Drawing up meds in syringe.....How to?

[Dratz]

I have the summer off and have some syringes and sterile water to practice with so here is the problem I seem to have. How does a person hold a vial or an ampule in one hand (the nondominant hand) while pulling down on the syringe (without touching the needles to the sides of anything) and all the while using one hand to pull the med out and steady the syringe? And while pulling down on the syringe I cannot seem to keep myself from touching the plunger part of the syringe.

I am all fumbles when it comes to this. I cannot for the life of me put the needle into the ampule without touching the sides of the ampule, nor can I figure out how to keep the needle from touching the sides of the ampule when I invert it.

Now, when I come to having to do this for the first time on a real live patient, my shaking hands will really add to this issue.

Does this all come with lots of practice and should I just keep plugging along with my practicing? Every time I watch a video the nurses all make it look so easy.

Any tips would be appreciated.

Thanks

[Daytonite, BSN, RN]

perhaps these first two pictorials on "withdrawing a solution from an ampule" and "withdrawing a solution from a vial" will help you. there is a video you might be able to access to see this procedure from the second link.

http://teach.lanecc.edu/nursingskills/injmeds/ampule.htm

http://teach.lanecc.edu/nursingskills/mix/vial.htm

http://flightline.highline.edu/drydberg/balckboard/injection%20equipment.htm - injection equipment and techniques: im injections. includes short discussion on needles, gauge, length and bevel, syringes and sizes (shows pictures of difference between regular and leur lock tips), what a carpuject and tubex cartridge looks like, how to draw up solutions from an ampule or a vial, im, subq, intradermal and z-track injection techniques as well as the im injection sites.

http://www.cotc.edu/professional/streaming/archive/nursing.htm - there are videos at this site regarding injections, but i have not looked at all of them so i do not know if they address drawing up medication from an ampule or a vial. you need a realone player to view the videos.

[painthorsecrazyRN]

Hi everybody, don't have time to go into detail about touching the barrel and all, but for getting used to sticking the needle in someone, get an orange and practice on it. It can be scary thinking about giving someone a shot for the first time, so maybe that will help you. When you go into a room with a patient, be confident in yourself, and you will do great!

[emllpn2006]

The only experiance I have at pulling medication out of a ampule was at school. I may be way off here but cant you turn a ampule upside down and no medication will come out. Then you can stick the needle in. hold the ampule with your thumb and forefinger, hold the out side of the syringe with your remainig fingers to steady it, then pull back on the plunger with your other hand pulling the entire contents into the syringe. Then you just waist what you dont kneed by squirting it out of the needle into a sink.

[greatshakes]

Yes it's hellish and the trouble I have is trying to withdraw the plunger and make it look easy. I know exactly where you are coming from and it is equally hard to convince myself that when I hold the ampoule upside down the medication won't come out. It does become easier with practice.

[akulahawkRN, ADN, RN, EMT-P]

Don't forget that if you're drawing from an ampule, you're also supposed to use a needle with a filter to draw... and change the needle before you inject the med. It's considered bad form to inject very small glass shards into a patient.

Also, never put air into an ampule that you're trying to draw from (they're not vials!) because you'll probably displace all the med onto the floor rather quickly... Oops.

[BabyLady, BSN, RN]

according to my fundamentals text potter and perry (p. 886 3rd edition, canadian edition), it explains that you are not supposed to allow the needle tip of the shaft to touch the rim of the ampule. (i wonder if that means i can still let the needle touch the sides once it is inside the solution in the ampule? apparently the rationale being that the broken rim of the ampule is contaminated. easier said than done!!!

as for touching the barrel, according to page 881 of the text, it states that "to maintain sterility, the nurse avoids letting any unsterile object touch the tip or the inside of the barrel, the hub or shaft of the plunger or the needle" and then it has a little picture of the barrel and it says "avoid touching".

so.......go figure??? i know that as a student i will probably be pretty nervous the first time i ever draw a med and heaven forbid if i accidentally touch anything!!.

i don't know, i am just studying my notes here and that is what i am being told.

this is what you are missing..you can touch the outside of the syringe barrel...that is not going to be sterile anyway as soon as you take it out of the package unless you are dropping it in a sterile field. the shaft of the plunger is to remain sterile. you don't touch the hub with your gloves after you clean it either before you access it.

the "rim" is the outside edge...that is not referring to the inside walls of the ampule. in fact, you will discover that with small amounts of drugs, you will need to angle the needle a bit in order to get the proper dose out.

[Always_Learning, BSN, RN]

I see some people hold the vial upside down to insert the needle; I find this very difficult. I set the vial on the table, hold it with my non-dominant hand, and then insert the needle and inject air if necessary. At that point, still holding the vial with my non-dominant hand, I flip the vial upside down (with needle still in there), and withdraw fluid.

Keep in mind that if you are sticking the needle into a vial, there is usually a little "circle" or "target" in the rubber on the top of the vial that you can aim for. Ampules are a little trickier; if you are nervous or unsteady, you might brace your elbow or wrist against a counter top or something before you insert the needle (so you don't touch the sides). I would still hold the ampule with my non-dominant hand to steady it.

In the real world, at least, keep in mind that the inside of the vial is sterile, so it doesn't matter so much if the needle touches the inside of the vial (as long as you don't bend the needle, which takes some work).

Also, a little tip I was taught: if you find that it is difficult for you to pull the plunger on the syringe back (to withdraw meds), when you get it out of the package, give the plunger a twist (turn it like a doorknob, 360 degrees). This kind of breaks the seal and makes life easier (especially when dealing with very large syringes like Toomeys).

Practice makes perfect; it does get easier, and I still have to fight with vials sometimes to get the last bit out!

[neenad]

The plunger shouldnt be touched due to contamination. My professor was on us. When you inject med into patient it must be free of all potential microorganisms

[neenad]

the plunger is the rubber inside the syringe when you pull back to draw med out you should not be touching any other part except for the tip where you will pull back your plunger. the inside of shaft should be kept sterile

[nurseprnRN, BSN, RN]

let's look at what we're saying here. if you have a syringe to manipulate while you read this, you'll see what i'm trying to describe.

1) when you take the syringe out of the package, the plunger is inside the barrel, sterile. the plug at the business end of it is sterile. the inside of the barrel is sterile. the little round part at the end where you'll push later is not, because you have touched it.

2) now, pull the plunger back as you draw up sterile fluid. go ahead and touch the plunger when you do, the stick part that comes out of the barrel between the plug and the little round part you'll push on to inject. now what's sterile? the inside of the barrel is still sterile where it counts, between the plug and the needle, where the stuff you're going to inject is. the plunger that's come outside of the barrel isn't, and the outside of the barrel isn't.

3) now take the cover off the needle, or remove the needle if you are using a needleless system as you should be, and inject. push the plunger all the way down to the bottom of the barrel. what is sterile now? not the plunger (you touched it) nor the inside of the barrel (the plunger touched that). but what about the far side of the plug, the part that pushed in the medication? still sterile, because it has touched nothing that wasn't sterile in its brief working life.

you have not contaminated your syringe by touching the plunger when drawing up your med.

if you draw something up and inject it into a vial, then you might contaminate the inside of the barrel because the plunger is out of the barrel and you touch it (see 3). then when you pull back into the same syringe, the plug passes through the area of the barrel interior that the contaminated plunger touched, and then the liquid touches that part of the barrel, and the med is contaminated.

you prevent that by a) being careful not to touch the plunger at all as it goes out the first time and back into the barrel the first time (the second time doesn't matter-- see 3) or b) using a second syringe to draw up the stuff in the vial.

[brandon1491]

Just my 2 cents:

1. before uncapping the syringetwist the needle to make sure it is tightly secured (then uncap)

2. insert the syringe directly into the center of the ampoule turning the ampoule upside down once inserted hold the needle and ampule with one hand wrapping the pinky andring finger around the syringe and the thumb and index holding the ampoule.

3.use the nondominant hand to draw up the solution at eye level

4. withdraw the the syringe and flick to remove any air bubbles

5. push the plunger up to remove any excess air and for an exact reading (all at eye level)

6. hopefully the cap is on a countertop.... place the syringe in the cap on the table (scooping) up the cap and then press the cap firmly

Hope this helps

[KatePasa]

the INSIDE of the barrel