Medication: Preparing Injection

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Preparing injection
Introduction:
Injectable medications can be prepared by withdrawing the medication from an ampule or vial into a sterile syringe, or using needleless injection systems.
Parenteral Drug Packaging:
Ampule:
An ampule is a glass container usually designed to hold a single dose of a drug. It is made of Clear glass and has a distinctive shape with a constricted neck.
Ampules vary in size from 1 to 10 mL or more. Most ampule necks have colored marks around them, indicating where they are pre-scored for easy 0pening.
Vial:
A vial is a small glass bottle with a sealed rubber cap.
Vials come in different sizes, from single to multidose vials. 
They usually have a metal or plastic cap that protects the rubber seal and must be removed to access the medication.
Skill-Preparing Injection:
Planning
Delegation
Preparing medications from ampules and vials involves knowledge and use of sterile technique. Therefore, these techniques are not delegated to UAP.
Equipments:
·         Medication Record
·         Antiseptic swabs or alcoholic gauze pad
From Ampule:
·         Ampulc of sterile medication
·         File (if ampule is not scored)
·         Syringe
·         Two Needles
From vial:
·         Syringe
·         Two needles
·         Diluent (NS or sterile water) (if indicated)
Stcps:
1)      Review order, including name and medication name, dose, route of administation and time of administration.
Rationale: Ensures correct administration of medication.
2)      Review pertinent information related to medication, including action, purpose, side effects and nursing implications.
Rationale: Allows nurse to administer medication properly and to monitor client's response.
3)      Check date of expiration of medication vial or ampoule.
Rationale: Medication potency may increase or decrease when outdated,
4)      Assess client's body build, muscle size and weight.
Rationale: Determines type and size of syringe and needles for injection.
5)      Perform hand hygiene.
Rationale: Reduces transmission of microorganisms
Prepare medication:
A.    Ampule preparation:
1.      Tap top of ampoule lightly and quickly with finger until fluid moves from neck of ampule
Rationale: Dislodges any fluid that collects above neck of ampule. All solution moves into lower chamber.
2.      Use an ampule opener or Place small gauze pad/ alcohol            pad around neck of ampoule and wipe it.
Rationale: Placing pad around neck of ampoule protects nurse's fingers from trauma as glass tip broken off.
3.      Snap neck of ampoule quickly and firmly away from hands.
Rationale: Protects nurse's fingers and face from shattering glass.
4.      Draw up medication quickly,
Rationale: System is open to airborne contaminants
5.      Hold the ampule on a flat surface, Insert syringe into center of ampule opening. Do not allow needle tip or shaft to touch rim of ampule.
Rationale; Broken rim of ampule is considered contaminated. when ampoule is inverted, solution does dribble out if needle tip or shaft touches rim of ampule.
6.      Aspirate medication into syringe by gently pulling back on plunger,
 Withdrawal of plunger creates negative pressure within syringe barrel, which pulls fluid into syringe.
7.      Keep needle tip under surface of liquid. Tip ampoule to bring all fluid within reach of the needle. 
Rationale: Prevents aspiration of air bubbles,
8.      If air bubbles are aspirated, do not expel air into ampoule;
Rationale: Air may force fluid out of ampoule and medication will be lost.
9.      To expel excess air bubbles, remove needle from ampoule, Hold syringe with needle pointing up. Tap side of syringe to bubbles to rise towards needle. Draw back slightly on plunger, and then push plunger upwards to eject air. Do not eject medication.
Rationale: Withdrawing plunger too far will remove it from barrel. Holding syringe vertically allows fluid to settle in bottom of barrel. Pulling back on plunger allows fluid within needle to enter barrel so fluid is not expelled, Air at top of barrel and within needle is then expelled.
10.  If syringe   medication, use sinks for disposal, Hold syringe vertically with needle tip up and slanted slightly towards sink, Slowly eject excess medication, into sink. Recheck medication level in syringe by holding it vertically.
Rationale: Medication is safely dispersed into sink. Position of needle allows medication to be expelled without down needle Shan, Rechecking fluid level ensures proper dose.
11.  Change needle on syringe.
Rationale: New needle prevent medication through skin and subcutaneous tissues.
Vial containing a solution:
                    i.            Remove cap covering top of unused vial to expose sterile rubber ml, keeping rubber sea sterile. If reusing multidose vial, firmly and briskly wipe surface of rubber seal With alcohol swab and allow it to dry.
Rationale: Vial comes packaged with cap to prevent contamination of rubber seal. Cap cannot be replaced after seal removal. Allowing alcohol to dry prevents needle being coated alcohol and mixing with medication.
                  ii.            Pick up syringe and remove needle cap. Pull back on plunger to draw amount of air into syringe equivalent to volume of medication to be aspirated from vial.
Rationale: Air must first be injected into vial to prevent build-up of negative   in vial when aspirating medication.
                iii.            With vial on flat surface, insert tip of needle with bevelled tip entering first through centre of rubber seal. Apply pressure to tip of needle during insertion.
Rationale: Centre of seal is thinner and easier to penetrate. Injecting bevelled tip first and using firm pressure prevent coring of rubber seal, which could enter vial or needle.
                iv.            Inject air into the vial's airspace, holding on to plunger. Hold plunger with firm pressure; plunger may be forced backwards by air pressure within the vial.
Rationale: Air must be injected before aspirating fluid. Injecting into vial's airspace prevents formation of bubbles and inaccuracy in dose.
                  v.            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.
Rationale: Inverting vial allows fluid to settle in lower half of container. Position of hands prevents forceful movement of plunger and permits easy manipulation of syringe.
                vi.            Keep tip of the needle below fluid level.
Rationale: Prevents aspiration of air.
              vii.            Allow air pressure from the vial to fill syringe gradually with medication. If necessary, pull back slightly plunger to obtain correct amount of solution.
Rationale: Positive pressure within vial forces fluid into syringe.
            viii.            When desired volume has been obtained, position needle into vial's airspace; tap side of Syringe carefully to dislodge any air bubbles, Eject any air remaining at top of syringe into vial.
Rationale: Forcefully barrel while needle is inserted in vial may bend needle. Accumulation of air displaces medication and causes dose errors.
                ix.            Remove needle from vial' by pulling back on barrel of syringe.
Rationale: Pulling plunger rather than barrel causes plunger to separate from barrel, resulting in loss of medication.
                  x.            Hold at eye level, at 90 degree angle, to ensure correct volume and absence of air bubbles. Remove any remaining air by tapping barrel to dislodge any air bubbles. Draw back slightly on plunger, then push plunger upwards to eject air. Do not eject fluid.
Rationale: Holding syringe vertically allows fluid to settle in bottom of barrel. Pulling back on plunger allows fluid within needle to enter barrel so fluid is not expelled. Air at top of barrel and within needle is then expelled. 
                xi.            Change needle to appropriate gauge and length according to route of medication.
Rationale: Inserting needle through a rubber stopper may dull bevelled tip. New needle is sharper, Because no fluid is along shaft, needle will not track medication through tissues.
              xii.            For multidose vial, make label that includes date of mixing,   of medication per millilitre and nurse's initials.
Rationale: Ensures that future doses will be prepared correctly. Some medications must be discarded after certain number of days after mixing of vial.
Vial containing a powder (reconstituting medications):
a)      Remove cap covering vial of powdered medication.
Rationale: Cap prevents contamination of rubber seal.
b)      Draw up diluent Into syringe.
Rationale: Prepares diluent for injection into vial containing powdered medication.
c)      Insert tip of needle through centre of rubber seal of vial of powdered medication. Inject diluent into vial. Remove needle.
Rationale: Diluent begins to dissolve and reconstitute medication.
d)      Mix medication thoroughly. Roll in palms. Do not shake.
Rationale: Ensures proper dispersal of medication solution. Shaking produces bubbles.
e)      Draw up the prescribed volume of reconstituted medication into syringe.
Rationale: Once diluent    been added, concentration of medication (mg/ml.) determines dose to be given.
f)       Dispose of soiled supplies. Place broken ampoule and/or vials aid used needle in puncture-proof and leak-proof sharps container. Clean work area and perform hygiene,
Rationale: Correct disposal of glass and needle prevents accidental injury to staff. Controls transmission of infection.Preparing injection
Introduction:
Injectable medications can be prepared by withdrawing the medication from an ampule or vial into a sterile syringe, or using needleless injection systems.
Parenteral Drug Packaging:
Ampule:
An ampule is a glass container usually designed to hold a single dose of a drug. It is made of Clear glass and has a distinctive shape with a constricted neck.
Ampules vary in size from 1 to 10 mL or more. Most ampule necks have colored marks around them, indicating where they are pre-scored for easy 0pening.
Vial:
A vial is a small glass bottle with a sealed rubber cap.
Vials come in different sizes, from single to multidose vials. 
They usually have a metal or plastic cap that protects the rubber seal and must be removed to access the medication.
Skill-Preparing Injection:
Planning
Delegation
Preparing medications from ampules and vials involves knowledge and use of sterile technique. Therefore, these techniques are not delegated to UAP.
Equipments:
·         Medication Record
·         Antiseptic swabs or alcoholic gauze pad
From Ampule:
·         Ampulc of sterile medication
·         File (if ampule is not scored)
·         Syringe
·         Two Needles
From vial:
·         Syringe
·         Two needles
·         Diluent (NS or sterile water) (if indicated)
Stcps:
1)      Review order, including name and medication name, dose, route of administation and time of administration.
Rationale: Ensures correct administration of medication.
2)      Review pertinent information related to medication, including action, purpose, side effects and nursing implications.
Rationale: Allows nurse to administer medication properly and to monitor client's response.
3)      Check date of expiration of medication vial or ampoule.
Rationale: Medication potency may increase or decrease when outdated,
4)      Assess client's body build, muscle size and weight.
Rationale: Determines type and size of syringe and needles for injection.
5)      Perform hand hygiene.
Rationale: Reduces transmission of microorganisms
Prepare medication:
A.    Ampule preparation:
1.      Tap top of ampoule lightly and quickly with finger until fluid moves from neck of ampule
Rationale: Dislodges any fluid that collects above neck of ampule. All solution moves into lower chamber.
2.      Use an ampule opener or Place small gauze pad/ alcohol            pad around neck of ampoule and wipe it.
Rationale: Placing pad around neck of ampoule protects nurse's fingers from trauma as glass tip broken off.
3.      Snap neck of ampoule quickly and firmly away from hands.
Rationale: Protects nurse's fingers and face from shattering glass.
4.      Draw up medication quickly,
Rationale: System is open to airborne contaminants
5.      Hold the ampule on a flat surface, Insert syringe into center of ampule opening. Do not allow needle tip or shaft to touch rim of ampule.
Rationale; Broken rim of ampule is considered contaminated. when ampoule is inverted, solution does dribble out if needle tip or shaft touches rim of ampule.
6.      Aspirate medication into syringe by gently pulling back on plunger,
 Withdrawal of plunger creates negative pressure within syringe barrel, which pulls fluid into syringe.
7.      Keep needle tip under surface of liquid. Tip ampoule to bring all fluid within reach of the needle. 
Rationale: Prevents aspiration of air bubbles,
8.      If air bubbles are aspirated, do not expel air into ampoule;
Rationale: Air may force fluid out of ampoule and medication will be lost.
9.      To expel excess air bubbles, remove needle from ampoule, Hold syringe with needle pointing up. Tap side of syringe to bubbles to rise towards needle. Draw back slightly on plunger, and then push plunger upwards to eject air. Do not eject medication.
Rationale: Withdrawing plunger too far will remove it from barrel. Holding syringe vertically allows fluid to settle in bottom of barrel. Pulling back on plunger allows fluid within needle to enter barrel so fluid is not expelled, Air at top of barrel and within needle is then expelled.
10.  If syringe   medication, use sinks for disposal, Hold syringe vertically with needle tip up and slanted slightly towards sink, Slowly eject excess medication, into sink. Recheck medication level in syringe by holding it vertically.
Rationale: Medication is safely dispersed into sink. Position of needle allows medication to be expelled without down needle Shan, Rechecking fluid level ensures proper dose.
11.  Change needle on syringe.
Rationale: New needle prevent medication through skin and subcutaneous tissues.
Vial containing a solution:
                    i.            Remove cap covering top of unused vial to expose sterile rubber ml, keeping rubber sea sterile. If reusing multidose vial, firmly and briskly wipe surface of rubber seal With alcohol swab and allow it to dry.
Rationale: Vial comes packaged with cap to prevent contamination of rubber seal. Cap cannot be replaced after seal removal. Allowing alcohol to dry prevents needle being coated alcohol and mixing with medication.
                  ii.            Pick up syringe and remove needle cap. Pull back on plunger to draw amount of air into syringe equivalent to volume of medication to be aspirated from vial.
Rationale: Air must first be injected into vial to prevent build-up of negative   in vial when aspirating medication.
                iii.            With vial on flat surface, insert tip of needle with bevelled tip entering first through centre of rubber seal. Apply pressure to tip of needle during insertion.
Rationale: Centre of seal is thinner and easier to penetrate. Injecting bevelled tip first and using firm pressure prevent coring of rubber seal, which could enter vial or needle.
                iv.            Inject air into the vial's airspace, holding on to plunger. Hold plunger with firm pressure; plunger may be forced backwards by air pressure within the vial.
Rationale: Air must be injected before aspirating fluid. Injecting into vial's airspace prevents formation of bubbles and inaccuracy in dose.
                  v.            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.
Rationale: Inverting vial allows fluid to settle in lower half of container. Position of hands prevents forceful movement of plunger and permits easy manipulation of syringe.
                vi.            Keep tip of the needle below fluid level.
Rationale: Prevents aspiration of air.
              vii.            Allow air pressure from the vial to fill syringe gradually with medication. If necessary, pull back slightly plunger to obtain correct amount of solution.
Rationale: Positive pressure within vial forces fluid into syringe.
            viii.            When desired volume has been obtained, position needle into vial's airspace; tap side of Syringe carefully to dislodge any air bubbles, Eject any air remaining at top of syringe into vial.
Rationale: Forcefully barrel while needle is inserted in vial may bend needle. Accumulation of air displaces medication and causes dose errors.
                ix.            Remove needle from vial' by pulling back on barrel of syringe.
Rationale: Pulling plunger rather than barrel causes plunger to separate from barrel, resulting in loss of medication.
                  x.            Hold at eye level, at 90 degree angle, to ensure correct volume and absence of air bubbles. Remove any remaining air by tapping barrel to dislodge any air bubbles. Draw back slightly on plunger, then push plunger upwards to eject air. Do not eject fluid.
Rationale: Holding syringe vertically allows fluid to settle in bottom of barrel. Pulling back on plunger allows fluid within needle to enter barrel so fluid is not expelled. Air at top of barrel and within needle is then expelled. 
                xi.            Change needle to appropriate gauge and length according to route of medication.
Rationale: Inserting needle through a rubber stopper may dull bevelled tip. New needle is sharper, Because no fluid is along shaft, needle will not track medication through tissues.
              xii.            For multidose vial, make label that includes date of mixing,   of medication per millilitre and nurse's initials.
Rationale: Ensures that future doses will be prepared correctly. Some medications must be discarded after certain number of days after mixing of vial.
Vial containing a powder (reconstituting medications):
a)      Remove cap covering vial of powdered medication.
Rationale: Cap prevents contamination of rubber seal.
b)      Draw up diluent Into syringe.
Rationale: Prepares diluent for injection into vial containing powdered medication.
c)      Insert tip of needle through centre of rubber seal of vial of powdered medication. Inject diluent into vial. Remove needle.
Rationale: Diluent begins to dissolve and reconstitute medication.
d)      Mix medication thoroughly. Roll in palms. Do not shake.
Rationale: Ensures proper dispersal of medication solution. Shaking produces bubbles.
e)      Draw up the prescribed volume of reconstituted medication into syringe.
Rationale: Once diluent    been added, concentration of medication (mg/ml.) determines dose to be given.
f)       Dispose of soiled supplies. Place broken ampoule and/or vials aid used needle in puncture-proof and leak-proof sharps container. Clean work area and perform hygiene,
Rationale: Correct disposal of glass and needle prevents accidental injury to staff. Controls transmission of infection.

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notes.nursium.com: Medication: Preparing Injection
Medication: Preparing Injection
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