DRUG

PREPARATION

(AMPULE and VIAL)

 PREPARING MEDICATIONS FROM AMPULES

1. Verify the medication order in the Doctor’s order sheet. Follow

the three checks for correct medication and dose. 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. • Calculate medication dosage accurately. • Confirm
that the route is correct.
2. Organize the equipment. Equipment: Ampule, File (if ampule is
not scored) and small gauze square or plastic ampule opener •
Antiseptic swabs ,syringe ,needle for administering the medication
3.Perform hand hygiene and observe other appropriate infection
prevention procedures.
4. Prepare the medication ampule for drug withdrawal.
Flick the upper stem of the ampule several times with a
fingernail. This will bring all medication down to the main
portion of ampule
5. • Use an the ampule.
opener.or place a piece of sterile gauze or
alcohol wipe between your thumb and the ampule neck or around
the ampule neck, and break off the top by bending it toward you to
ensure the ampule is broken away from yourself and away from
others. The sterile gauze protects the fingers from the broken
glass, and any glass fragments will spray away from the nurse.

OR Place the antiseptic wipe packet over the top of the ampule
before breaking off the top. This method ensures that all glass
fragments fall into the packet and reduces the risk of cuts. •
Dispose of the top of the ampule in the sharps container.
 6. Place the ampule on a flat surface. • Attach the filter
needle/straw to the syringe. The filter needle/ straw
prevents glass particles from being withdrawn with the
medication.
7. • 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. This will keep
the needle sterile.
8. Withdraw the amount of drug required for the dosage.
Dispose of the filter needle by placing in a sharps container.
10. Perform hand hygiene.
PREPARING MEDICATIONS FROM VIALS
1. Verify the medication order in the Doctor’s order
sheet.
2. Organize the equipment. Equipment: vial of sterile
medication, antiseptic swabs ,syringe ,needle for
administering the medication, sterile water.
3. Perform hand hygiene and observe other appropriate
infection prevention procedures.
4. Prepare the medication vial for drug withdrawal. Mix
the solution by rotating the vial between the palms of
the hands. Some vials contain aqueous suspensions,
which settle when they stand. In some instances,
5. Remove the protective cap, or clean the rubber cap of a
previously opened vial with an antiseptic wipe by rubbing
in a circular motion. The antiseptic cleans the cap and
reduces the number
6.Drawback of microorganisms.
an amount of air into the syringe that is equal
to the specific dose of medication to be withdrawn.
7. Pierce the rubber stopper in the center with the needle
tip and inject the measured air into the space above the
solution. The vial may be positioned upright on a flat
surface or inverted. Allows particulate matter to
precipitate out of the solution.
8. Invert the vial and withdraw the needle tip slightly so
that it is below the fluid level. This prevents air from
being aspirated into the syringe.
9. Draw up the prescribed amount of medication while
holding the syringe at eye level and vertically. This
facilitates accurate reading ,and vertical position makes
removal of air
10. .Remove bubbles
any from
bubbles the syringe
accumulate in easy.
the syringe by
tapping the barrel of the syringe sharply and move the
needle past the fluid into the air space to re-inject the air
bubble into the vial. Return the needle tip to the solution
and continue
11.Remove thewithdrawing
needle fromthe
themedication.
vial and carefully replace
the cap over the needle. This prevents contamination of
the needle and protects the nurse against accidental
needle sticks
 12. If a multi dose vial is being used, label the vial with
the date and time opened, and store the vial containing
the remaining medication according to agency policy.
13. Perform hand hygiene.
 DRUG
ADMINISTRATIO
N

(IM, SQ, ID)

INTRAMUSCULAR INJECTION
STEPS:

1. Secure medication card and check this carefully against the doctor’s order.
2. Calculate dosage prn.
3. Wash hands thoroughly.
4. Place needed equipment and supplies of medication cart and bring to
client’s bed side.
5. Prepare medication.
INTRAMUSCULAR INJECTION
6. (If medication was prepared at nurses station, bring equipment and
supplies to bed side.) Identify client; explain procedure.
7. Provide appropriate environment.
8. Put on gloves.
9. Assist client to assume a comfortable position.
10. Locate site of choice.
11. Clean area with technique; allow site to dry.
12. Keep swab between fingers of non dominant hand.
13. Take syringe from medication tray, maintain asepsis. Remove needle cap.
14. Hold syringe with dominant hand, use other hand to stretch or grasp skin and
underlying tissue.
15. Insert needle at 90° angle.
16. When needle is in place, aspirate the plunger and check the barrel of the syringe
for blood.
17. If blood occurs, discard syringe and needle then start over. If no blood appears,
hold syringe steady with non dominant hand and inject medication slowly.
18. After injecting the drug, remove needle quickly while applying pressure on the
injection site with the alcoholized cotton.
19. Massage area with alcoholized cotton.
20. Without recapping or after using one handed recapping technique,
place used syringe in sharp disposal container.
21. Turn medication card face down.
AFTER CARE:
Patient:
22. Assist patient assume a comfortable position, remove gloves.
23. Check on client 10-30 minutes after injection.
Equipment:
24. Throw disposable materials into trash can.
25. Return medication tray to proper place, ready for next use.
26. Do handwashing.
CHARTING:
27. In medication sheet, sign on the appropriate slot indicating the time
the drug was given. For single dose medication, tear the card and
discard and document the time, name of drug, amount, site and route of
injection at the nurses remarks.
SUBCUTANEOUS INJECTION
STEPS:

1. Secure medication card and check this carefully against the doctor’s order.
2. Calculate dosage prn.
3. Wash hands thoroughly.
4. Place needed equipment and supplies of medication cart and bring to
client’s bed side.
5. Prepare medication.
6. (If medication was prepared at nurses station, bring equipment
and supplies to bed side.) Identify client; explain procedure.
7. Provide appropriate environment.
8. Put on gloves.
9. Assist client to assume a comfortable position.
10. Locate site of choice.
11. Clean area with technique; allow site to dry.
12. Keep swab between fingers of non dominant hand.
13. Take syringe from medication tray, maintain asepsis. Remove
needle cap.
14. Hold syringe with dominant hand, use other hand to stretch or
grasp skin and underlying tissue.
15. Insert needle at 45-90° angle.
16. When needle is in place, aspirate the plunger.
17. If no blood aspirated, hold syringe steady and inject medication
slowly.
18. After injecting the drug, remove needle quickly while applying
pressure on the injection site with the alcoholized cotton.
19. Massage area with alcoholized cotton.
20. Without recapping or after using one handed recapping technique,
place used syringe in sharp disposal container.
21. Turn medication card face down.
AFTER CARE:
Patient:
22. Assist patient assume a comfortable position, remove gloves.
23. Check on client 10-30 minutes after injection.
Equipment:
24. Throw disposable materials into trash can.
25. Return medication tray to proper place, ready for next use.
26. Do handwashing.
CHARTING:
27. In medication sheet, sign on the appropriate slot indicating the time
the drug was given. For single dose medication, tear the card and
discard and document the time, name of drug, amount, site and route of
injection at the nurses remarks.
INTRADERMAL INJECTION
STEPS:

1. Secure medication card and check this carefully against the doctor’s order.
2. Calculate dosage prn.
3. Wash hands thoroughly.
4. Place needed equipment and supplies of medication cart and bring to
client’s bed side.
5. Prepare medication.
6. (If medication was prepared at nurses station, bring
equipment and supplies to bed side.) Identify client; explain
procedure.
7. Provide appropriate environment.
8. Put on gloves.
9. Assist client to assume a comfortable position.
10. Locate site of choice.
11. Clean area with technique; allow site to dry.
12. Keep swab between fingers of non dominant hand.
13. Take syringe from medication tray, maintain asepsis. Remove needle cap.
14. Hold syringe with dominant hand, use other hand to stretch skin over
site.
15. With needle at 5-15° angle, insert it slowly until resistance is felt.
16. Advance needle for about 3mm (1/8 inch) below surface. Bevel can be
seen through skin.
17. Inject medication slowly (except resistance). Otherwise, needle might be
into deep and must be withdrawn.
18. Observe for the formation of a light-colored bleb, about ½ inch in
diameter forms.
19. Withdrawn needle while applying alcoholized cotton gently over injection site.
Do not massage the area.
20. Without recapping or after using one handed recapping technique, place used
syringe in sharp disposal container.
21. Turn medication card face down.
AFTER CARE:
Patient:
22. Use pen to draw circle at perimeter of bleb.
23. Assist patient assume a comfortable position, then remove gloves.
24. Return to evaluate response to medications 30 minutes after injection.
Equipment:
25. Throw disposable materials into trash can.
26. Return medication tray to proper place, ready for next use.
27. Do handwashing.
CHARTING:
28. In medication sheet, sign on the appropriate slot indicating the time
the drug was given. For single dose medication, tear the card and
discard and document the time, name of drug, amount, site and route of
injection at the nurses remarks.