Reduce transfer of microorganisms: Perform Hand Hygiene for a minimum of 15 seconds.
1. Be vigilant: avoid distractions while preparing an injection. Be sure that your patients receive the appropriate medications. Know why your patient is receiving each medication; know what you need to do before, during and after medication administration; and evaluate the effectiveness of medications and any adverse effects after administration.
2. Verify that the medications have not expired.
3. Use at least two identifiers before administering medications and check against the medication administration record.
4. No interruption Zones have been recommended by the Institute for Safe Medicine Practices
5. Minimize a patient’s discomfort when giving an injection
Check accuracy & completeness of each MAR or computer printout with prescriber’s written medication order. Check patient’s name, medication name and dosage, route of administration, and time of administration. Recopy or reprint any portion of MAR that is difficult to read.
Assess patient’s medical and medication history.
Assess patient’s history of allergies: Know type of allergies and normal allergic response: In other words, if a person has an allergy, what is the response to this allergy if it occurs?
Review medication reference information for action, purpose, side effects and nursing implications.
Assess patient’s body build, muscle size, and weight if giving subcutaneous or intramuscular medication (IM).
If using a medication cart, move it outside patient’s room.
Unlock medication drawer or cart or log onto computerized medication dispensing system.
Follow agencies “No-Interruption Zone” policy. Distractions can be deadly! Prepare medications for one patient at a time. Keep all pages of MAR’S or computer printouts for one patient together or look at only once patient’s electronic MAR at a time.
Select correct drug from stock supply or unit-dose drawer. Compare label of medication with MAR computer printout or computer screen.
Check expiration date on each medication, one at a time.
To expel excess air bubble, remove needle from ampule. Hold syringe vertically with needle pointing up. Tap side of syringe to cause bubbles to rise toward needle. Draw back slightly on plunger and push plunger upward to eject the air. Do not eject the fluid.
If syringe contains excess fluid, use sink for disposal. Hold syringe vertically with needle tip up and slanted slightly toward sink. Slowly eject excess fluid into the sink. Recheck fluid level in syringe by holding it vertically.
Cover needle with its safety sheath or cap. Replace filter needle with regular sharps with engineered sharps injury protection needle.
Remove cap covering top of unused vial to expose sterile rubber seal. If a multi-dose vial has been used before, cap is already removed. Firmly and briskly wipe surface of rubber seal with alcohol swab and allow it to dry.
Pick up syringe and remove needle cap or cap covering needleless access device. Pull back on plunger to draw amount of air into syringe equivalent to volume of medication to be aspirated from the vial.
CLINICAL DECISION POINT: Some medications and agencies require use of a filter needle when preparing medications from vials. Check agency policy or medication reference. If you use a filter needle to aspirate medication, you need to change it to a regular SESIP needle of the appropriate size to administer the medication.
With vial on flat surface, insert tip of needle or needleless device through center of rubber seal. Apply pressure to tip of needle during insertion.
Project air into air space of vial, holding onto the plunger. Hold plunger firmly; plunger is sometimes forced backward by air pressure within vial.
Invert vial, while keeping firm hold on syringe and plunger. Hold vial between thumb and middle fingers of non-dominant hand. Grasp end of syringe barrel and plunger with thumb and forefinger of dominant hand to counteract pressure in vial.
Keep tip of needle or needleless device below fluid level.
Allow air pressure from vial to fill syringe gradually with medication. If necessary, pull back slightly on plunger to obtain correct amount of medication.
When you obtain desired volume, position needle in needleless device into air space of vial; tap side of syringe barrel gently to dislodge any air bubbles. Eject any air remaining at top of syringe into vial.
Remove needle or needleless access device from vial by pulling back on barrel of syringe.
Hold syringe at eye level at 90 degree angle to ensure correct volume and absence of air bubble. Remove any remaining air by tapping barrel to dislodge any air bubbles. Draw back slightly on plunger; then push it upward to eject air. Do not eject fluid. Recheck volume of medication.
D. Insert needle or needleless device into Vial B, inject volume of air into vial B, and withdraw medication from vial B into syringe.
E. Withdraw needle or needleless device and syringe from vial B. Ensure that proper volume has been obtained.
F. Determine on syringe scale what the combined volume of medications should measure.
G. Invert needle or needleless device into Vial A, being careful not to push plunger and expel medication within syringe into vial. Invert vial and carefully withdraw the desired amount of medication from vial A into syringe.
H. Withdraw needle or needleless device and expel any excess air from syringe. Check fluid level in syringe for proper dose. Medications are now mixed.
I. change needle or needleless device for appropriate size needle if medication is being injected. Keep needle or needless device capped until administration time.
A. If patient takes insulin that is cloudy, roll bottle of insulin between hands to re-suspend insulin preparation.
B. Wipe off top of both insulin vials with alcohol swab.
C. Verify insulin dose against MAR.
D. If mixing rapid or short acting insulin with intermediate or long-acting insulin, take insulin syringe and aspirate volume of air equivalent to dose to be withdrawn from intermediate or long acting insulin first. If two intermediate or long acting insulins are mixed, it makes no difference which vial is prepared first.
E. Insert needle and inject air into vial of intermediate or long acting insulin. Do not let tip of needle touch solution.
F. Remove syringe from vial of insulin without aspirating medication.
G. With the same syringe, inject air equal to the dose of rapid or short acting insulin into vial and withdraw correct dose into syringe.
H. Remove syringe from rapid or short acting insulin and remove any air bubbles to ensure accurate dose.
I. Verify short acting insulin dosage with MAR and show insulin prepared in syringe to another nurse to verify that correct dosage of insulin was prepared. Determine which point on syringe scale the combined units of insulin should measure by adding the number of units of both insulins together (e.g., 4 units Regular + 10 units NPH = 14 units total. Verify combined dosage.)