Preparing, Drawing Up, and Mixing Medication (One Ampule & One Vial) ~ Nursing

Preparing, Drawing Up, and Mixing Medication (One Ampule & One Vial)

Equipment
■ Medication vials, ampules, and/or prefilled syringe.
■ Alcohol prep pad (70% alcohol) or CHG-alcohol product.
■ Syringe of the appropriate size for medication volume and viscosity.
■ VAD, filter needle, or safety needle.
■ Gauze pad or ampule snapper.

Assessment
■ Check that the ampule and vial are intact, and that the medication is clear, with no discoloration, cloudiness, or particles. Post-Procedure Reassessment
■ Assess for a change in color, cloudiness, particles in the medication mixed.

Key Points
■ Be Smart! Before beginning, determine the total volume of all medications to be put in the syringe and whether that volume is appropriate for the administration site.
■ Be Safe! Make sure the medications are compatible.
■ Maintain the sterility of the needles and medication.
■ Be Smart! When drawing up from a single-dose vial and ampule, draw up from the vial first.
■ Scrub the stopper of a multidose vial using an alcohol wipe or CHG-alcohol product. Use povidone-iodine only when there is sensitivity to alcohol.
■ Draw up the same volume of air as the dose of medication ordered for the vial.
■ Inject air into the vial, being careful not to let the needle enter the fluid.
■ Then invert the vial and withdraw the dose; expel the air bubbles; and, when the dose is correct, withdraw the needle from the vial.
■ Be Safe! When opening ampules, protect yourself from injury by using an ampule snapper, folded gauze pad, or still-wrapped alcohol wipe.
■ Attach a filter needle or straw to withdraw medication from ampules; change to a needle of the proper length and gauge for administering the medication.
■ Flick or tap the top of the ampule to remove medication from the neck of the ampule.
■ Open the ampule by wrapping the neck with a folded gauze pad or an unopened alcohol wipe or use an ampule snapper. Snap open away from you.
■ Withdraw the second medication very carefully because the medications are mixed as you pull back the plunger; therefore, you must withdraw the exact amount. If there is any excess, you must discard the contents of the syringe and start over. You must avoid contaminating a multidose vial with the second medication.
■ Draw 0.2 mL of air into the syringe.
■ Confirm the dose is correct by holding the syringe vertically and checking the dose at eye level.
■ Be Smart! Always recap a sterile needle using a safety capping device or the one-handed scoop method.

Documentation
■ Document per MAR, according to agency policy.