Injections
Preparing Injections from a Vial
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- » Preparing Injections from an Ampule
- » Preparing Injections from a Vial
- » Preparing and Administering Insulin
- » Drawing up More Than One Type of Insulin
- » Administering Intradermal Injections
- » Administering Subcutaneous Injections
- » Administering Intramuscular Injections
Take the Review Test:
Safety
- Ensure that the Six Rights of Medication Administration are followed: right medication, right dose, right patient, right route, right time, and right documentation.
- Some medications may require the use of a filter needle when withdrawing the medication from a vial. Check your agency’s policy or the medication insert. If you use a filter needle to withdraw the medication, change it to a regular SESIP (sharps with engineered sharps injury protection) needle of the appropriate size to administer the medication.
- Use strict asepsis when preparing an injection from a vial.
- Single-dose vials must be discarded after use, regardless of the amount of medication remaining in the vial.
- When preparing medication from a single-dose vial, do not assume that the volume listed on the label is the total volume in the vial. Some manufacturers provide a small amount of extra liquid, expecting some fluid to be lost during the preparation. Be sure to draw up only the desired volume.
- When using a multidose vial, write the date that the vial is opened and your initials on the vial label. Verify with your agency how long an opened multidose vial may be used.
- Establish a “No Interruption Zone” when preparing medications.
Equipment
(Roll cursor over items to see labels)
SESIP safety needle
Calculator
Medication in single dose vial
Medication in multidose vial
Diluent, if needed
Syringe
Needleless blunt-tip vial access cannula
Alcohol swab
1-inch tape for labeling syringe
Permanent marker
PrintableDelegation
The skill of preparing an injection from a vial may not be delegated to nursing assistive personnel (NAP).
Preparation
- Check the accuracy and completeness of each medication administration record (MAR) against the health care provider’s orders. Confirm the patient’s name, medication name, dosage, route of administration, and time of administration. Clarify incomplete or unclear orders with the health care provider.
- Note if the patient has allergies.
- Observe the Six Rights of Medication Administration: right medication, right dose, right patient, right route, right time, and right documentation. (For details, see the Video Skill “Ensuring the Six Rights of Medication Administration.”)
- When drawing up medication for injection away from the patient’s bedside, be sure to label the syringe with the name of the medication and the amount it contains.
- Review the medication reference information for action, purpose, side effects, and nursing implications.
- Assess the patient’s body build, muscle size, and weight if you are giving a subcutaneous or intramuscular medication.
Follow-up
- Just before administering the drug to the patient, compare the MAR with the label of the prepared drug, and compare the dose in the syringe with the desired dose.
Documentation
Record medication administration after giving the drug. It is not necessary to document medication preparation from a vial separately.
Review Questions
1. A nurse is preparing to withdraw medication from an open multidose vial. After confirming that the vial contains the appropriate medication and checking the expiration date, what would the nurse do next?
Apply clean gloves.- Vigorously shake the vial.
Wipe the rubber seal of the vial with an alcohol swab.- Introduce air equal to the amount of medication needed.
INCORRECT. Wearing gloves is not necessary when preparing medication from a vial.
INCORRECT. Shaking a vial of medication is not an appropriate technique.
CORRECT. The rubber seal of a multidose vial must be cleansed with alcohol before use.
INCORRECT. Air is introduced into the syringe later in the procedure.
2. What would the nurse do to remove air trapped in a syringe before withdrawing the syringe from the vial?
- Position the tip of the needle in the vial’s airspace, and tap the barrel of the syringe.
- Position the tip of the needle below the fluid line, and tap the vial.
- Position the vial on a flat surface, and tap the syringe.
- Position the syringe above the vial, and tap the vial.
CORRECT. Positioning the tip of the needle in the vial’s airspace and then tapping the barrel of the syringe will encourage any trapped air to move to the top of the syringe, where it can be expelled into the vial airspace.
INCORRECT. Positioning the tip of the needle below the fluid line and then tapping the vial will not encourage the air to move to the top of the syringe.
INCORRECT. Positioning the vial on a flat surface and then tapping the syringe will not encourage the air to move to the top of the syringe.
INCORRECT. Positioning the syringe above the vial and then tapping the vial will not encourage the air to move to the top of the syringe.
3. How can the nurse prevent negative pressure from building up in the vial when preparing an injection?
- Inject an amount of air into the vial equivalent to the volume of medication to be withdrawn.
- Insert the needle through the center of the rubber seal.
- Keep the tip of the needle below the level of fluid in the vial.
- Tap the barrel of the syringe to dislodge air bubbles.
CORRECT. Inserting air into the vial to replace the medication to be drawn out will prevent the buildup of negative pressure in the vial.
INCORRECT. The needle must be inserted through the center of the rubber seal because it is thinner and easier to penetrate, not because doing so will keep negative pressure from building up in the vial.
INCORRECT. Keeping the tip of the needle below the level of fluid in the vial when drawing up medication will prevent air bubbles from entering the syringe but will not keep negative pressure from building up in the vial.
INCORRECT. Removing air bubbles from the syringe will ensure that the correct dose of medication is prepared but will not keep negative pressure from building up in the vial.
4. How can the nurse ensure that medication from a single-dose vial is used appropriately?
- Check to see when the medication vial was opened initially.
- Write the date and his or her initials on the label when opening the vial.
- Draw the entire amount of medication from the vial into the syringe.
- Discard the vial and any remaining medication in the vial directly after use.
INCORRECT. A single-dose vial is not reused, so checking to see when the vial was initially opened is unnecessary.
INCORRECT. A single-dose vial is discarded after the first use, so it is unnecessary to date and initial the label.
INCORRECT. The vial may be manufactured in a single dose that is larger than the dose your patient needs. Draw up only the volume called for in the orders.
CORRECT. A single-dose vial is not reused after it is opened, regardless of the amount of medication remaining. The nurse would discard the vial and its contents.
5. What will the nurse do after opening a multidose vial and withdrawing a dose of medication from it?
- Discard the unused portion of the medication.
- Wipe the entire vial with an antiseptic swab.
- Send the unused portion back to the pharmacy.
- Label the vial with the date it was opened and your initials.
INCORRECT. Multidose vials are not discarded after a single use.
INCORRECT. It is unnecessary to wipe the vial with an antiseptic swab.
INCORRECT. A multidose vial contains several doses of medication and must be stored in a secure location on the unit/floor for future use.
CORRECT. The medication in an open multidose vial is perishable. Labeling the vial with the date on which it is opened will prevent administration of medication that has expired or lost its efficacy.
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