Medication: Mixing Medication


Mixing medication
If two medications are compatible, it is possible to mix them in one injection as long as the final volume is within accepted limits for the site to be used. A client will then receive just one injection at a time,
·         MAR
·         Two vials of medication; one vial and one ampule; two ampules; or one vial or ampule and one cartridge
·         Antiseptic swabs
·         Sterile syringe and needle
·         or insulin syringe and needle
Check the medication administration record (MAR).
Before preparing and combining the medications, ensure that the total volume of the injection is appropriate for the injection site.
2.   Organize the equipment
l.   Perform hand hygiene and observe other appropriate infection control procedures.
2.  Prepare the medication ampule or vial for drug withdrawal.
Inspect the appearance other medication for clarity. Some medications are always cloudy,
Rationale: that have changed in appearance should be discarded.
 If using insulin, thoroughly mix the solution in each vial prior to administration.
Clean the tops of the vials with antiseptic swabs.
3. Withdraw the medications,
·         Take the syringe and draw up a volume of air equal to the volume of medications to be withdrawn from both vials A and B.
·         Inject a volume of air equal to the volume of medication to be withdrawn into vial A. Make sure the needle does not touch the solution. 
Rationale: This prevents cross-contamination of the medications
·         Withdraw the needle from vial A and inject the remaining air into vial B.
·         Withdraw the required amount of medication from vial B.         
Rationale: The same needle is used to inject air into and withdraw medication from the second vial. It must not be contaminated with the medication in vial.
·         Using a newly attached sterile needle, withdraw the required amount of medication from vial A. Avoid pushing the plunger as that will introduce medication B into vial A.
·         Be careful to withdraw only the ordered amount and to not create air bubbles.
Rationale: The syringe now contains two medications and an excess amount cannot be returned to the vial
a)       First prepare and withdraw the medication from the vial.
Rationale: Ampules do not require the addition of air prior to withdrawal of the drug.
b)      Then withdraw the required amount of medication from the ampule.
Mixing and preparing insulin:
Insulin is the hormone used to treat diabetes mellitus as well as some other medical disorders. It must be administered by injection because it is a protein and therefore would be broken down and destroyed in the GI tract.
The following is an example of mixing 10 units of regular insulin and 30 units of neutral protamine Hagedom (NPH) insulin, which contains protamine.
Inject 30 units of air into the NPH vial and withdraw the needle. (There should be no insulin in the needle.) The needle should not touch the insulin.
Inject 10 units of air into the regular insulin vial and immediately withdraw 10 units of regular insulin and always withdraw the regular insulin first to minimize the possibility of the regular insulin becoming contaminated with the additional protein in the NPH.
Re-insert the needle into the NPH insulin vial and withdraw 30 units of NPH insulin.
Clinical alert:
One way to determine which insulin to withdraw first is to remember the saying "Clear before cloudy." (Regular insulin is clear and NPH is cloudy to the proteins in the insulin).



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item Medication: Mixing Medication
Medication: Mixing Medication
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