Proper insulin combining?

[danursern]

I also need this I need a how to paper on proper insulin combining and what insulins cannot be mixed with each other?

I've witness nurses incorrectly drawing cloudy before clear, and mixing Regular with lantus. I know you pull up the clear before cloudy as to not contaminate the Regular with long acting, but oters do not. I need to get this info out to the staff, because if I witness two I know there is more doing it. We use lots of agency and I do not know what they are doing. Not to knock agency or anything, this was our own facility nurses I witness doing it incorrectly.

Darcy

[danursern]

we keep ours refrigerated too- i would suggest that drawing it uip while it's still cold is not a terrible thing, but waiting a short time before injection- or rolling the syringe in your fingers to warm it manually- might help. i've personally never heard a patient complain of stinging, i didnt realize it was an issue until i read this message board.

:)

I do believe she is right about cold insulin stinging, however when they say refridgerate I think they mean to refridgerated when not using and do not leave out any length of time longer than that. I give mind at 6:30am I get it out at around 6:15am to warmup some, and rolling it to mix it helps warm it.

[ogrern2002]

I was told if you refridgerate a insulin then you need to keep it in there. It shortens the experation date if you leave it out after refridgerating. I see a lot nurses break this rule. Our facility goes by the American Diabetics ASS. we discard after 28 days. Looking at all insulin is a requirement of any good nurse because it can be bad after two days of opening.

Any insulin according to ADA and basic Nursing 101, any injectable drug from a multidose vial should be discarded or used in under 30 days...it has to do with the preservative used in the medication to stabilize it, usually something like Benzyl Alcohol. That is one of the reasons safe practice guidelines have us mark a vial. As for the refrigerating after opening of insulin...as long as it is not above around 85 degrees F for a prolonged period of time, no color changes, no cloudiness when it is supposed to be clear and no stopper floaties then it is in theory good for 4 weeks (28 days) after opening....it isn't so much the refrigeration that shortens the expiration date, it is a combination of exsposure to heat and or use. That is why it is important to look at your all your vials.....and truelly only use those vials that state multi-dose vials for more than one dose....I caught a nurse using a dated one dose vial of lido one day trying to infiltrate a laceration....the lido had lost it's effect...we looked it had been opend 3 days previously and was a single dose 20ml vial but somebody thought they were going to save a buck or two and had put it back in the drawer.....single dose vials have no preservatives so as soon as they are accessed and air contaminated the drug usually starts to degrade and sometime it is just a matter of minutes.....the insulin that is a main focus here does have preservatives added and an adjusted pH that aids in the stability of it so yes good for up to 28-30 days after first accesssing......sorry to get geeky on people but I like to have a reason to back up my opinions and stances on things hope everyone is having a good day

[sjb2005]

Clear to cloudy.

Don't mix anything with lantus.

Pt only needs humalog/novolog or regular w/ lantus. Not all 3 insulins.

It is recommended not to inject lantus in areas where other insulins are injected.

The american diabetes association, drug manufacturers or CDE nurse resources have lots of literature available. You can get some handouts or posters to help the staff understand the basics to insulin.