Need help with mixing meds for injection

Clovery · Nov 12, 2011

they're both in multi-dose vials? we didn't quite cover that in my lab but we did cover mixing insulins... i'm gonna take a guess since you don't have any replies. i'm curious about the right answer too...

for one ampule and one vial: inject air into the vial. withdraw medication. change to a filter needle. break and withdraw the med from the ampule. change to a new needle appropriate for your patient and site of injection. inject med using Z-track.

for two multidose vials - I guess for different medications you'd have to use two different needles to avoid the risk of contamination. So inject air into one, being careful not to touch the medication. Then inject air into the other and draw out the dose. *change the needle (not sure this is necessary, but it's being cautious and can't hurt)* draw the dose from the first vial you put air into. change the needle again and do your z-track injection.

if one isn't a multidose vial, then you wouldn't have to worry about changing the needle in between drawing the meds, since you are just going to waste anything that's not used.

when doing a z-track IM you always want to change the needle after drawing up a medication to avoid getting the solution into the superficial tissues, which can be irritating. you don't have to z-track for the deltoid site but you shouldn't inject more than .5 ml there.

you also want to be checking the MAR in between drawing the doses to make sure you have the right amount of each.

xtxrn, ASN, RN · Nov 13, 2011

Deltoid can take up to 1cc.

Double check compatibility chart.

If it's a single use vial, you don't need to change needles until ready to inject the patient. (same with an amp- unless you're using a filtered needle).

Does the pharmacology book seriously not cover this? The nursing lab films?

What are your thoughts on how to do this? :)

Esme12, ASN, BSN, RN · Nov 13, 2011

they're both in multi-dose vials? we didn't quite cover that in my lab but we did cover mixing insulins... i'm gonna take a guess since you don't have any replies. i'm curious about the right answer too...
for one ampule and one vial: inject air into the vial. withdraw medication. change to a filter needle. break and withdraw the med from the ampule. change to a new needle appropriate for your patient and site of injection. inject med using Z-track.
for two multidose vials - I guess for different medications you'd have to use two different needles to avoid the risk of contamination. So inject air into one, being careful not to touch the medication. Then inject air into the other and draw out the dose. *change the needle (not sure this is necessary, but it's being cautious and can't hurt)* draw the dose from the first vial you put air into. change the needle again and do your z-track injection.
if one isn't a multidose vial, then you wouldn't have to worry about changing the needle in between drawing the meds, since you are just going to waste anything that's not used.
when doing a z-track IM you always want to change the needle after drawing up a medication to avoid getting the solution into the superficial tissues, which can be irritating. you don't have to z-track for the deltoid site but you shouldn't inject more than .5 ml there.
you also want to be checking the MAR in between drawing the doses to make sure you have the right amount of each]
Removing meds from a vial....
You have no one else to ask????? I find this concerning. Notify your supervisor please for help.

Clovery · Nov 14, 2011

Deltoid can take up to 1cc.
Double check compatibility chart.
If it's a single use vial, you don't need to change needles until ready to inject the patient. (same with an amp- unless you're using a filtered needle).
Does the pharmacology book seriously not cover this? The nursing lab films?
What are your thoughts on how to do this? :)

we learned 0.5 for the deltoid, any more would be uncomfortable for most people. yes, you can do up to 1 ml but it should be avoided if possible. also we learned that you ALWAYS need to use a filter needle with an ampule because there may be glass fragments in the solution that are too tiny to see.

Honestly my book and accompanying video doesn't go into mixing two medications other than NPH and regular insulin in one syringe. And for that we're told that you don't need to change needles between drawing as long as you draw the regular insulin first. So I was just guessing (and erring on the side of caution) that if you're mixing completely different meds you'd want to change needles between drawing them if they're both multidose vials.

Somewherenear · Nov 17, 2011

Sure.

M = meperidine

A = atropine.

Two vials:

You will need two needles, two alcohol swabs, and one syringe.

- One swab one job - swab each vial top.

- Attach needle to syringe and inject however many cc of fluid you're drawing up but in air (stablize pressure or whatever) for M. (wording is weird - bascially if you want to give 3 ml of M - draw up 3 ml of air into the syringe and inject into the vial first). BUT DO NOT TOUCH IT WITH THE FLUID, INJECT THE AIR ABOVE.

- Using the same needle (hasn't been contaminated yet...) draw up the amount of air you would need the amount of cc for of A (wording is weird - basically if you want to give 2 cc of A - draw up 2 ml of air into the syringe and inject it into the second vial).

- Now draw up your 2cc of A.

- Remove fluid from needle - draw bag, remove bubbles... remove needle, dispose of in sharps container.

- Attach new needle to the syringe, go into the first vial (M) and DO NOT INJECT ANY ANY ANY FLUID of A into the M vial, you need to be percise with how much you draw up b/c if you took out more than the 3cc of M that you wanted, guess what? You've gotta toss that whole thing, waste meds, document, and start over....).

So at this point you should have 5 cc of fluid in your syringe - 2 cc of A and 3 cc of M... if it's an irritatig thing you'd want to switch for another needle, do you landmarking, z-track, aspirate, and inject.

For a vial and ampule

- To me, this is much easier and less nerve wracking.

- You will need, 1 swab, 1 needle, 1 syringe

- Draw up the 3cc of air into your syrine, swab your top of your M vial - inject the air, draw up your 3 cc of fluid.

-Open your ampule and draw up your 2 cc of fluid...

You're all set.