The Royal Marsden Hospital Manual of Clinical Nursing Procedures - Lisa Dougherty [560]
2 Inspect the solution for cloudiness or particulate matter. If this is present, discard and follow hospital guidelines on what action to take, for example return drug to pharmacy. To prevent the patient from receiving an unstable or contaminated drug (NPSA 2007d, C).
Procedure
3 Tap the neck of the ampoule gently. To ensure that all the solution is in the bottom of the ampoule (NPSA 2007d, C).
4 Cover the neck of the ampoule with a sterile topical swab and snap it open. If there is any difficulty, a file or ampoule opening aid may be required. To minimize the risk of contamination. To prevent aerosol formation or contact with the drug which could lead to a sensitivity reaction. To reduce the risk of injury to the nurse (NPSA 2007d, C).
5 Inspect the solution for glass fragments; if present, discard. To minimize the risk of injection of foreign matter into the patient (NPSA 2007d, C).
6 Open packaging and attach the needle onto the syringe. To assemble equipment. E
7 Withdraw the required amount of solution, tilting the ampoule if necessary. To avoid drawing in any air (NPSA 2007d, C).
8 Replace the sheath on the needle using one-handed scooping method and tap the syringe to dislodge any air bubbles. Expel air (replacing the sheath should not be confused with resheathing used needles).
Or: An alternative to expelling the air with the needle sheath in place would be to use the ampoule or vial to receive any air and/or drug. To prevent needlestick injury and aerosol formation (NPSA 2007d, C). To ensure that the correct amount of drug is in the syringe (NPSA 2007d, C).
9 Attach a new needle if required (and discard used needle into appropriate sharps container) or attach a plastic end cap or insert syringe into the syringe packet. To reduce the risk of contamination of the syringe tip. To avoid tracking medications through superficial tissues and to ensure that the correct size of needle is used for intramuscular or subcutaneous injection. To reduce the risk of injury to the nurse (NPSA 2007d, C).
10 Attach a label to the syringe. To ensure practitioner can identify medication in syringe (NPSA 2007d, C).
Procedure guideline 13.13 Medication: single-dose ampoule: powder preparation
Essential equipment
Medication ampoule
Diluent
Needle
Syringe
Sharps container
Swab
Preprocedure
Action Rationale
1 Wash hands with bactericidal soap and water or bactericidal alcohol handrub. To prevent contamination of medication and equipment (DH 2007, C).
2 Open packaging and attach needle to the syringe. To assemble the equipment. E
Procedure
3 Open the diluent and draw up required volume. To ensure the correct volume of diluent. E
4 Tap the neck of the ampoule gently. To ensure that any powder lodged here falls to the bottom of the ampoule (NPSA 2007d, C).
5 Cover the neck of the ampoule with a sterile topical swab and snap it open. If there is any difficulty, an ampoule opening device may be required. To minimize the risk of contamination. To prevent contact with the drug which could cause a sensitivity reaction. To prevent injury to the nurse (NPSA 2007d, C).
6 Inject the correct diluent slowly into the powder within the ampoule. To ensure that the powder is thoroughly wet before agitation and is not released into the atmosphere (NPSA 2007d, C).
7 Agitate the ampoule. To dissolve the drug (NPSA 2007d, C).
8 Inspect the contents. To detect any glass fragments or any other particulate matter. If present, continue agitation or discard as appropriate (NPSA 2007d, C).
9 When the solution is clear, withdraw the prescribed amount, tilting the ampoule if necessary. To ensure the powder is dissolved and has formed a solution with the diluent. To avoid drawing in air (NPSA 2007d C).
10 Replace the sheath on the needle using a one-handed scooping method and tap the syringe to dislodge any air bubbles. Expel air. To prevent aerosol formation. To ensure that the correct amount of drug is in the syringe (NPSA 2007d, C).
11 Attach a new needle if required (and discard used needle into appropriate