The Royal Marsden Hospital Manual of Clinical Nursing Procedures - Lisa Dougherty [561]
12 Attach a label to the syringe. To ensure practitioner can identify medication in syringe (NPSA 2007d, C).
Procedure guideline 13.14 Multidose vial: powder preparation using a venting needle
Equipment
Medication ampoule
Diluent
Needle
Syringe
Alcohol 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 Remove the tamper-evident seal and clean the rubber septum with the chosen antiseptic and let it air dry for at least 30 seconds. To prevent bacterial contamination of the drug, as the plastic lid prevents damage but does not ensure sterility (NPSA 2007d, C).
5 Insert a 21 G needle into the cap to vent the bottle (see Action Figure 5a). To prevent pressure differentials, which can cause separation of needle and syringe (NPSA 2007d, C).
6 Insert the needle bevel up, at an angle of 45° to 60°. Before completing the insertion of the needle tip, lift the needle to 90° and proceed (see Action Figure 6). To minimize the risk of coring when inserting the needle into the cap. E
7 Inject the correct diluent slowly into the powder within the ampoule. To ensure that the powder is thoroughly wet before it is shaken and is not released into the atmosphere (NPSA 2007d, C).
8 Remove the needle and the syringe. To enable adequate mixing of the solution. E
9 Place a sterile topical swab over the venting needle (see Action Figure 5b) and shake to dissolve the powder. To prevent contamination of the drug or the atmosphere. To mix the diluent with the powder and dissolve the drug (NPSA 2007d, C).
10 Inspect the solution for cloudiness or particulate matter. If this is present, discard. Follow hospital guidelines on what action to take, for example return drug to pharmacy. To prevent patient from receiving an unstable or contaminated drug (NPSA 2007d, C).
11 Withdraw the prescribed amount of solution, and inspect for pieces of rubber which may have ‘cored out’ of the cap (see Action Figure 5c in Procedure guideline 13.14). To ensure that the correct amount of drug is in the syringe (NPSA 2007d, C). To prevent the injection of foreign matter into the patient (NPSA 2007d, C).
12 Remove air from syringe without spraying into the atmosphere by injecting air back into the vial (see Action Figure 5d in Procedure guideline 13.14) or replace the sheath on the needle using a one-handed scooping method and tap the syringe to dislodge any air bubbles. Expel air. To reduce risk of contamination of practitioner. To prevent aerosol formation (NPSA 2007d, C).
13 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 possible trauma to the patient if the needle has barbed (become bent/hooked), 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).
14 Attach a label to the syringe. To ensure practitioner can identify medication in syringe (NPSA 2007d, C).
Action Figure 5 Suggested method of vial reconstitution to avoid environmental exposure. (a) When reconstituting vial, insert a second needle to allow air to escape when adding diluent for injection. (b) When