Withdrawing of medicine from a vial into a syringe

Authors: Rednenko V.V., Rednenko L.I., Poplavets E.V.

Editor: Rednenko V.V.

Equipment for the practical skill:

• medical manipulation table (see Preparing of the workplace for injections and intravenous infusions)
• disinfection table (see Preparing of the workplace for injections and intravenous infusions)
• medicines in ampuls (according medical records)
• medical records

Clinical situation:

• You are a nurse at the hospital therapeutic department. Withdraw the prescribed medication from a vial into a syringe

Order of the skill performance:

Preparatory stage:

• before starting work, remove jewelry from hands
• perform hygienic hand antiseptics
• verify: the name and dose of the medication on the vial with prescription
• place a syringe of required volume, extra needle and vial of medication on the manipulative table
• check the expiry date and integrity of the packaging of medical items and medication,
• put on PPE (gloves)
• take the pincette and using it take from the sterile package a individual paper packaging with sterile swabs. Put it on the table and unfold paper wrapper using hands

Main stage:

• Prepare a vial of medication:
  • Take a sterile swab and soak it by disinfectant
  • Treat the upper third of the vial with a swab
  • Put the used swab into the container “Disinfection of dressings, PPE”
  • Remove metal or plastic cover from vial with scissors
  • Take second sterile swab and soak it by disinfectant
  • Cleanse the rubber stopper of the vial with a swab
  • Place the vial on the manipulative table
  • Place the used swab in the container "Disinfection of dressings, PPE"
• Prepare extra needle:
  • take the 0.8x40 mm (green) needle packaging (extra needle) from the manipulative table
  • tear up the packaging from the  needle hilt  side (without touching needle) and place it on the manipulative table
• Prepare syringe:
  • take the packaging of the syringe from the manipulative table, tear up and open the packaging from the side of the plunger
  • take the syringe from the opened package in your dominant hand (leave the needle inside package)
  • put on the 0.8x40 mm needle (green) on the syringe needle cone with your left hand, without removing the needle from the package
  • remove the packaging from the needle with your left hand and place it in the “Packaging” container
  • fasten the cannula of the needle with the first and second fingers of the left hand on the syringe needle cone
• Withdraw the medication from the vial
  • place the index finger of the dominant hand on the needle hilt , with other fingers grab the syringe barrel
  • remove a cap from the needle with your non dominant hand, holding the needle hilt with the index finger of your dominant hand, place the cap in the "Plastic" container
  • take of your non dominant hand the vial between the second and third fingers, holding it at chest level, move the first and third fingers to the vial wall, the second one place on a bottom of the vial;
  • place the vial between the second and third fingers, grasp the syringe barrel with the first and fifth fingers of non dominant hand, move the fourth finger to the needle hilt
    
  • withdraw the required amount of the medication into the syringe, pulling the plunger “towards you” with your dominant hand
  • remove the needle from the vial
  • put the empty vial in the container "Empty vials"

• remove the needle from the syringe with the first and second fingers of your non dominant hand, place it in the container “Disinfection of sharp medical items”
• take the opened syringe package with the needle in it with your non dominant hand
• put the needle on the syringe needle cone without removing the needle from the package
• remove the syringe with needle from the package, place the package on the manipulative table
• fasten the needle with the first and second fingers of the non dominant hand on the syringe needle cone (needle bevel and cylinder scale should be on the same side)
• transfer the syringe to non-dominant hand, place the index finger on the hilt of the needle, grip the barrel of the syringe with other fingers
• place the second and third fingers of the dominant hand on the flange of the syringe barrel, place the first finger on the plunger
• without removing the cap from the needle, discard any air that has been withdrawn into syringe and discard any excess medication by pressing on the syringe plunger with the first finger of your dominant hand

Final stage::

• place the syringe with the medicine into the opened syringe package