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Equipment ▪ Medical administration record (MAR) ▪ Sterile syringe and needle ▪ Extra needle of proper gauge and length in accord with site Procedure 1. Wash your hands. 2. Hold the ampule and quickly and lightly tap the top chamber until all fluid flows into the bottom chamber. 3. Place a sterile gauze or alcohol wipe around the neck of the ampule (Figure 29-14). 4. Firmly grasp the neck of the ampule and quickly snap the top off away from your body. Place the ampule on a flat surface. 5. Withdraw the medication from the ampule, maintaining sterile technique. ▪ Check connection of needle to syringe by turning barrel to right while holding needle guard. ▪ Use a filter needle if recommended. ▪ Remove needle guard, and hold syringe in dominant hand. ▪ With nondominant hand grasp ampule and turn upside down, or stabilize ampule on a flat surface. ▪ Insert the needle into the center of the ampule; do not allow the needle tip or shaft to touch the rim of the ampule. ▪ Keep needle tip below level of meniscus (Figure 29-15).
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Ampule of prescribed medication Sterile gauze or alcohol swab Filter needle
Rationale 1. Decreases transmission of microorganisms. 2. Moves the fluid trapped above the neck of the ampule to the lower chamber of the ampule. 3. Contains the glass fragments and shields the nurse’s fingers from the broken ampule. 4. Directs shattered glass fragments away from the nurse’s face and fingers. Prevents spillage of medication. 5. Prevents the transmission of microorganisms. ▪ Ensures an airtight system. ▪ ▪ ▪ Filters out fine glass particles. Promotes dexterity. Provides access to medication.
Prevents needle tip or shaft.
Prevents air from entering syringe and fluid from leaking out while the ampule is inverted.
7. ▪ New vial. Prevents contamination of the needle and protects the nurse against inadvertent needlesticks. Prevents microorganisms. Change needle and properly discard used needle. 8. ▪ Remove the needle cap and pull back on plunger to fill syringe with an amount Rationale ▪ Allows syringe. 7. Sterility of a medication is lost in an open ampule. (Note: Manufacturers do not ensure sterility of rubber top. 6. Provides access to vial. Prepare the vial. Wash hands. and gently push the plunger upward to eject air. 8. spread of Vial of medication Sterile needle Rationale 1. Secure needle to syringe by turning the barrel to right while holding the needle guard. Draw back slightly on plunger. and dispose of the ampule top in a suitable container after comparing with MAR. 6. ▪ If air bubbles are aspirated. Removes surface contamination. Moves air bubbles above the fluid level in the syringe. Recap. ▪ Used vial. ▪ Wash your hands. Reduces the risk that the drug will cause irritation to subcutaneous tissue. Open the alcohol wipe. Withdrawing Medication from a Vial Equipment Medication administration record (MAR) Sterile syringe and needle Alcohol swab Procedure 1. Reduces transmission of microorganisms. medication to enter the ▪ Prevents loss of medication from the ampule caused from air pressure. 9. Hold syringe with needle pointing up and tap sides of the syringe. Choose a syringe of appropriate size to accommodate the volume of medication to be withdrawn. Reinsert the needle in the middle of the ampule and continue to withdraw the medication. Remove excess air from the syringe and check the dosage of medication in the syringe.) . remove metal cap from vial of medicine and cleanse the rubber top of the vial. Allows for accurate measurement of medication dose. cleanse the rubber top of the vial. 2. 3. remove the needle from the ampule. 2. Prepare syringe. Pulls medication from needle so only air is ejected from the syringe. 9. ▪ Grasp needle and turn barrel of syringe to the right.▪ Procedure ▪ Aspirate the medication by gently pulling on the plunger. Discard any unused portion of the medication.
Never shake. Creates positive pressure inside vial to allow accurate withdrawal of medicine. Gather necessary equipment. Check with the client and the chart for 3. 5. Make sure suspensions are thoroughly mixed. Complies with safety standards for ensuring the correct dosage. ▪ Ensures withdrawing all the medication at one time. 11. Slowly rotate each bottle of insulin. Removes air bubbles created by the dead space in the needle’s hub. 6. Invert vial. ▪ Displaces the solution with air to prevent the formation of a vacuum in the sealed vial. Expel air from the syringe while needle remains within the inverted vial by tapping the side of the syringe with your finger. 10. Remove cap from the needle. 4. Follow the five rights of medication administration. 2. Attach the new needle to the syringe by turning the barrel to the right. Insert needle into vial of the suspension. 9. 6. (Cloudy insulin such as NPH should be completely mixed. and medicine. Ensures a closed system. Prevents the leakage of solution from the vial. 10. keep the vial at eye level and the needle’s bevel below the fluid level. Clean the rubber stoppers of the vials with an alcohol swab. and dispose in the sharps container. 5. Prevents needlestick. Remove caps from insulin vials (if not already off). Compare the medication in the syringe with the prescribed dosage. 7. Turn vial upright and remove the needle. 7. Check the MAR against written health care orders.1. 6. Check the client’s identification band. Ensures accurate dose. and remove the exact amount of medicine while touching only the syringe barrel and plunger tip (Figure 29-17). 9. Prevents contamination of the plunger. Open the sterile package of the new needle. allows for accurate measurement of the solution. Insert the needle into the center of the upright vial and inject air into the vial. Check the amount of medicine in the syringe. 8. 4. Provides a sharp needle for injection that decreases the client’s discomfort. known allergies or medical conditions that would contraindicate the use of the drug. 11. 9. Inject 4. Draw air into the syringe equal to the dose of insulin to be given. 5. 3. 7. Replace the needle cap. Remove used needle.) 8. of air equal to amount of solution to be withdrawn from the vial. Wash your hands. Mixing Insulins in One Syringe Equipment Medication administration record (MAR) Insulin vials Procedure Alcohol swabs . being careful not to touch the needle to the medication in the vial. barrel. 8.
Drawing back slowly helps prevent air from being drawn into the syringe. 6. 5. ▪ Have another nurse check the prescribed dose. 10. 1. 4.to 1/2-inch needle. 9. Select and clean the site. Injected air displaces insulin and facilitates withdrawal. Insert needle into the vial of longeracting insulin. 4. be sure the tip of the needle is below the surface of the fluid level. Ensures correct client. Invert bottle and pull plunger down to withdraw the appropriate dose of insulin. Air bubbles must be removed to ensure that an accurate dose of insulin is in the syringe. refer to Procedure 29-2 or 29-3 as appropriate. Remove needle. Prevents reactions. 8. 3. Wash your hands. Inverting the vial allows the air to rise and the solution to settle on the bottom of the vial. 12. 13. 3. Take the medication to the client’s room and place on a clean surface. Air isplace the medication in the syringe and can cause errors in dosage. 11. Ensures complete mixture of suspension. Procedure 2. 10. Check with the client and the chart for any known allergies. Invert the bottle. Do not withdraw any insulin yet. 8. provide for privacy. Place the client in a comfortable position. hold it up to the light and look for air bubbles. 25 to 27 gauge. Prepare the medication from an ampule or vial. Permits access to solution. 12. 14. and slowly draw back to dose of insulin required. 3/8. Follow the five rights. Reduces transmission of microorganisms. With needle in the bottle. Fill syringe with air equal to dose of regular insulin. . Explain the procedure to the 7. Store insulin vials according to your agency policy. Promotes efficiency. ▪ Ensures accuracy. To remove air bubbles. Ensures accuracy in identification of medication. Pull back to get the appropriate dose of insulin free of air. 2. Wash hands and don nonsterile gloves. tap or flick the syringe with your finger to cause air to rise. Push plunger to push air and some insulin back into the vial.Insulin syringe Rationale 1. 9. Injected air will displace the insulin to be removed. occurrence of adverse Administering an Intradermal Injection Equipment Medication administration record (MAR) Sterile tuberculin syringe and short bevel. the air into the vial and remove the needle. 11. Helps remove surface contaminants. 6. client. Check the client’s identification armband. 7. Wash hands. Make sure there are no crystals on the bottom of the vial. Remove the needle. Insert needle into bottle and inject air into vial. 5.
▪ Do not massage the area after removing the needle. ▪ Withdraw the needle. 6. Promotes absorption of the medication. allow alcohol to dry. Decreases anxiety. withdraw the needle slightly. 12. ▪ Cleanse the site with an alcohol wipe using a firm circular motion. ▪ Express any air bubbles from the syringe. observe the development of a bleb (large flaccid vesicle that resembles a mosquito bite). redness. ▪ Remove the needle guard. cleanse from inside to outside. Accurately identifies the client. Discard the needle and syringe in a sharps container. 13. reduces trauma to the body’s tissue. Inject the medication. Prevents the occurrence of hypersensitivity reactions such as hives. Decreases contact with blood and body fluids. Reduces of microorganisms. 14. ▪ Check the amount of solution in the syringe. Promotes comfort. Prepare the syringe for injection. bevel side up. Reduces the client’s anxiety and enhances cooperation. ▪ Pat area gently with a dry 2 × 2 sterile gauze pad. or broken tissue. 5. 8. dispose of in appropriate receptacle. 2. 10. 4. ▪ Place the needle close to the skin. 15. ▪ With nondominant hand. ▪ Administer the medication slowly. 16. ▪ Hold the syringe in dominant hand. Promotes absorption of the drug. Remove gloves. grasp the client’s dorsal forearm and gently pull the skin taut on ventral forearm(Figure 29-20). and advance the needle approximately 3 mm below the skin surface. Document medication and site of injection on the MAR. ▪ ▪ Aids in the removal microorganisms on the skin. the needle’s tip should be visible under the skin. transmission Medication Alcohol swab and sterile 2 × 2 gauze pad Disposable gloves 1. urticaria. Insert the needle at a 10° to 15° angle until resistance is felt. Observe for signs of an allergic reaction. Draw a circle around the perimeter of the bleb with a ball point pen. 7. of . 11. Promotes client safety. and wash hands. or anaphylactic shock. Assess the client’s skin for bruises. ▪ Select an appropriate site using appropriate anatomic landmarks. Reduces transmission of microorganisms. 3. If none appears.13.
▪ Indicates that the medication was injected into the dermis. Provides a written description of the injection site and states the time the medication was administered. skin facilitates needle ▪ Ensures that medication is injected into the intradermal tissue. Ensures correct dosage of medication in the syringe. Ensures client safety. initial resistance indicates the needle’s tip is in the subcutaneous region. 14. Prevents spreading the medication beyond the point of injection. Prevents needlesticks.10. 16. 15. 13. Reduces the spread of microorganisms. ▪ Taut insertion. ▪ . Allows for easy recognition and observation of the injection site.
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