Proper insulin combining?

DutchgirlRN, ASN, RN · Sep 14, 2005

NEVER mix Lantus Insulin with any other insulin. I always draw up NPH before Regular. That's the way I learned it 30 years ago. I think it's still the same? We have to double check each other each and every time we give insulin. I was told by a nurse who came here (Nashville) from California that they don't double check insulin before giving it. I thought that was Nursing 101. She said this must be something new in Tennesee. Ah, no we've been doing it for at least 30 years and probably longer. I'm glad we do. I caught an agency nurse last year using a TB syringe to draw up 6 units and she had drawn up 0.6 cc. YIKES !!!

txspadequeenRN, BSN, RN · Sep 14, 2005

Clear to cloudy and never mix lantus with anything!!!!

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 waht they are doing.
Darcy

danursern · Sep 14, 2005

Clear to cloudy and never mix lantus with anything!!!!

Yes, I know this already what I need is a written description from a good source to spead it around on my unit. I can't get my PP on my copy machine to work right.

Thanks

danursern · Sep 14, 2005

NEVER mix Lantus Insulin with any other insulin. I always draw up NPH before Regular. That's the way I learned it 30 years ago. I think it's still the same? We have to double check each other each and every time we give insulin. I was told by a nurse who came here (Nashville) from California that they don't double check insulin before giving it. I thought that was Nursing 101. She said this must be something new in Tennesee. Ah, no we've been doing it for at least 30 years and probably longer. I'm glad we do. I caught an agency nurse last year using a TB syringe to draw up 6 units and she had drawn up 0.6 cc. YIKES !!!

All the books say you inject air in the cloudy or long acting first and then inject air into the regular last, and draw it first, because it is fast acting and if you contaminate it with long acting, it is useless after that. Get Potter and Perry Clinical Skills book. I learn this 10 years ago in LPN school always draw clear in the syringe before cloudy. This is the mistake I am seeing lately nurses are drawing the long acting up first then sticking the needle in the clear and drawing it back in the syringe. It to risky.

Darcy

lsyorke, RN · Sep 14, 2005

I was taught draw regular and then NPH, but I have to say that hubby diabetic of 45 years always draws nph first. His doctor told him that contaminating nph to reg or reg to nph is still contaminated either way and proper aspiration of the liquid will not result in contamination. There's NO way I'll change his mind!!

danursern · Sep 14, 2005

Yes, I hear you, I won't change either. I was taught a certain way and I'll stick to it.

How about Lente anything on it? Some people confuse this with Lantus?

Larry77, RN · Sep 14, 2005

Air to clowdy then to clear...draw up clear then clowdy.

Another tip: If you are giving both Lantus and coverage (ie regular sliding scale), give the coverage first because Lantus tends to burn a little on injection and if the patient is confused you may not get another chance...

reyaguilar · Sep 14, 2005

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

You should report this to whoever is in charge of your facility. The practice you mentioned will cause contamination.

rogramjet · Sep 14, 2005

Lantus is not a "normal" insulin and does not work like other insulins, it is actually broken down according to your body's pH. It CANNOT be mixed. Mixing it will make it ineffective. If you get any other insulin in the vial it will contaminate and probably make the rest of that Lantus unstable. At around $90 a vial, this can be an expensive error.

Hairstylingnurse · Sep 14, 2005

:pYour absolutely right. I'm a type 1 diabetic and do 5 shots a day. I take reg. during the day and lantus at bedtime and I do like you say (your statement on which one to inject air into first & everything). I take my lantus at bedtime and you can't mix it at all. I started out on reg. mixed with nph only at bedtime. You always draw clear before cloudy. I can't believe these nurses are doing it backwards. When I was in LPN school, our instructor must have put that mixing question on at least 200 of our tests. I wasn't diabetic then, but it is definantly memorized now. I called 3 different pharmacists at wal-mart & walgreens(when I was switched from nph to lantus) about why can't lantus be mixed with other insulins and they didn't know why. Does anyone here have a reason why they can't be mixed????????? :rolleyes: p.s. Lantus is the next best thing since the invention of white bread...

All the books say you inject air in the cloudy or long acting first and then inject air into the regular last, and draw it first, because it is fast acting and if you contaminate it with long acting, it is useless after that. Get Potter and Perry Clinical Skills book. I learn this 10 years ago in LPN school always draw clear in the syringe before cloudy. This is the mistake I am seeing lately nurses are drawing the long acting up first then sticking the needle in the clear and drawing it back in the syringe. It to risky.
Darcy

cumberland40 · Sep 14, 2005

you dont need a print-outs from any sources. What you should do is to speak up, to the nurse that you saw doing that and to the nursing director. Because it is very clear rule, Put air to cloudy then to regular and then aspirate regular and then cloudy. There is no controversy behind that.