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when outdated,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.
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.
COMMENTS