Withdrawing Medication from an Ampule

Equipment Medical administration record (MAR) Sterile syringe and needle Extra needle of proper gauge and length in accord with site Procedure 1. Wash your hands. 2. Hold the ampule and quickly and lightly tap the top chamber until all fluid flows into the bottom chamber. 3. Place a sterile gauze or alcohol wipe around the neck of the ampule (Figure 29-14). 4. Firmly grasp the neck of the ampule and quickly snap the top off away from your body. Place the ampule on a flat surface. 5. Withdraw the medication from the ampule, maintaining sterile technique. Check connection of needle to syringe by turning barrel to right while holding needle guard. Use a filter needle if recommended. Remove needle guard, and hold syringe in dominant hand. With nondominant hand grasp ampule and turn upside down, or stabilize ampule on a flat surface. Insert the needle into the center of the ampule; do not allow the needle tip or shaft to touch the rim of the ampule. Keep needle tip below level of meniscus (Figure 29-15).

Ampule of prescribed medication Sterile gauze or alcohol swab Filter needle

Rationale 1. Decreases transmission of microorganisms. 2. Moves the fluid trapped above the neck of the ampule to the lower chamber of the ampule. 3. Contains the glass fragments and shields the nurses fingers from the broken ampule. 4. Directs shattered glass fragments away from the nurses face and fingers. Prevents spillage of medication. 5. Prevents the transmission of microorganisms. Ensures an airtight system. Filters out fine glass particles. Promotes dexterity. Provides access to medication.

Prevents needle tip or shaft.

contamination

of

Prevents air from entering syringe and fluid from leaking out while the ampule is inverted.

Procedure

Aspirate the medication by gently

pulling on the plunger. If air bubbles are aspirated, remove the needle from the ampule. Hold syringe with needle pointing up and tap sides of the syringe. Draw back slightly on plunger, and gently push the plunger upward to eject air. Reinsert the needle in the middle of the ampule and continue to withdraw the medication.

Choose a syringe of appropriate size to accommodate the volume of medication to be withdrawn. Grasp needle and turn barrel of syringe to the right. Remove the needle cap and pull back on plunger to fill syringe with an amount Rationale Allows syringe.

medication to enter the

Prevents loss of medication from the

ampule caused from air pressure. Moves air bubbles above the fluid level in the syringe. Pulls medication from needle so only air is ejected from the syringe.

6.

Remove excess air from the syringe and check the dosage of medication in the syringe. Recap.

7.

Discard any unused portion of the medication, and dispose of the ampule top in a suitable container after comparing with MAR. 8. Change needle and properly discard used needle. Secure needle to syringe by turning the barrel to right while holding the needle guard. 9. Wash hands.

6.

Allows for accurate measurement of medication dose. Prevents contamination of the needle and protects the nurse against inadvertent needlesticks.

7.

Sterility of a medication is lost in an open ampule.

8. Withdrawing Medication from a Vial

Equipment Medication administration record (MAR) Sterile syringe and needle Alcohol swab Procedure 1. 2. Wash your hands. Prepare the vial. Open the alcohol wipe. New vial, remove metal cap from vial of medicine and cleanse the rubber top of the vial. Used vial, cleanse the rubber top of the vial. 3. Prepare syringe.

Reduces the risk that the drug will cause irritation to subcutaneous tissue. 9. Prevents microorganisms. spread of

Vial of medication Sterile needle Rationale 1. Reduces transmission of microorganisms. 2. Provides access to vial. Removes surface contamination. (Note: Manufacturers do not ensure sterility of rubber top.)

1. Check with the client and the chart for

3. Ensures a closed system. known allergies or medical conditions that would contraindicate the use of the drug. 2. Gather necessary equipment. 3. Check the MAR against written health care orders. 4. Wash your hands. 5. Follow the five rights of medication administration. Check the clients identification band. 6. Remove caps from insulin vials (if not already off). 7. Slowly rotate each bottle of insulin. Never shake. Make sure suspensions are thoroughly mixed. (Cloudy insulin such as NPH should be completely mixed.) 8. Clean the rubber stoppers of the vials with an alcohol swab. 9. Remove cap from the needle. Draw air into the syringe equal to the dose of insulin to be given. Insert needle into vial of the suspension, being careful not to touch the needle to the medication in the vial. Inject 4. Creates positive pressure inside vial to allow accurate withdrawal of medicine. 5. Prevents contamination of the plunger, barrel, and medicine.

Ensures withdrawing all the medication at one time. Displaces the solution with air to prevent the formation of a vacuum in the sealed vial.

of air equal to amount of solution to be withdrawn from the vial. 4. Insert the needle into the center of the upright vial and inject air into the vial. 5. Invert vial; keep the vial at eye level and the needles bevel below the fluid level, and remove the exact amount of medicine while touching only the syringe barrel and plunger tip (Figure 29-17). 6. Expel air from the syringe while needle remains within the inverted vial by tapping the side of the syringe with your finger. 7. Check the amount of medicine in the syringe. 8. Turn vial upright and remove the needle. 9. Replace the needle cap. Open the sterile package of the new needle. Remove used needle, and dispose in the sharps container. 10. Attach the new needle to the syringe by turning the barrel to the right. 11. Compare the medication in the syringe with the prescribed dosage.

6. Removes air bubbles created by the dead space in the needles hub; allows for accurate measurement of the solution. 7. Ensures accurate dose. 8. Prevents the leakage of solution from the vial. 9. Prevents needlestick. 10. Provides a sharp needle for injection that decreases the clients discomfort. 11. Complies with safety standards for ensuring the correct dosage.

Mixing Insulins in One Syringe

Equipment Medication administration record (MAR) Insulin vials Procedure

Alcohol swabs

Insulin syringe Rationale 1. Prevents reactions. occurrence of adverse

Administering an Intradermal Injection

Equipment Medication administration record (MAR) Sterile tuberculin syringe and short bevel, 25 to 27 gauge, 3/8- to 1/2-inch needle. Procedure

2. Promotes efficiency. 3. Ensures accuracy in identification of medication. 4. Reduces transmission of microorganisms. 5. Ensures correct client. 6. Permits access to solution.

1.

Check with the client and the chart for any known allergies. 2. 3. Wash hands. Follow the five rights. 4. Prepare the medication from an ampule or vial; refer to Procedure 29-2 or 29-3 as appropriate. Take the medication to the clients room and place on a clean surface. 5. Check the clients identification armband. 6. client. Explain the procedure to the

7. Ensures

complete mixture of suspension. Make sure there are no crystals on the bottom of the vial. 8. Helps remove surface contaminants.

9. Injected air will displace the insulin to be

removed.

the air into the vial and remove the needle. Do not withdraw any insulin yet.

7.

10. Fill syringe with air equal to dose of

regular insulin. Insert needle into bottle and inject air into vial. Invert bottle and pull plunger down to withdraw the appropriate dose of insulin. 11. With needle in the bottle, hold it up to the light and look for air bubbles. To remove air bubbles, tap or flick the syringe with your finger to cause air to rise. Push plunger to push air and some insulin back into the vial. Pull back to get the appropriate dose of insulin free of air. Remove the needle. 12. Insert needle into the vial of longeracting insulin; be sure the tip of the needle is below the surface of the fluid level. Invert the bottle, and slowly draw back to dose of insulin required. Remove needle. Have another nurse check the prescribed dose. 13. Store insulin vials according to your agency policy. 14. Wash your hands.

Place the client in a comfortable position; provide for privacy. 8. Wash hands and don nonsterile gloves. 9. Select and clean the site.

10.

Injected air displaces insulin and facilitates withdrawal. Inverting the vial allows the air to rise and the solution to settle on the bottom of the vial. 11. Air isplace the medication in the syringe and can cause errors in dosage. Air bubbles must be removed to ensure that an accurate dose of insulin is in the syringe.

12.

Drawing back slowly helps prevent air from being drawn into the syringe. Ensures accuracy.

13. Reduces of microorganisms.

transmission

Medication Alcohol swab and sterile 2 2 gauze pad Disposable gloves 1. Prevents the occurrence of hypersensitivity reactions such as hives, urticaria, or anaphylactic shock. 2. Reduces transmission of microorganisms. 3. Promotes client safety. 4. Accurately identifies the client.

5.

Reduces the clients anxiety and enhances cooperation. 6. Promotes comfort. Promotes absorption of the medication. Decreases anxiety. 7. Decreases contact with blood and body fluids. 8. Promotes absorption of the drug; reduces trauma to the bodys tissue.

Check the amount of solution in the syringe. 11. Inject the medication. Hold the syringe in dominant hand. With nondominant hand, grasp the clients dorsal forearm and gently pull the skin taut on ventral forearm(Figure 29-20). Place the needle close to the skin, bevel side up. Insert the needle at a 10 to 15 angle until resistance is felt, and advance the needle approximately 3 mm below the skin surface; the needles tip should be visible under the skin. Administer the medication slowly; observe the development of a bleb (large flaccid vesicle that resembles a mosquito bite). If none appears, withdraw the needle slightly. Withdraw the needle. Pat area gently with a dry 2 2 sterile gauze pad. Do not massage the area after removing the needle. 12. Discard the needle and syringe in a sharps container. 13. Remove gloves, dispose of in appropriate receptacle, and wash hands. 14. Observe for signs of an allergic reaction. 15. Draw a circle around the perimeter of the bleb with a ball point pen. 16. Document medication and site of injection on the MAR.

Assess the clients skin for bruises, redness, or broken tissue. Select an appropriate site using appropriate anatomic landmarks. Cleanse the site with an alcohol wipe using a firm circular motion; cleanse from inside to outside; allow alcohol to dry. 10. Prepare the syringe for injection. Remove the needle guard. Express any air bubbles from the syringe.

Aids in the removal microorganisms on the skin.

of

10.

Ensures correct dosage of medication in the syringe.

Taut insertion.

skin

facilitates

needle

Ensures that medication is injected into the intradermal tissue; initial resistance indicates the needles tip is in the subcutaneous region.

Indicates that the medication was injected into the dermis.

Prevents spreading the medication beyond the point of injection. Prevents needlesticks. 13. Reduces the spread of microorganisms. 14. Ensures client safety. 15. Allows for easy recognition and observation of the injection site. 16. Provides a written description of the injection site and states the time the medication was administered.