Name: Zyra A.

Obedencio Date: 11/05/21

Evaluator/Signature: Grade:

PREPARING MEDICATIONS FROM AMPULES AND VIALS

Definition:

Ampules are glass container usually designed to hold a single dose of a drug. It is made clear and has a distinct shape with a constricted neck.
Vials are small glass bottles with seated rubber caps in different sizes, single to multidose vial.

Equipment:

● The vial or ampule of medication

● Sterile gauze
● A sterile needle and syringe
● Special filter needle [optional] for withdrawing premixed liquid medications from multi-dose vials or from ampules to filter out glass slivers.
● Antiseptic solution
● Sterile water, if necessary. Some vials contain only a powder, and it is necessary to instill a liquid such as sterile water to prepare the medication. The
manufacturer specifies preparation directions.
● File if required to open the ampule
● Medication chart and the medication ticket

MATERNAL AND CHILD HEALTH NURSING COMPETENCY WORKBOOK 01

Special Considerations:

1. Before administering any unfamiliar medications, know the following:

● Mode of action and purpose of medication.

● The side effects of the medication and its contraindications.
● Precautions to take before giving the medication.
● Proper administration technique.

2. Check the medication chart.

● Check the label of the ampule carefully against the MAR to make sure the correct medication is being prepared.
● Follow the three checks for administering medications. Read the label on the medication (1) when it is taken from the medication container, (2) before
withdrawing the medication, (3) after withdrawing the medication.

3. Organize the equipment.

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 PERFORMED
ACTION RATIONALE REMARKS
YES NO
1. Follow the six “rights” of medication To fulfill these rights for patient safety.
administration.

2. Follow the three checks for administering To administer drug properly.

medications. Read the label on the
medication (1) when it is taken from the
medication container, (2) before withdrawing
the medication, (3) after withdrawing the
medication.
3. Wash hands and observe other appropriate To avoid contaminating the medication that may affect the patient.
infection control procedures before handling
the ampule and prepare medication in clean
area.
AMPULES
1. Compare drug and dosage ordered with drug To countercheck whether we are giving the right medication.
and dose on hand Check expiration date,
dose/milliliter and total volume of solution in
the ampule. Look for contaminants such as
solutes present in the solution or defects in
the ampule.
2. Flick the upper stem of the ampule several To make opening of the ampule very easy.
times with a fingernail or, holding the upper
stem of the ampule, twist your wrist quickly
while holding the ampule vertically.
3. Partially file the neck of the ampule if To start clean break
necessary to start a clean break.

4. Place a piece of sterile qauze on the far side
of the ampule neck or around the ampule
neck, and break off the top by bending it
toward the gauze, away from the nurse.
5. Place the ampule on a flat surface.
To avoid spilling the medications toward the nurse and also protects the nurse’s
hand in case the glass breaks.
For better withdrawal of the medication.

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 PERFORMED
ACTION RATIONALE REMARKS
YES NO
6. Disconnect the regular needle, leaving the To withdraw the medication.
cap on and attach a filter needle to the
syringe.
7. Remove the cap from the filter needle, insert To keep the needle sterile as to avoid contaminating the medication.
the needle in the ampule, and withdraw the
amount of drug required for the dosage. Do
not touch the rim of the ampule with the
needle tip or shaft.
8. Remove the cap from the filter needle, insert To keep the needle sterile as to avoid contaminating the medication.
the needle in the ampule, and withdraw the
amount of drug required for the dosage. Do
not touch the rim of the ampule with the
needle tip or shaft.
9. Withdraw the desired amount of medication
plus a small amount more (approximately
30%). Ensure that there is no air injected in
to the solution.
Use either of the following methods:

a. Introduce the tip of the needle in the To properly withdraw the needed amount of solution.
ampule, which is standing on a flat
surface, and withdraw fluid into the
syringe. Touch plunger at knob only.
b. Insert the tip of the needle into the To avoid contaminating the drug and by the keeping the needle sterile.
ampule and invert the ampule. Have
the needle centered and not touching
the sides of the ampule. Withdraw
fluid into the syringe. Touch plunger
at knob only.
10. Wait until the needle has been removed to To ensure that there is no air included in the solution.
tap the syringe and expel air carefully by To avoid overdosing.
pushing on the plunger. Check the amount of
medication in the syringe with the
medication dose and discard any excess base
on hospital policy.

MATERNAL AND CHILD HEALTH NURSING COMPETENCY WORKBOOK 04

 PERFORMED
ACTION RATIONALE REMARKS
YES NO
11. Replace the filter needle with a regular To ensure the medication administration is appropriate.
needle and tighten the cap at the hub of the
needle before injecting the client.
VIALS – Preparatory phase
1. Follow the six “rights” of medication To fulfill these rights for patient safety.
administration.
2. Follow the three checks for administering To countercheck whether we are giving the right medication.
medications. Read the label on the
medication (1) when it is taken from the
medication container, (2) before withdrawing
the medication, (3) after withdrawing the
medication.
3. Wash hands and observe other appropriate To avoid contaminating the medication that may affect the patient.
infection control procedures before handling
the vial and prepare medication in clean area.
4. Compare drug and dosage ordered with drug To countercheck whether we are giving the right medication and to avoid
and dose on hand Check expiration date, overdosage which may harm the patient.
dose in the vial and check for defects in the
vial.
5. Calculate drug dosage, and check To ensure the needed amount to avoid overdose.
calculations with another nurse.

Vial containing a solution

6. Remove cap covering top of unused vial to To keep the medication sterile
expose sterile rubber seal, keeping rubber
seal sterile. If a multi-dose vial that has been
used before is being used again, firmly and
briskly wipe surface of rubber seal with
alcohol swab and allow it to dry.
7. Pick up syringe and remove needle cap. Pull To remove pressure and the sufficient amount of medications.
back on plunger to draw amount of air into
syringe equivalent to volume of medication
to be aspirated from vial.

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 PERFORMED
ACTION RATIONALE REMARKS
YES NO
8. With vial on flat surface, insert tip of needle To properly withdraw later on the procedure.
with beveled tip entering first through center
of rubber seal. Apply pressure to tip of
needle during insertion.

9. Inject air into the vial's airspace, holding on To remove the pressure inside or the vacuum inside which prevents medication
to plunger. Hold plunger with firm pressure; withdrawal.
plunger may be forced backward by air
pressure within the vial.
10. Invert vial while keeping firm hold on To countercheck pressure on vial
syringe and plunger. Hold vial between
thumb and middle fingers of nondominant
hand. Grasp end of syringe barrel and
plunger with thumb and forefinger of
dominant hand to counteract pressure in vial.
11. Keep tip of needle below fluid level. To get the fluid and withdraw the syringe

12. Allow air pressure from the vial to fill To obtain correct amount of solution.
syringe gradually with medication. If
necessary, pull back slightly on plunger to
obtain correct amount of solution.

13. When desired volume has been obtained, To remove air bubbles which administration of medication
position needle into vial's airspace; tap side
of syringe barrel carefully to dislodge any air
bubbles. Eject any air remaining at top of
syringe into vial.
14. Remove needle from vial by pulling back on To remove the syringe.
barrel of syringe.

15. Hold syringe at eye level, at 90-degree angle, To ensure correct volume and observe if there are any air bubbles.
to ensure correct volume and absence of air
bubbles. Draw back slightly on plunger; then
push plunger upward to eject air. Do not
eject fluid

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 PERFORMED
ACTION RATIONALE REMARKS
YES NO
16. If medication is to be injected into client's To administer the medication properly via the prescribed route.
tissue, change needle to appropriate gauge
and length according to route of medication.
17. For multidose vial, make label that includes To ensure medication viability and for safety purposes.
date of mixing, concentration of medication
per milliliter, and nurse's initials.
Vial containing a powder( reconstituting
medications)
1. Remove cap covering vial of powered To prepare the vial for the withdrawal of medication.
medication and cap covering vial of proper
diluent.
2. Draw up diluent into syringe. Insert tip of To dilute the powdered solute.
needle through center of rubber seal of vial
of powdered medication. Inject diluent into
vial. Remove needle.
3. Mix medication thoroughly. Roll in palms. To properly mix the solution for proper administration
Do not shake.
4. Reconstituted medication in vial is ready to To avoid administration and overdose which affect the client
be drawn into new syringe. Read label
carefully to determine dose after
reconstitution.
5. Dispose of soiled supplies. Place broken To maintain a clean work field and avoid contaminating medications.
ampoule and/or used vials and used needle in
puncture-proof and leak-proof container.
Clean work area and wash hands.

Learner’s Reflection: (What did you learn most of the activity? What is its impact to Instructor’s Comments:
you?)
Medications should be drawn up in a designated clean medication preparation area
that is not adjacent to potential sources of contamination, including sinks or other
water sources. When administering the medication, the nurse should always
countercheck the medication to avoid giving the incorrect medication to the patient.

MATERNAL AND CHILD HEALTH NURSING COMPETENCY WORKBOOK 07