ASPIRATING DRUGS FROM AMPULES AND VIALS

AMPULES

1. Before preparing to open the ampule, make certain that all of the drug
content is in the ampule proper and not in the stem.
Rationale: The drug tends to be trapped in the stem and it may be necessary
to tap the stem several times to help bring the drug down.

2. Wipe the neck of the ampule with cotton ball soaked in 70% alcohol.
Rationale: Wiping the ampule with an antiseptic solution is necessary to
remove the dust that might have lodged in it.

3. Use sterile gauze or dry cotton ball to hold ampule while breaking to protect
the fingers.
Rationale: Sterile material is necessary because it will be in direct contact
with the opening of the ampule when the stem is removed.

4. Discard cotton or gauze and the stem and put the ampule down.

5. To remove the drug, insert the needle into the ampule and withdraw the
solution being careful not to touch the mouth of the ampule with the needle
in order to minimize all chances of contamination.
Rationale: The fluid in the ampule is immediately displaced by air, therefore
there is no resistance to its withdrawal.

VIALS
1. Remove metal cap by means of a file.
Rationale: This exposes the rubber part which is the means of entrance into
the vial.

2. Cleanse rubber cap with cotton ball soaked in 70% alcohol. Inject air of the
same amount as the solution to be withdrawn.
Rationale: This increases the pressure within the vial and the drug can be
withdrawn easily since fluids move from an area of greater pressure to an
area of lesser pressure.

3. Hold the plunger firmly when withdrawing drugs from vial especially when
solution is in large amount.
 PARENTERAL MEDICATION

Introduction:

The safe preparation and administration of parenteral medications is a

routine nursing responsibility that requires dexterity; sterile technique; a
knowledge of the actions, usual dosage, desired effects, and potential side effects
of the drug being given; and the knowledge of how and where to give the drug. It is
possible to cause pain while giving the injection but, focusing on the beneficial
effect that the medication brings to the patient will help ease such apprehension.

Definition:

Parenteral drug administration can be taken literally to mean any non-oral

means of drug administration, but it is generally interpreted as relating to injection
directly into the body, by-passing the skin and mucous membranes.

Principles:

1. Use only sterile needles and syringes.

2. Select appropriate length of needle to deposit the medication in the proper

tissue layer.

3. Select the injection site carefully to avoid major nerves, blood vessels and
underlying organs.

4. Select an injection site that is relatively free of hair, lesions, inflammation,

rashes, moles, freckles and the like.

5. Rotate injection sites for patients receiving repeated injections by

establishing a predetermined plan.

6. Obtain assistance as needed in giving an injection when the patient is a

frightened child or an uncooperative adult.

7. Aspirate by pulling back on the plunger (except: heparin) to avoid injecting

subcutaneous and intramuscular medications into a blood vessel.

8. Check for drug allergies before administration of medication.

9. Identify the medication you will administer and observe for side effects and
therapeutic actions.

Common Routes:
 1. Intradermal

2. Subcutaneous

3. Intramuscular

4. Intravenous

SYRINGES

A syringe is a device used for injecting, removing or infusing fluids. They are
most commonly known in health care settings for injecting medications and for use
in removing blood from the body. Syringes can differ in size and type, and they can
be made of glass or plastic. The syringe chosen usually depends on its intended
purpose. The syringe consists of a plunger, barrel, hub, needle and the needle's
protective cover. It is important that all parts of a syringe coming into contact with
the body be kept free of contamination.

PARTS OF SYRINGES
Plunger - is located at the end of the syringe and can be made of clouded or colored glass or plastic. Its
purpose is to fill or empty the barrel. The plunger is pulled back to fill the barrel and is pushed forward
for emptying.

Barrel - is the part of the syringe that contains the fluid, whether it is a medication, blood or a solution
drawn from the body. It is usually calibrated in tenths (a tenth is equal to 0.1 milliliters) to make precise
measurements of the quantity of the fluid that is to be given or removed. The barrel can range in size from
0.5 mL to 50 mL.
Hub - the lower end of the syringe, opposite the plunger, terminates into a needle hub. The hub consists
of a needle adapter that allows the needle to be attached to the syringe. The hub also functions to lock the
needle in place while using the syringe for its desired function.

Needle - consists of the shaft, lumen and bevel. Needles vary in length, size of the shaft and size of the
lumen.

The shaft is the metal's length and is usually chosen depending upon the route and site of
administration, physical mass of the client, and the thickness of the medication.

The lumen, also known as the bore, is the hollow space within the needle. The diameter of the
lumen is known by the needle's number gauge. The lumen is chosen with the same specifications as the
shaft.

The last part of the needle, the bevel, is the pointed end and determines the needle's sharpness.

Protective Cover/Cap - is provided to maintain the needle's sterility. Needle sticks are a common way of
transporting infections to health care providers and clients. The needle's bevel is covered to limit the
amount of accidents that could happen involving needles and to ensure that only the intended client
receives the needle stick. In an attempt to reduce contamination and increase safety, most needles are
disposable and are thrown out after a single use.

\
 INTRADERMAL OR INTRACUTANEOUS INJECTION

It is the introduction of a solution by means of a syringe and a needle into the superficial layer of
the skin or just below the epidermis of the skin.

Purposes:

1. To identify allergens to which the patient may be hypersensitive (skin test).

2. To diagnose individuals who have developed antibodies against specific pathogens, such as
tubercle bacillus.
3. To vaccinate, e.g. BCG.

Sites of Injection:

1. Inner surface of the forearm

2. Upper chest if not hairy
 3. Upper back

Equipment:

A. Hypodermic Tray lined with sterile towel containing:

1. Medicine Ticket
2. Solution prescribed
3. Disposable sterile tuberculin syringe
4. Disposable sterile 2cc syringe
5. Disposable sterile needle G25-26, 5/8”
6. Disposable sterile aspirating needle
7. A jar of cotton balls soaked in 70% ROH (more than 2 CBs)
8. Waste Receptacle

B. Sharps Container

Procedure:

Action

1. Check for the physician’s order and assemble all equipment.

Rationale: To ensure that the patient receives the right medication at the right time by the
proper route.

2. Assess the patient’s history of allergies and note the substances the patient is allergic to and
the normal allergic reactions.
Rationale: Certain substances have similar compositions, the nurse should not administer
substance if the patient is known to be allergic to prevent its occurrence.

3. Wash your hand and assemble all equipment.

Rationale: Handwashing deters the spread of microorganisms.

4. Follow the basic Five Rights (1st 5 Rights).

Rationale: Promotes the patient’s safety by preventing medical error.

5. Pick up syringe and attached the aspirating needle.

Rationale: This prevents contamination of the needle and syringe.

6. Proceed as in the procedure of preparing/withdrawing a drug from ampule or vial.

Rationale: Pharmaceutical products for parenteral administration are supplied in various
containers.

Note: To prepare for skin testing, withdraw 0.9cc of the diluents and 0.1cc of the prescribed
medicine
7. Change aspirating needle with G25 or 26 needle. Maintain sterility by retaining the cap of the
needle. Place on top of hypotowel.

8. Present preparation to C.I. for checking together with the empty ampule or vial of the drug
prepared and pink booklet for signing.
Rationale: This guards against error in medication.

9. Carry tray to patient’s room. Identify the patient and explain the procedure.
Rationale: This prevents error in medication. An explanation encourages the patient
cooperation and reduces apprehension.

10. Select an area on the inner aspect of the forearm (or other appropriate sites).
Rationale: The forearm is a convenient and easy location for introducing an agent
intradermally.

11. Cleanse the area with a cotton ball soaked in 70% alcohol wiping with a firm, circular motion
and moving outward from the injection site. Discard used cotton ball. Allow the skin to dry.
Rationale: Pathogens on the skin can ba forced into the tissues by the needle. Drying the skin
will prevent introducing alcohol into the tissues during injection as alcohol is irritating to
the tissues and this makes patient ubcomfortable.

12. Pick up syringe and remove the cap. Use your non-dominant hand to grasp the dorsal forearm
and gently pull the skin taut.
Rationale: Taut skin provides an easy entrance into intradermal tissue.

13.Place the needle 5-15 ° angle against the patient’s skin. With bevel side up, insert the needle
beneath the skin so that the point of the needle can be seen through the skin. Insert the needle
only about 1/8 inch.
Rationale: Intradermal tissue will be entered when the needle is held as near parallel to the
skin as possible and is inserted about 1/8 inch.

14. Slowly inject the agent while watching for a small wheal or bleb to appear. If non appears,
withdraw the needle slightly.
Rationale: If a small wheal or bleb appears, the agent is in intradermal tissue.

15. Withdraw the needle quickly at the same angle that it was inserted.
Rationale: Withdrawing the needle quickly and at the angle at which it entered the skin
minimize tissue damage and discomfort for the patient.

16. Do not massage the area after removing the needle. Pat dry. Encircle the wheal with a blue or
black pen and instruct the patient and/or watcher not to disturb the wheal nor erase the mark.
Inform the patient/watcher that you will be back with physician after 30 minutes.
Rationale: Massaging the area where an intradermal injection is given may interfere with the
results by spreading medication to underlying subcutaneous tissue. A red pen may influence
the reading. The physician will interpret the result of the procedure.

17. Use the fish-hook technique to recap the used needle and placed it on top of the hypodermic
towel.
Rationale: Most accidental puncture wounds occur when recapping the needles. Leaving the
needle uncapped protects the needle from accidental injury with the needle.
18. Write the time injected, due time and site at the back of the medicine ticket.
Rationale: The nurse considers the well-being of the patient.

19.Inform the C.I. of the procedure done, patient’s name, due time and site. Endorse the
medicine ticket to the NOD.
Rationale: Awareness of the procedure done and to give time to contact the physician for
interpretation.

20. Leave the medicine ticket and the used syringe on the hypodermic towel for possible re-skin
testing. Wash your hands.
Rationale: If the result is doubtful, there may be a need for re-skin testing as ordered.
Handwashing deters the spread of microorganisms.

21. Observe the area for signs of a reaction within 30 minutes. Accompany the attending
physician or ROD to interpret the result.
Rationale: A circle easily identifies the site of intradermal injection and allows for careful
observation of the exact area.

22. Write the positive (+) or negative (-) sign on the appropriate space of the medicine ticket.