Mixing Insulins question

[twinbee25]

Hi,

I am a 2nd semester ADN student, and last week during clinicals was my 1st time to mix insulins. I was to mix regular insulin (10units), and Novalog (15units). Well I did everything correctly ...clear to cloudy... then when I was withdrawing the needle out of the Novalog, my thumb bumped the plunger of the syringe and 2 units of the mixed insulin went into the vial of the Novalog. My instructor was there with me.

..now, what to do? We had the charge nurse come, and she said since the Novalog vial was full, it would be ok and that 2 units of the mixed solution wouldnt hurt and to go ahead and draw back up the 2 units of Novalog. Later I asked my instructor about that, and she said she would have wasted the Novalog and started over.

So I am curious as to what other nurses do when something like this happens. Please keep in mind, this was my 1st time mixing insulins, and its a "mechanics" thing going on. In post-conference, another student who gives self-injections, said she always set the vial down first before taking out the needle. So I will remember that next time, as I was still holding the vial/syringe upside down.

So again, my question is what do/would you do if this happened to you?

[grinnurse, RN]

I would start over b/c every dose would be off after that from that vial. I realize its a cost containment issue, but I would go with safety for my patient first!!

[RedSox33RN]

As a diabetic, I can tell you that it was contaminated, and should have been thrown out, full vial or not. In a home setting, the vial may or may not have been thrown out (depending on the practitioner), but in a hospital setting it definitely should have been tossed.

We did have something similar happen during our rotation last semester, and they had to toss 2 vials. Better safe than sorry.

[unknown99, BSN, RN]

It is never ok to use a contaminated vial. Insulin is a high risk drug, so why make it even more so? That staff nurse was wrong. Your instructor was right.

[humglum, BSN, RN]

Exactly. I would have tossed the contaminated insulin.

[kadokin, ASN, RN]

why do we mix insulin anyway? To me it has always seemed a very high risk practice. How can we be sure we don't comtaminate microscopically? I for one simply do not do it in the hospital setting I work and if a pt. were to ask for instructions on how to do it, I would not feel comfortable teaching it, mostly because I am not proficient at it and also because I don't think it's safe. And this was in our nursing textbooks as accepted practice. Any one else feel the same way? How much does an insulin syringe cost, anyway, is that what is? A cost-saving measure?

[Fiona59]

Its not so much cost saving as saving the patient two injections each time...

[Tweety, BSN, RN]

When in doubt, throw it out.

[Tony35NYC]

I would toss it and start over. Besides, one vial of insulin is not so costly that it should become a cost containment issue for the hospital.

[RedSox33RN]

Its not so much cost saving as saving the patient two injections each time...

Good point. Actually, some of the newer insulins, like Lantus, cannot be mixed with ANY other insulin.

There is also a huge risk of drawing up the incorrect amounts. It has not happened as a SN to myself or anyone I know of, but I did hear of patients and parents of diabetic children transposing numbers sometimes (supposed to take 5R and 20N, but drew up and injected 20R and 5N). I had a diabetic friend take her morning dose in the evening MANY times (which was much higher than the evening dose), and was up all night checking her blood sugar every 1/2 hour or so.

On a lot of occasions, I did just take seperate injections. To me, it actually hurt worse to prick my darn fingers all the time than to take an extra injection.

But I'm on a pump now, and very glad my mixing days are over!

[MamaTheNurse, BSN, RN]

I have a weird question - why was someone mixing Regular (short-acting) with Novolog (rapid-acting) - I've never seen that ever (and I work with an endocrinologist who sometimes does funky stuff in the name of blood glucose control.....)