Drugs for Injection

If compatible medications are to be administered by injection, the can be combined in one syringe from multidose vials, ampules, and cartridge-injection systems. This method is effective at minimizing the number of injections, though caution must be taken to ensure compatibility and that the dose does not exceed the amount that can be absorbed at the injection site. 

Required Equipment

• * Medications and patient medication chart
• * Alcohol pads
• * Sterile syringe and needle
• * Cartridge-injection system, safety needle, or filter needle as applicable

 

Admixture from two multidose vials

1. Wipe the top of the first vial with an alcohol pad
2. Without inverting the vial, inject air into the vial equal to the amount of medication to be withdrawn to prevent a partial vacuum from forming upon withdrawal
3. Repeat the first two steps for the second vial with a new needle
4. Invert the second vial and withdraw the prescribed dose 
5. Wipe the stopper on the first vial with an alcohol pad
6. Invert the vial and withdraw the required dosage

 

Admixture from a multidose vial and an ampule

• 1) Wipe the top of the vial with an alcohol pad
• 2) Without inverting the vial, inject air into the vial equal to the amount of medication to be withdrawn to prevent a partial vacuum from forming upon withdrawal
• 3) Invert the vial and withdraw the prescribed dose
• 4) Tap the ampule stem then use an alcohol or gauze pad to wrap around the neck, carefully snapping it open
• 5) Change to a filter needle block glass splinters
• 6) Withdraw the correct dose from the ampule
• 7) Change to a regular needle for injection

Admixture from two ampules

• 1) Tap the ampule stem then use an alcohol or gauze pad to wrap around the neck, carefully snapping it open
• 2) Repeat for the second ampule
• 3) Insert a syringe with a filter needle and withdraw the correct dosage from each ampule
• 4) Change to a regular needle for administration
  

Considerations

1. * Observe proper hand hygiene, documentation, and disposal for all procedures.
2. * Insert needles bevel up and at a slight angle through the vial's rubber stopper
3. * Take caution not to contaminate one drug with the other
4. * Ensure compatibility before combining two drugs, and never combine more than two
5. * Some medications are time sensitive due to environmental factors which can alter compatibility
6. * If mixing regular and long acting insulin, draw the regular insulin first as the long-acting suspension could contaminate the regular insulin
7. * If combining using a cartridge-injection system, use a separate needle and syringe for injecting air into the multidose vial

 

Cartridge-Injection System

Convenient, prefilled cartridge holder syringes and medication cartridges form a cartridge injection system. This can make injections more convenient, accurate, and sterile. However, not all medications are available in cartridges.