Hold the vial in one hand and use the other to withdraw the medication. Touch the plunger at the knob only. Draw up the prescribed amount of medication while holding the syringe at eye level and vertically. Turn the vial over and then remove needle from vial. Show
How do you draw two vials?Hold the vial in one hand and use the other to withdraw the medication. Touch the plunger at the knob only. Draw up the prescribed amount of medication while holding the syringe at eye level and vertically. Turn the vial over and then remove needle from vial. How do you draw medicine out of a vial?Tap the syringe with your finger to move air bubbles to the top. Then push gently on the plunger to push the air bubbles back into the vial. If you have a lot of bubbles, push the plunger to push all the medicine back into the vial. Draw medicine out again slowly and tap air bubbles out. Why you would need to mix two medications from two different vials?Some medications must be mixed from two vials or from a vial and an ampule. Mixing compatible medications avoids the need to give a patient more than one injection. Most nursing units have medication compatibility charts. Compatibility charts are in drug reference guides or are posted within patient care areas. Turn the vial upside down or position the bag so that the fluid is above the needle inside the bag. Pull back on the plunger to withdraw the necessary fluid amount. If needed gently tap on the barrel of the syringe to force air bubbles into the hub of the needle. What happens if you accidentally inject air into muscle?Injecting a small air bubble into the skin or a muscle is usually harmless. But it might mean you aren’t getting the full dose of medicine, because the air takes up space in the syringe. How many types of vials are there?There are different types of vials such as: glass, plastic tubes, jars, aluminum tubes, and dispenser tubes. A vial is a small container, cylindrical, and is made of glass; it is used specifically for holding liquid medicines. It is a known fact that vials are commonly used in the medical industry. Can medication be mixed in the same syringe?While it is not recommended to use the same needle and syringe to enter more than one medication vial because of the risks described above, there are circumstances where more than one vial may need to be entered with the same syringe and needle (e.g., when reconstituting medications or vaccines). How long can you keep medication in a syringe?Hospitals may be relying on literature to support the beyond-use dating of medications stored in syringes, or they may believe a beyond-use date of 24 hours or less is sufficient to ensure the products’ potency when stored in a syringe (as noted in the July 31 BD letter). What happens when IV drugs are incompatible?Drug incompatibilities can lead to reduced drug activity or inactivity, the formation of a new toxic or nontoxic active ingredient, increased toxicity of one or more of the involved drugs, and organoleptic changes. Should you change the needle after drawing up medication?DO NOT change the needle in order to reuse the syringe; – DO NOT use the same mixing syringe to reconstitute several vials; – What is the difference between vial and ampule?Whilst they may seem identical to the untrained eye, ampoules and vials are different storage containers with different uses. Ampoules are smaller and used to hold single-dose medicines, whereas vials tend to be larger, and the product inside can be stored and reused. Why should an intramuscular injection be given at a 90 degree angle?Overwhelmingly the evidence supports a 90 degree angle of needle insertion for intramuscular injection as being that most effective in terms of patient comfort, safety and efficacy of vaccine. What happens if you inject air into your stomach?Small embolisms generally dissipate into the bloodstream and don’t cause serious problems. Large air embolisms can cause strokes or heart attacks and could be fatal. Prompt medical treatment for an embolism is essential, so immediately call 911 if you have concerns about a possible air embolism. What happens if you inject in the wrong place?“A vaccine is an immunologically sensitive substance, and if you were to receive an injection too high – in the wrong place – you could get pain, swelling and reduced range of motion in that area,” says Tom Shimabukuro, deputy director of the Centers for Disease Control and Prevention’s immunization safety office. How long does it take for an air embolism to affect you?You may not have these symptoms immediately. They can develop within 10 to 20 minutes or sometimes even longer after surfacing. Do not ignore these symptoms – get medical help immediately. Updated by: Linda J. Vorvick, MD, Clinical Associate Professor, Department of Family Medicine, UW Medicine, School of Medicine, University of Washington, Seattle, WA. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.
Do not compound IV push medications (combining two or more medications) in a single syringe outside the pharmacy.undefined#ref4">4 Insulin is considered a high-alert medication, and it is strongly recommended that insulin doses be verified by two nurses to prevent errors.5 If indicated by the organization’s practice, have the dose of clear insulin verified before mixing. Have the dose verified a second time after the medications are mixed. Administer a mixture of insulin quickly after preparation. Rapid- or short-acting insulin can bind with intermediate- or long-acting insulin, thus reducing the action of the more rapid-acting insulin. Do not use a single-dose vial more than once. Multiple use of single-dose vials increases the risk for blood-borne pathogen infections.7 Use one needle, one syringe, only one time on one patient.7 Take steps to eliminate interruptions and distractions during medication preparation. OVERVIEWSome medications must be mixed from two vials or from a vial and an ampule. Mixing compatible medications avoids the need to give a patient more than one injection. Most nursing units have medication compatibility charts. Compatibility charts are in drug reference guides or are posted within patient care areas. If uncertain about medication compatibilities, consult a pharmacist. When mixing medications, fluid must be correctly aspirated from each type of container. When using multidose vials, the nurse must not contaminate the vial’s contents with medication from another vial or ampule. When mixing medications from a vial and an ampule, the nurse should prepare medications from the vial first and then withdraw medication from the ampule using the same syringe and a filter needle. When mixing medications from two vials, the nurse must not contaminate one medication with another and must ensure that the final dose is accurate. Aseptic technique must be maintained.9 Single-dose vials do not contain antimicrobials; therefore, multiple accesses place the patient at risk for infection.7 The nurse must give special consideration to the proper preparation of insulin. Insulin is the hormone used to treat diabetes mellitus. Insulin is classified by rate of action, including rapid acting, short acting, intermediate acting, and long acting. A patient with diabetes sometimes requires more than one type of insulin. In addition, some patients require several injections in a day that combine two different insulin preparations to duplicate the normal pattern of their insulin production. Insulin is available in vials. If more than one type of insulin is required to manage the patient’s diabetes and the types of insulin are compatible, the nurse may mix them in one syringe. This may result in a patient response to insulin that is different from the response that would occur if the insulins were given separately. When mixing insulin in one syringe, the rapid- or short-acting insulin should be drawn up first. Only insulins from the same manufacturer are recommended for mixing.9 The American Association of Diabetes Care & Education Specialists has a list of recommendations for mixing insulins (Box 1). Insulin syringes are available in sizes that hold 0.3 to 1 ml and are calibrated in units. Most insulin syringes are U-100s, designed to be used with U-100 strength insulin (Figure 1). Each milliliter of U-100 insulin contains 100 units of insulin. Use U-100 insulin syringes with preattached 25- to 31-G needles when giving U-100 insulin and 1-ml tuberculin syringes when giving U-500 insulin. The U-500 insulin is five times more potent than U-100 insulin; however, a specific U-500 insulin syringe does not exist. U-500 insulin contains 500 units of insulin per 1 ml of fluid and should be used only for patients requiring doses above 200 units a day.3 Before use, the nurse must carefully examine the syringe to determine the measurement scale and to ensure use of the correct syringe for preparing the ordered medication.9 To help reduce the impact of pharmaceutical waste on the environment, the Environmental Protection Agency (EPA) released a final rule on the management of hazardous waste pharmaceuticals.2 The rule decreases the cost of disposing of certain nicotine products and streamlines the process of disposing of pharmaceutical waste. The organization’s practice for safe disposal of ampules, vials, syringes, and needles should be followed. If the patient expresses concern regarding the accuracy of a medication, the medication should not be given. The concern should be explored, the practitioner notified, and the order verified. EDUCATION
ASSESSMENT AND PREPARATIONAssessment
Preparation
PROCEDURE
Mixing Medications From Two Vials
Mixing Insulin
Mixing Medications From a Vial and an Ampule
MONITORING AND CARE
EXPECTED OUTCOMES
UNEXPECTED OUTCOMES
DOCUMENTATION
PEDIATRIC CONSIDERATIONS
OLDER ADULT CONSIDERATIONS
HOME CARE CONSIDERATIONS
REFERENCES
ADDITIONAL READINGSSchutijser, B.C.F. and others. (2019). Interruptions during intravenous medication administration: A multicentre observational study. Journal of Advanced Nursing, 75(3), 555-562. doi:10.1111/jan.13880 *In these skills, a “classic” reference is a widely cited, standard work of established excellence that significantly affects current practice and may also represent the foundational research for practice. Adapted from Perry, A.G. and others. (Eds.). (2022). Clinical nursing skills & techniques (10th ed.). St. Louis: Elsevier. Elsevier Skills Levels of Evidence
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