PREPARING MEDICATIONS FROM AMPULE

Equipment: MAR, ampule, file, small gauze, antiseptic swabs, syringe, filter needle, sharps container

1. Assemble equipment and supplies needed.
2. Check the label on the ampule carefully against
the MAR to make sure that the correct
medication is being prepared.
3. Follow the three checks for administering
medications. Read the label on the medication:
-When it is taken from the medication cart
-Before withdrawing the medication
-After withdrawing the medication
4. Perform hand hygiene and observe other
appropriate infection control measures.
5. Flick the upper stem of the ampule several
times with a fingernail.
6. Place a piece of sterile gauze between thumb
and the ampule neck or around the ampule
neck, and break off the top by bending it toward away from the nurse. By bending it toward you to
the nurse.
7. Dispose of the top of the ampule in the sharps
container.
8. Place the ampule on flat surface. Attach
filter/aspirating needle to the syringe.
9. Remove the cap from the filter needle and
insert the needle into the center of the ampule.
Do not touch the rim of the ampule with the
needle tip or shaft.
10. With a single-dose ampule, hold the ampule
slightly on its side, if necessary, to obtain all the
medication.
To save time, effort, and energy and to prevents
interruption while doing the procedure.
This is to ensure that we are giving the right
medication with the right dose to the client. And to
make sure that we are administering it through the
right route.
To reduce the number of microorganisms in our
hands and to prevent transmission and cross
contamination.
This will bring all medication down to
the main portion of the ampule
The sterile gauze protects the fingers from the
broken glass, and any glass fragments will spray
ensure the ampule is broken away from yourself and
away from others
Proper disposal prevents possible injury.
The filter needle/straw prevents glass particles from
being withdrawn with the medication.
This will keep the needle sterile
 Equipment: MAR, vial, antiseptic swabs, safety needle and syringe, filter needle, sterile water or normal saline

1. Assemble equipment and supplies needed. To save time, effort, and energy and to prevents
interruption while doing the procedure.
2. Check the label on the vial carefully against the MAR to make sure that the correct medication is being prepared.
3. Follow the three checks for administering This is to ensure that we are giving the right
medications. Read the label on the medication: medication with the right dose to the client. And to
-When it is taken from the medication cart make sure that we are administering it through the
-Before withdrawing the medication right route.
-After withdrawing the medication
4. Perform hand hygiene and observe other To reduce the number of microorganisms in our hands
appropriate infection control measures. and to prevent transmission and cross contamination.
5. Mix the solution, if necessary, by rotating the vial Some vials contain aqueous suspensions, which settle
between the palms of the hands, not by shaking. when they stand. In some instances, shaking cause the
mixture to foam.
6. Remove the protective cap, or clean the rubber The antiseptic cleans the cap and reduces the number
cap of a previously opened vial with an antiseptic of microorganisms.
wipe by rubbing in a circular motion.
7. Attach a filter/aspirating needle, to draw up Using the filter needle prevents any solid particles
premixed liquid medications from multidose from being drawn up through the needle.
vials.
8. Ensure that the needle is firmly attached to the Loose attachment of needle will not draw the
syringe. medication properly.
9. Remove the cap from the needle, and then draw up into the syringe the amount of air equal to the volume
of the medication to be withdrawn.
10. Carefully insert the needle, into the upright vial through the center of the rubber cap, maintaining the
sterility of the needle.
11. Inject air into the vial, keeping the bevel of the The air will allow the medication to be drawn out
needle above the surface of the medication. easily because negative pressure will not be created
inside the vial. The bevel is kept above the medication
to avoid creating bubbles in the medication.
12. Withdraw the prescribed amount of medication Keeping the vial in the upright position while
using either of the following methods: withdrawing the medication allows particulate matter
-Hold the vial down, move the needle tip so that it is to precipitate out of the solution. Leaving the last few
below the fluid level and withdraw the medication. drops reduces the chance of withdrawing foreign
Avoid drawing up the last drops of the vial. OR particles.
-Invert the vial, ensure the needle tip is below the fluid Keeping the tip of the needle below the fluid level
level and gradually withdraw the medication. prevents air from being drawn into the syringe.
13. Hold then syringe and vial at eye level to Ejecting the air gives an accurate measurement of the
determine that the correct dosage of the drug is medication because small amount of air will not harm
drawn into the syringe. Eject the air remaining at the tissues.
the top of the syringe into the vial.
14. When the correct volume of the medication plus a little more is obtained, withdraw the needle from the
vial and replace the cap over the needle using the coop method thus maintaining its sterility.
15. If necessary, tap the syringe barrel to dislodge The tapping motion will cause the air bubbles to rise
any air bubbles present into the syringe. to the top of the syringe where they can be ejected
out of the syringe
16. If giving an injection, replace the filter/aspirating This method can decrease possibility of contamination by
needle with a regular or safety needle of the the first needle and maintain sharp of the tip on needle
correct gauge and length.
17. Eject air from new needle and verify correct medication To ensure that we will administer the correct volume of the
volume. medication.
 ADMINESTERING INTRADERMAL INJECTION

1. Check the label on the medication carefully against

the MAR to make sure that the correct
medication is being prepared.
2. Follow the three checks for administering This is to ensure that we are giving the right medication
medications. Read the label on the medication: with the right dose to the client. And to make sure that we
-When it is taken from the medication cart are administering it through the right route.
-Before withdrawing the medication
-After withdrawing the medication
3. Organize equipment and supplies needed.
4. Perform hand hygiene and observe other
appropriate infection control measures.
5. Prepare the medication from the vial or ampule for To prepare correct medication safely before using
drug withdrawal.
6. Prepare the client. Introduce self and verify client’s This ensures that the right client receives the medication.
identity.
7. Explain procedure to the client. Explain to the client Information can facilitate acceptance of and
that the medication will produce a small compliance with the therapy
wheal.
8. Provide for client privacy. To provide a secure environment for the client and
maintain his dignity.
9. Select and clean the site. Put on gloves as indicated
by agency policy.
10. Cleanse the skin at the site using firm, circular Cleansing the injection site prepares it for the
motion, starting at the center and widening the injection. This method remove pathogen away from
circle outward. Allow the area to dry thoroughly. the injection site.
11. Prepare the syringe for injection. Remove the needle Alcohol gives full play to disinfect after dried
cap while waiting for the antiseptic to dry.
12. Expel any air bubbles from the syringe. A small amount of air will not harm the tissues.
13. Grasp the syringe in your dominant hand, close to The possibility of the medication entering the
the hub, holding it between thumb and subcutaneous tissue increases when using an angle
forefinger. Hold the needle almost parallel to the greater than 15°
skin surface, with the bevel of the needle up.
14. With the nondominant hand, pull the skin at the site Taut skin allows for easier entry of the needle and less
until it is taut. discomfort for the client.
Insert the tip of the needle far enough to place the bevel through the epidermis into the dermis. The outline of the bevel
should be visible under the skin surface.
15. Stabilize the syringe and needle and inject the This verifies that the medication entered the dermis.
medication carefully and slowly so that it produces a
small wheal on the skin.
16. Withdraw the needle quickly at the same angle at Slow needle withdrawal may be uncomfortable for the
which it was inserted. Apply a band-aid, if indicated. client
17. Do not massage the area. Also, instruct the client not Massage can disperse the medication into the tissue or out
to massage the area. through the needle insertion site
18. Dispose of the syringe and needle into the sharps Do not recap the needle in order to prevent needlestick
container. injuries
19. Remove gloves and perform hand hygiene.
20. Circle the injection site with ink to observe for
redness or induration per agency policy.
21. Document all relevant information. Record the Documenting data serves as a legal evidence that we
testing material given, the time, dosage, route, site conduct medicine administration.
and nursing assessment.
 ADMINISTERING INTRAMUSCULAR INJECTION

1. Check the label on the medication carefully against the MAR to make sure that the correct medication is being
prepared.
2. Follow the three checks for administering medications. Read the label on the medication:
▪ When it is taken from the medication cart; Before withdrawing the medication; After withdrawing the
medication
3. Organize equipment and supplies needed.
4. Perform hand hygiene and observe other appropriate infection control measures.
5. Prepare the medication from the vial or ampule for drug withdrawal.
6. Provide for client privacy.
7. Prepare the client. Introduce self and verify client’s identity.
8. Explain procedure to the client. Include relevant information about effects of the medication.
9. Assist the client to a supine, lateral, prone, or sitting The client’s position should be suitable for the
position depending on the chosen site. chosen injection site.
10. Select a site free of tenderness, harness, swelling, Choosing the correct site allows for accurate reading
scarring, itching, burning and localized inflammation. of the test site at the appropriate time.
Select a site that has not been used frequently.
11. If injections are to be frequently, alternate sites. This is to reduce the discomfort of intramuscular
Avoid using the same site twice in a row. injections.
12. Put on clean gloves.
13. As per agency protocol, clean the site with an Cleansing the injection site prepares it for the
antiseptic swab. Start at the center of the site and clean injection. This method remove pathogen away from
in a widening circle to approximately 5 cm (2 inches). the injection site. Alcohol gives full play to disinfect
Allow the area to dry thoroughly. after dried
14. Place and hold a clean swab between the third and fourth fingers of the nondominant hand, or position the
swab on the client’s skin above the intended site. For easy access of swab after injection.
15. Prepare the syringe for injection. Remove the needle To maintain the sterility of the needle.
cover and discard without contaminating the needle.
16. If using a prefilled unit-dose medication, take caution Medication left on the needle can cause pain when it
to avoid dripping medication on the needle prior to is tracked through the subcutaneous tissue
injection. If this does occur, wipe the medication off the
needle with a sterile gauze.
17. Inject the medication using a Z-track technique. Use Pulling the skin and subcutaneous tissue or pinching
the ulnar side of the nondominant hand to pull the skin the muscle makes it firmer and facilitates needle
approximately 2.5cm (1in) to the side. insertion.
18. Holding the syringe between the thumb and Using a quick motion lessens the client’s discomfort.
forefinger, pierce the skin quickly and smoothly at a 90-
degree angle and insert the needle into the muscle.
19. Hold the barrel of the syringe steady with nondominant hand and aspirate by pulling back on the plunger with
dominant hand. Aspirate for 5-10 seconds. If blood appears in the syringe, withdraw the needle, discard the
syringe and prepare a new injection. This step determines whether the needle has been inserted into a blood
vessel.
20. If blood does not appear, inject the medication Injecting medication slowly promotes comfort and
steadily and slowly while holding the syringe steady. allows time for tissue to expand and begin
absorption of the medication
21. After injection, wait 10 seconds. Waiting permits the medication to disperse into the
muscle tissue, thus decreasing the client’s
discomfort.
22. Withdraw the needle smoothly at the same angle of This minimizes tissue injury
insertion. Release the skin.
23. Apply gentle pressure at the site with a dry sponge or Use of an alcohol swab may cause pain or a burning
cotton. sensation
24. If bleeding occurs, apply pressure with a dry sterile To stop the bleeding.
gauze until it stops.
25. Discard the uncapped needle and attached syringe into the proper receptacle. Remove glove and perform
hand hygiene. Proper disposal prevents injury.
26. Document the time of administration, drug name, Documentation provides coordination of care
dose, route, and the client’s reactions.
27. Assess the effectiveness of the medication at the Assessment of the site discourages any untoward
time it is expected to act. effects
 ADMINISTERING SUBCUTANEOUS INJECTION

1. Check the label on the medication carefully against the MAR to make sure that the correct medication
is being prepared.
2. Follow the three checks for administering medications. Read the label on the medication:
▪ When it is taken from the medication cart; Before withdrawing the medication; After withdrawing
the medication
3. Organize equipment and supplies needed.
4. Perform hand hygiene and observe other appropriate infection control measures.
5. Prepare the medication from the vial or ampule for drug withdrawal.
6. Provide for client privacy.
7. Prepare the client. Introduce self and verify
client’s identity.
8. Explain procedure to the client. Explain to the client that the medication will produce a small wheal.
9. Select a site free of tenderness, hardness, Choosing the correct site allows for accurate
swelling, scarring, itching, burning, or localized reading of the test site at the appropriate time.
inflammation. Select a site that has not been used
frequently.
10. Apply clean gloves.
11.As per agency protocol, clean the site with an Cleansing the injection site prepares it for the
antiseptic swab. Start at the center of the site and injection. This method remove pathogen away
clean in a widening circle to approximately 5 cm (2 from the injection site. Alcohol gives full play to
inches). Allow the area to dry thoroughly. disinfect after dried
12. Place and hold a clean swab between the third and fourth fingers of the nondominant hand, or
position the swab on the client’s skin above the intended site. Using this technique keeps the swab
readily accessible when the needle is withdrawn
13. Prepare the syringe for injection. Remove the The needle will become contaminated if it touches
needle cap while waiting for the antiseptic to dry. anything but the inside of the cap, which is sterile
Pull the cap straight off to avoid contaminating the
needle by the outside edge of the cap.
14. Dispose of the needle cap.
15. Grasp the syringe in dominant hand by holding it For patients with little subcutaneous tissue, it
between thumb and fingers. With palm facing to the is best to insert the needle at a 45-degree
side or upward for a 45-degree angle insertion or angle.
with the palm downward or 90-degree angle
insertion, prepare to inject.
16. Using the nondominant hand, pinch or spread Keeping the needle steady helps keep the
the skin at the site and insert the needle using the needle in place.
dominant hand a firm steady push.
17. When the needle is inserted, move nondominant
hand to the end of the plunger.
18. Inject the medication by holding the syringe
steady and depressing the plunger with slow, even
pressure.
19. Remove the needle smoothly, pulling along the Depressing the skin places countertraction on it and
line of insertion while depressing the skin with your minimizes the client’s discomfort when the needle is
nondominant hand. withdrawn.
20. If bleeding occurs, apply pressure to the site with Bleeding rarely occurs after subcutaneous injection.
dry sterile gauze until it stops.
21. Dispose of the syringe and needle into the sharps
container. Dispose of other supplies appropriately.
22. Remove gloves and perform hand hygiene.