The Royal Marsden Hospital Manual of Clinical Nursing Procedures - Lisa Dougherty [562]
Action Figure 6 Method to minimize coring.
Procedure guideline 13.15 Multidose vial: powder preparation using equilibrium method
Essential equipment
Medication vial
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 With the needle sheathed, draw into the syringe a volume of air equivalent to the required volume of solution to be drawn up. To prevent bacterial contamination of the drug (NPSA 2007d, C).
6 Remove the needle cover and insert the needle bevel up, at an angle of 45–60°, into the rubber septum. Before complete insertion of the needle tip, lift the needle to 90° and proceed (see (see Action Figure 6 in Procedure guideline 13.14). To gain access to the vial and reduce the risk of coring. E
7 Invert the vial. Keep the needle in the solution and slowly depress the plunger to push the air into the vial. To create an equilibrium in the vial (NPSA 2007d, C).
8 Release the plunger so that the solution flows back into the syringe (if a large volume of solution is to be withdrawn, use a push-pull technique). To create an equilibrium in the vial (NPSA 2007d, C).
9 Inject the diluent into the vial. Keeping the tip of the needle above the level of the solution in the vial, release the plunger. The syringe will fill with the air which has been displaced by the solution. This ‘equilibrium method’ helps to minimize the build-up of pressure in the vial (NPSA 2007d, C).
10 With the needle and syringe in place, gently swirl the vial to dissolve all the powder. To mix the diluent with the powder and dissolve the drug (NPSA 2007d, C).
11 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).
12 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).
13 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).
14 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).
15 Attach a label to the syringe. To ensure practitioner