Mixing Medications Using One Syringe

N u rs i n g S k i l l s E n h a n c e m e nt G u i d e
OBJECTIVES:
At the end of the lecture discussion, the students will be able to:

a. Discuss the purpose of mixing medications in one syringe

b. Demonstrate the procedure and explain the rationale for the steps in mixing
medications in one syringe
c. Ensure proper observance of aseptic technique when performing the procedure
Integral
Components of M I X I N G M E D I C AT I O N S
Nursing Care USING ONE SYRINGE
 Medication
Administration — to spare the client the experience of being injected twice two
drugs (if compatible) are often mixed in one syringe and given
as one injection

— it involves knowledge and use of aseptic technique. Therefore,

this procedure is not delegated to UAP

NURSING SKILLS ENHANCEMENT LY C E U M O F A PA R R I – C O L L E G E O F H E A LT H

Integral
Components of
Nursing Care

 Medication
Administration
D RU G C O C K TA I LS
— drugs that are combined or
mixed together in a single
syringe or an infusion

NURSING SKILLS ENHANCEMENT LY C E U M O F A PA R R I – C O L L E G E O F H E A LT H

Integral
Components of
Nursing Care

 Medication
Administration

New Antibody Cocktail Drug for Covid – 19 treatment

NURSING SKILLS ENHANCEMENT LY C E U M O F A PA R R I – C O L L E G E O F H E A LT H

Integral
Components of D R U G I N C O M PAT I B I L I T I E S
Nursing Care

 Medication — mixing solutions of parenteral drugs has the potential for

Administration
incompatibility and consequent loss of activity of one or both
drugs

— physical reactions can cause visible changes, including

precipitation, changes in color, consistency, or opalescence;
or gas production

NURSING SKILLS ENHANCEMENT LY C E U M O F A PA R R I – C O L L E G E O F H E A LT H

Integral
Components of
Nursing Care MIXING
 Medication
INSULINS IN
Administration ONE SYRINGE

NURSING SKILLS ENHANCEMENT LY C E U M O F A PA R R I – C O L L E G E O F H E A LT H

Integral
Components of
Nursing Care MIXING INSULINS IN ONE SYRINGE
 Medication
Administration 1. Inject equivalent amount of air into the NPH vial and withdraw the
needle. (There should be no insulin in the needle.) The needle should
not touch the insulin

2. Inject equivalent amount of air into the regular insulin vial and
immediately withdraw the ordered amount of regular insulin

NURSING SKILLS ENHANCEMENT LY C E U M O F A PA R R I – C O L L E G E O F H E A LT H

Integral
Components of
Nursing Care MIXING INSULINS IN ONE SYRINGE
 Medication
Administration 3. Reinsert the needle into the NPH insulin vial and withdraw the
ordered amount of NPH insulin (The air was previously injected into
the vial). Be careful to withdraw only the ordered amount and to not
create air bubbles

4. If excess medication has been drawn up, discard the syringe and
begin the procedure over again

NURSING SKILLS ENHANCEMENT LY C E U M O F A PA R R I – C O L L E G E O F H E A LT H

Integral
Components of
Nursing Care MIXING INSULINS IN ONE SYRINGE
 Medication
Administration

Mixing Regular (clear) and NPH (cloudy) insulin

NURSING SKILLS ENHANCEMENT LY C E U M O F A PA R R I – C O L L E G E O F H E A LT H

 N u rs i n g S k i l l s E n h a n c e m e n t G u i d e

Mixing Medications Using One Syringe

 Mixing Medications Using One Syringe

ASSESSMENT
1. Assess for the patient’s knowledge of and learning needs about the medication
• may include but is not limited to specific drug action, side effects, interactions, and
adverse reactions

2. Ask for allergies to the medication to be administered

3. Identify the intended route of parenteral medication to determine the
appropriate size of syringe and needle for the client

NURSING SKILLS ENHANCEMENT LY C E U M O F A PA R R I – C O L L E G E O F H E A LT H

 Mixing Medications Using One Syringe

ASSESSMENT
4. Check the available form of medication for clarity and expiration date
5. Perform appropriate assessments (e.g., vital signs, laboratory results) specific
to the medication
6. Determine if the assessment data influence administration of the medication
i.e., is it appropriate to administer the medication or does the medication need to be held
and/or the primary care provider notified?

7. Determine that the two medications are compatible

NURSING SKILLS ENHANCEMENT LY C E U M O F A PA R R I – C O L L E G E O F H E A LT H

 Mixing Medications Using One Syringe

I M P L E M E N TAT I O N
8. Verify doctor’s order for the said medication and check the MAR.
• Check the label on the vial carefully against the MAR to make sure that 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 cart
(2) before withdrawing the medication, and
(3) after withdrawing the medication

NURSING SKILLS ENHANCEMENT LY C E U M O F A PA R R I – C O L L E G E O F H E A LT H

 Mixing Medications Using One Syringe
I M P L E M E N TAT I O N
9. Organize the equipment and supplies needed
• Client’s MAR or computer printout
• Two vials of medication; one vial and one ampule; two ampules; or one vial or ampule and one
cartridge
• Antiseptic swabs
• Sterile syringe and safety needle or insulin syringe and needle (If insulin is being given, use a
small-gauge hypodermic needle, e.g., #26 gauge.)
• Additional sterile subcutaneous or intramuscular safety needle (optional)

10. Perform hand hygiene and observe other appropriate infection control procedures

NURSING SKILLS ENHANCEMENT LY C E U M O F A PA R R I – C O L L E G E O F H E A LT H

 Mixing Medications Using One Syringe
I M P L E M E N TAT I O N
11. Prepare the medication ampule or vial for drug withdrawal
a. Inspect the appearance of the medication for clarity. Note however, that some
medications are always cloudy
b. If using insulin, thoroughly mix the solution in each vial prior to administration.
Rotate the vials between the palms of the hands
c. Clean the tops of the vials with antiseptic swabs

12. Prepare the medication ampule or vial for drug withdrawal

NURSING SKILLS ENHANCEMENT LY C E U M O F A PA R R I – C O L L E G E O F H E A LT H

 Mixing Medications Using One Syringe
I M P L E M E N TAT I O N
13. Mixing medications from two vials
a. Take the syringe and draw up a volume of air equal to the volume of medications to be
withdrawn from both vials A and B.
b. Inject a volume of air equal to the volume of medication to be withdrawn into vial A.
Make sure the needle does not touch the solution.
c. Withdraw the needle from vial A and inject the remaining air into vial B.
d. Withdraw the required amount of medication from vial B.

NURSING SKILLS ENHANCEMENT LY C E U M O F A PA R R I – C O L L E G E O F H E A LT H

 Mixing Medications Using One Syringe
I M P L E M E N TAT I O N
13. Mixing medications from two vials
d. Withdraw the required amount of medication from vial B.
e. Using a newly attached sterile needle, withdraw the required amount of medication
from vial A. Avoid pushing the plunger because that will introduce medication B into vial
A. If using a syringe with a fused needle, withdraw the medication from vial A.
f. Be careful to withdraw only the ordered amount and to not create air bubbles

NURSING SKILLS ENHANCEMENT LY C E U M O F A PA R R I – C O L L E G E O F H E A LT H

 Mixing Medications Using One Syringe
I M P L E M E N TAT I O N
14. Mixing medications from one vial and one ampule
a. First prepare and withdraw the medication from the vial
b. Then withdraw the required amount of medication from the ampule

NURSING SKILLS ENHANCEMENT LY C E U M O F A PA R R I – C O L L E G E O F H E A LT H

 Mixing Medications Using One Syringe

E VA LUAT I O N
15. Check the sufficiency of the amount and integrity of the
medications aspirated
16. Observe for signs of drug interactions

NURSING SKILLS ENHANCEMENT LY C E U M O F A PA R R I – C O L L E G E O F H E A LT H

REFERENCES:
 Berman, A. et. al. (2016). Kozier & Erb’s Fundamentals of Nursing Concepts, Process and
Practice (10th ed). England. Pearson Education Limited

 Potter, P A., Perry, A.G., et. al. (2017). Fundamentals of Nursing (9th ed). Elsevier (Singapore)
Pte. Ltd.

 RegisteredNurseRN. (2016, July 16). How to Mix Insulin NPH and Regular Insulin Nursing |
Mixing Insulin Clear to Cloudy [Video]. Youtube. https://www.youtube.com/watch?v=O_kXOnrYYRA

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