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
   Remove the tamper‐evident seal on the vial. Clean the rubber septum with an alcohol swab and let it air dry for at least 30 seconds.
   To prevent bacterial contamination of the drug, as the plastic lid prevents damage but does not ensure sterility (NPSA [268], C).
3. 5.Show
   Insert a 21 G needle into the cap to vent the bottle (Action figure 5a).
   To prevent pressure differentials, which can cause separation of needle and syringe (NPSA [268], C).
4. 6.Show
   Insert the needle bevel up, at an angle of 45–60°. Before completing the insertion of the needle tip, lift the needle to 90° and proceed (Action figure 6).
   To minimize the risk of coring when inserting the needle into the cap. E
5. 7.Show
   Inject the correct diluent slowly into the powder within the ampoule.
   To ensure that the powder is thoroughly wet before it is mixed and is not released into the atmosphere (NPSA [268], C).
6. 8.Show
   Remove the needle and the syringe.
   To enable adequate mixing of the solution. E
7. 9.Show
   Place a sterile topical swab over the venting needle (Action figure 5b) and gently swirl to dissolve the powder.
   To prevent contamination of the drug or the atmosphere. To mix the diluent with the powder and dissolve the drug (NPSA [268], C).
8. 10.Show
   Inspect the solution for cloudiness or particulate matter. If this is present, discard. Follow hospital guidelines on what action to take; for example, return drug to pharmacy.
   To prevent the patient from receiving an unstable or contaminated drug (NPSA [268], C).
9. 11.Show
   Withdraw the prescribed amount of solution. Inspect for pieces of rubber, which may have been ‘cored out’ of the cap (Action figure 5c).
   To ensure that the correct amount of drug is in the syringe (NPSA [268], C). To prevent the injection of foreign matter into the patient (NPSA [268], C).
10. 12.Show
    Remove air from the syringe without spraying into the atmosphere by injecting air back into the vial (Action figure 5d) and tap the syringe to dislodge any air bubbles. Expel air.
    To reduce the risk of contamination of the practitioner. To prevent aerosol formation (NPSA [268], C).
11. 13.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).
12. 14.Show
    Attach a label to the syringe.
    To ensure the practitioner can identify the medication in the syringe (NPSA [268], C).
13. 15.Show
    Keep all ampoules/vials and diluents in the tray with the syringe.
    To enable checking at the bedside. E