Checlist FnE

7/29/2019 Checlist FnE

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PREPARING MEDICATIONS FROM AMPULES AND VIALS

Definition:

Equipment:

Special Considerations:

1.

2.

PROCEDURE RATIONALE

1. Wash hands and observe otherappropriate infection control procedures.

AMPULES

2. Flick the upper stem of the ampule severaltimes with a fingernail or, holding the

upper stem of the ampule, make a large

circle with the arm extended.


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PROCEDURE RATIONALE

3. Partially file the neck of the ampule ifnecessary to start a clean break.

4. Place a piece of sterile qauze on the farside of the ampule neck or around the

ampule neck, and break off the top by

bending it toward the gauze, away from

the nurse.

5. Place the ampule on a flat surface.

6. Disconnect the regular needle, leaving thecap on and attach a filter needle to the

syringe.

7. Remove the cap from the filter needle,insert the needle in the ampule, and

withdraw the amount of drug required for

the dosage. Do not touch the rim of the

ampule with the needle tip or shaft. With a

single-dose ampule, hold the ampule

slightly on its side, if necessary, to obtain

all the medication.

8. Replace the filter needle with a regularneedle and tighten the cap at the hub of

the needle before injecting the client.

VIALS

9. Mix the solution, if necessary, by rotatingthe vial between the palms of the hands,

not by shaking.

10.Remove the protective metal cap or cleanthe rubber cap of a previously opened vial

with an antiseptic, such as 70% alcohol on

a sterile gauze, by rubbing in a rotary

motion.


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PROCEDURE RATIONALE

11.Remove the cap from the needle; thendraw up into the syringe the amount of air

equal to the volume of the medication to

be withdrawn, In some agencies, a special

filter needle is used to draw up premixed

liquid medications from multi-dose vials.

The filter needle is then replaced by a

regular needle to inject the medication

into the client.

12.Carefully insert the needle into the vialthrough the center of the rubber cap,

maintaining the sterility of the needle.

13.Inject the air into the vial, keeping thebevel of the needle above the surface of

the medication.

14.Invert the vial, ensure the needle tip isbelow the fluid level and hold it at eye

level while withdrawing the correct dosage

of the drug into the syringe.

OR

Hold the vial down, move the needle tip so

it is below the fluid level and withdraw the

medication. Avoid drawing up the last drops

of the medication.

15.Withdraw the needle from the vial, andreplace the cap over the needle, thus

maintaining its sterility. To recap an

unused needle, lay the cap on a firm

surface and insert the needle carefully,

maintaining its sterility. If a filter needle

was used to withdraw the medication,

replace it with a regular needle before

injecting the client.


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PROCEDURE RATIONALE

Preparing and Using Multidose Vials

16.Read the manufacturers directions. Thefollowing are two examples of the

preparation of powdered drugs.

a. Single-dose vial: Instructions forpreparing a single-dose vial direct that

1.5mL of sterile water be added to the

sterile dry powder, thus providing a

single dose of 2mL. The volume of the

drug powder was 0.5mL, therefore the

1.5mL of water plus the 0.5mL of

powder results in 2mL of solution does

not increase the volume. Therefore, it

is important to follow the

manufacturers direction.

b. Multi-dose vial: A does of 750 mg of acertain drug is ordered for a client. On

hand is a 10g multidose vial. The

directions for preparation read: Add

8.5mL of sterile water, and eachmilliliter will contain 1.0g or 1000mg.

Thus, after adding the solvent, the

nurse will give 750/1000 or mL

(0.75mL) of the medication.

17.Withdraw an equivalent amount of airfrom the vial before adding the solvent,

unless otherwise indicated by the

directions.

18.Add the amount of sterile water or salineindicated in the directions.

19.If a multidose vial is reconstituted, labelthe vial with the date, time it was

prepared, the amount of drug contained in

each milliliter of solution, and your initials.

20.Once reconstituted, store the medicationto the vial in a refrigerator or as

recommended by the manufacturer.


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MIXING MEDICATIONS IN ONE SYRINGE

Equipment:

D D D D D D D D D


1.

2.

PROCEDURE RATIONALE

Mixing Medications from Two Vials


2. Inspect the appearance of the medicationsfor clarity. Some medications are normally

cloudy.

3. If using insulin, thoroughly mix thesolution in each vial prior to

administration. Rotate the vials between

the palms of the hands and invert the

vials.

4. Clean the tops of the vials withdisinfectant swabs.


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PROCEDURE RATIONALE

5. Inject a volume of air equal to the volumeof medication to be withdrawn into vial A

or intothe vial of longer-acting insulin (eg.

NPH insulin).

6. Withdraw the needle from vial A, andinject the prescribed amount of air into

vial B or into the vial of shorter-acting

insulin (e.g. regular or crystalline zinc

insulin).

7. Withdraw the required amount ofmedications from vial B.

8. Using a newly attached sterile needle,withdraw the required amount of

medication from vial A. If using a syringe

with a fused needle, withdraw the

medication from vial A. The syringe now

contains a mixture of medications from

vials A and B.

Mixing Medications from One Vial and

One Ampule

9. First prepare and withdraw the medicationfrom the vial.

10.Then withdraw the required amount ofmedication from the ampule.


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ADDING AN IV MEDICATION TO AN IV BOTTLE OR BAG

Definition:

Purpose:

Equipment:

D D D D D D D


1.

2.

PROCEDURE RATIONALE


2. Prepare the drug dosage from a vial orampule.


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PROCEDURE RATIONALE

3. For a glass IV container, remove the metalcap and the rubber disc, if the bottle is

vented. Locate the injection port.

OR

For a plastic container, locate the separate,

self-sealing, soft rubber injection port. An

injection port may be designated in several

ways: by a triangular indentation or by the

word add. It is important not to inject

medication through the port for the

administration spike or through an air vent

port if there is an injection port.

4. Clean the injection port with an antisepticswab.

5. Remove the needle cover from themedication syringe, and inject the

medication into the port.

6. Remove the needle. For a glass container,cover the top immediately either with an

antiseptic swab with the metal IV cap

taped over it or the special sterile cap

provided by the manufacturer.

7. Gently rotate the solution container to mixthe drug with the solution.

7. Attach the medication label upside down to

the fluid container. Include the name of

the client, the dose of medication, the date,

time and nurses initials.

8. Clamp the IV tubing. Spike and hang thecontainer, and regulate the flow rate

according to the dosage required when the

medication is to be administered.


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PROCEDURE RATIONALE

9. Document the medication in theappropriate form on the clients record.

10.During the administration, observe theclient for signs of an adverse reaction,

such as noisy respirations, changes in

pulse rate, chills, nausea, or headache. If

any adverse sign occurs, follow the agency

policy (slow IV rate or stop flow) and

notify the physician or nurse in charge.

Also monitor the client for signs of the

intended action of the medication.

Variation for Adding Medications to an

Infusing Container

11.Determine that the IV solution in thecontainer is sufficient for adding the

medication.

12.Confirm the desired dilution of themedication, that is, the amount of

medication per milliliter of solution.

13.Close the infusion clamp.

14.Clean the medication port with anantiseptic swab.

15.Remove the needle cover from themedication syringe.

16.While supporting and stabilizing the bagwith your thumb and fore finger, carefully

insert the syringe needle through the port

and inject the medication.

17.Gently lift and rotate the container.


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ADMINISTERING INTERMITTENT INTRAVENOUS

MEDICATION USING A SECONDARY SET

Definition:

Purpose:

Equipment:

D D D D D D D


1.

2.

3.

PROCEDURE RATIONALE1. Wash hands and observe other

appropriate infection control procedures.

2. Provide for client privacy.

3. Prepare the client. Check the clients identification band.

If not previously assessed, takeappropriate assessment measures

necessary for the medication


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PROCEDURE RATIONALE

4. Explain the purpose of the medication andhow it will help, using language that the

client can understand.

5. Assemble the secondary infusion. Closethe clamp on the secondary infusion

tubing.

6. Spike the secondary infusion medicationinfusion bag.

7. Squeeze the drip chamber and fill one-third to one-half full.

8. Hang the secondary container at or abovethe level of the primary infusion. Use the

extension hook to lower the primary

infusion if a piggy back setup is required.

9. Attach the sterile needle or needlelesscannula to the tubing, open the clamp to

prime the tubing and close the clamp

when the tubing is filled with solution.

10.Clean the Y-port on the primary IV linewith an antiseptic swab. Clean the primary

port (the port furthest from the client) for

a piggyback alignment and the secondary

port (the port closest to the client) for a

tandem set up.

11.If the medication is not compatible withthe primary infusion, temporarily

discontinue the primary infusion. Flush the

primary line with saline solution before

attaching the secondary set. To flush the

line, wipe the port with an antiseptic

swab, clamp the primary line and using a

sterile needleless adapter (or needle) and

syringe, instill sufficient saline solution

through the port to flush any primary fluid

out of the infusion tubing.


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PROCEDURE RATIONALE

12.Insert the needleless canula of thesecondary line into the primary tubing

port.

13.Secure needle with tape if using a needlesystem.

14.Attach appropriate label to the secondarytubing.

Using a Piggyback Set

15.Ensure the primary line is unclamped ifthe port has a back-check valve.

16.Open the clamp on the piggyback line andregulate it in accordance with the

recommended rate for the medication.

Usually, medications are administered in

30 to 60 minutes.

Tandem Infusion

17.Open the clamp on the secondary line andregulate its flow.

18.For continuous infusion, set the secondarysolution to the appropriate drip rate for

the medication and then adjust the

primary solution to achieve the desired

total infusion flow.

19.For intermittent infusion, clamp theprimary line and adjust the primary drip

rate after the secondary solution is

completed.

20.Document the time, date, medication,dose,, route and solution, assessments of

the IV site, if appropriate; and the clients

response. Record the volume of fluid of

medication infusion bag on the clients

intake and output record.


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ADMINISTERING MEDICATION BY IV PUSH

Definition:

Indications:

1.

2.

3.

4.

5.

6.

7.


1.

2.

3.

4.

5.

6.

7.

Equipments:

D D D D D D


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PROCEDURE RATIONALE

9. While holding the port steadily, insert theneedle into the port.

10.Draw back on the plunger to withdrawsome blood into the IV tubing (not into the

syringe).

11.Inject the medication at the ordered rate,withdraw the needle, reopen the clamp,

and reestablish the intravenous infusion at

the correct rate.

12.If the medication is particularly irritatingto the veins, run the IV rapidly for about a

minute, and then adjust the rate.

IV Push into an Intermittent Set

13.Swab the injection port with an antisepticswab.

14.Insert the needle with the normal salineinto the port and aspirate for blood return.

15.Inject 2 ml of the normal saline solution(optional, depending on agency policy).

16.Remove the saline-filled syringe, and capthe needle to maintain its sterility.

17.Insert the needle attached to themedication syringe.

18.Inject the medication slowly at therecommended rate of infusion.

19.Observe the client closely for adversereactions.

20.Remove the needle and the syringe whenall medication is administered.


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