Goal: The proper dosage of medication is withdrawn into a syringe using sterile technique.
1. Gather equipment. Check the medication order against the original order in the medical record, according to facility policy.
2. Know the actions, special nursing considerations, safe dose ranges, purpose of administration, and adverse effects of the medications to be administered. Consider the appropriateness of the medication for this patient.
3. Perform hand hygiene.
4. Move the medication cart to the outside of the patient’s room or prepare for administration in the medication area.
5. Unlock the medication cart or drawer. Enter pass code and scan employee identification, if required.
6. Prepare medications for one patient at a time.
7. Read the CMAR/MAR and select the proper medication from the patient’s medication drawer or unit stock.
8. Compare the label with the CMAR/MAR. Check expiration dates and perform calculations, if necessary. Scan the bar code on the package, if required.
9. Remove the metal or plastic cap on the vial that protects the rubber stopper.
10. Swab the rubber top with the antimicrobial swab and allow to dry.
11. Remove the cap from the needle or blunt cannula by pulling it straight off. Touch the plunger at the knob only. Draw back an amount of air into the syringe that is equal to the specific dose of medication to be withdrawn. Some facilities require use of a filter needle when withdrawing premixed medication from multidose vials.
12. Hold the vial on a flat surface. Pierce the rubber stopper in the center with the needle tip and inject the measured air into the space above the solution. Do not inject air into the solution.
13. Invert the vial. Keep the tip of the needle or blunt cannula below the fluid level.
14. Hold the vial in one hand and use the other to withdraw the medication. Touch the plunger at the knob only. Draw up the prescribed amount of medication while holding the syringe vertically and at eye level.
15. If any air bubbles accumulate in the syringe, tap the barrel of the syringe sharply and move the needle past the fluid into the air space to re-inject the air bubble into the vial. Return the needle tip to the solution and continue withdrawal of the medication.
16. After the correct dose is withdrawn, remove the needle from the vial and carefully replace the cap over the needle. If a filter needle has been used to draw up the medication, remove it and attach the appropriate administration device. Some facilities require changing the needle, if one was used to withdraw the medication, before administering the medication.
17. Check the amount of medication in the syringe with the medication dose and discard any surplus.
18. Recheck the label with the CMAR/MAR.
19. If a multidose vial is being used, label the vial with the date and time opened, and store the vial containing the remaining medication according to facility policy.
20. Lock the medication cart before leaving it.
21. Perform hand hygiene.
22. Proceed with administration, based on prescribed route.
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