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
   Open the packaging and attach the needle to the syringe.
   To assemble the equipment. E

Procedure

1. 3.Show
   Open the diluent and draw up the required volume.
   To ensure the correct volume of diluent. E
2. 4.Show
   Tap the neck of the ampoule gently.
   To ensure that any powder lodged here falls to the bottom of the ampoule (NPSA [268], C).
3. 5.Show
   Cover the neck of the ampoule with a sterile topical swab and snap it open. If there is any difficulty, an ampoule opening device may be required.
   To minimize the risk of contamination. To prevent contact with the drug, which could cause a sensitivity reaction. To prevent injury to the nurse (NPSA [268], C).
4. 6.Show
   Inject the correct diluent slowly into the powder within the vial.
   To ensure that the powder is thoroughly wet before agitation and is not released into the atmosphere (NPSA [268], C).
5. 7.Show
   Agitate the ampoule.
   To dissolve the drug (NPSA [268], C).
6. 8.Show
   Inspect the contents.
   To detect any glass fragments or any other particulate matter. If present, continue agitation or discard as appropriate (NPSA [268], C).
7. 9.Show
   When the solution is clear, withdraw the prescribed amount, tilting the ampoule if necessary.
   To ensure the powder is dissolved and has formed a solution with the diluent. To avoid drawing in air (NPSA [268], C).
8. 10.Show
   Tap the syringe to dislodge any air bubbles. Expel air.
   To prevent aerosol formation. To ensure that the correct amount of drug is in the syringe (NPSA [268], C).
9. 11.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 possible trauma to the patient if the needle has barbed (become bent or hooked), 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).
10. 12.Show
    Attach a label to the syringe.
    To ensure the practitioner can identify the medication in the syringe (NPSA [268], C).
11. 13.Show
    Keep all ampoules/vials and diluents in the tray with the syringe.
    To enable checking at the bedside. E