Mixing medication
Introduction:
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,
MIXING MEDICATIONS USING ONE SYRINGE:
Equipment:
·
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
Preparation:
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
Performance:
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,
MEDICATIONS FROM TWO VIALS:
·
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volume of air equal to the volume of medications to be withdrawn from both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the volume of medication to be withdrawn into vial A. Make sure the needle does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
MIXING MEDICATIONS FROM ONE VIAL AND ONE AMPULE:
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).
COMMENTS