Pre‐procedure

ActionRationale

1. 1.Show
   Wash hands with bactericidal soap and water or an alcohol‐based handrub.
   To prevent contamination of medication and equipment (DH [64], C).
2. 2.Show
   Inspect the solution for cloudiness or particulate matter. If present, discard and follow hospital guidelines on action to take; for example, return drug to pharmacy.
   To prevent the patient from receiving an unstable or contaminated drug (NPSA [268], C).

Procedure

1. 3.Show
   Tap the neck of the ampoule gently.
   To ensure that all the solution is in the bottom of the ampoule (NPSA [268], C).
2. 4.Show
   Cover the neck of the ampoule with a sterile topical swab and snap it open. If there is any difficulty, a file or ampoule opening aid may be required.
   To minimize the risk of contamination. To prevent aerosol formation or contact with the drug, which could lead to a sensitivity reaction. To reduce the risk of injury to the nurse (NPSA [268], C).
3. 5.Show
   Inspect the solution for glass fragments; if present, discard.
   To minimize the risk of injection of foreign matter into the patient (NPSA [268], C).
4. 6.Show
   Open the packaging and attach the needle onto the syringe.
   To assemble the equipment. E
5. 7.Show
   Withdraw the required amount of solution, tilting the ampoule if necessary.
   To avoid drawing in any air (NPSA [268], C).
6. 8.Show
   Tap the syringe to dislodge any air bubbles. Expel air.
   To prevent needle stick injury and aerosol formation (NPSA [268], C). To ensure that the correct amount of drug is in the syringe (NPSA [268], C).
   Or:

   An alternative to expelling the air with the needle sheath in place is to use the ampoule or vial to receive any air and/or drug.
    
7. 9.Show
   Attach a new needle if required (and discard the used needle into the appropriate sharps container) or attach a plastic end cap or insert the syringe into the syringe packet.
   To reduce the risk of contamination of the syringe tip. 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 [268], C).
8. 10.Show
   Attach a label to the syringe.
   To ensure the practitioner can identify the medication in the syringe (NPSA [268], C).
9. 11.Show
   Keep all ampoules/vials and diluents in the tray with the syringe.
   To enable checking at the bedside. E