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
   Re‐inject the diluent into the vial. Keeping the tip of the needle above the level of the solution in the vial, release the plunger. The syringe will fill with air that has been displaced by the solution.
   To prevent bacterial contamination of the drug (NPSA [268], C).
4. 6.Show
   With the syringe and needle still in place, gently swirl the vial to dissolve all the powder.
   To mix the diluent with the powder and dissolve the drug (NPSA [268], C).
5. 7.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).
6. 8.Show
   Invert the vial. Keep the needle in the solution and slowly depress the plunger to push the air into the vial.
   To create equilibrium in the vial (NPSA [268], C).
7. 9.Show
   Release the plunger so that the solution flows back into the syringe (if a large volume of solution is to be withdrawn, use a push–pull technique).
   To create equilibrium in the vial (NPSA [268], C).
8. 10.Show
   Inject the diluent into the vial. Keeping the tip of the needle above the level of the solution in the vial, release the plunger. The syringe will fill with the air that has been displaced by the solution.
   This ‘equilibrium method’ helps to minimize the build‐up of pressure in the vial (NPSA [268], C).
9. 11.Show
   Withdraw the prescribed amount of solution and inspect for pieces of rubber, which may have been ‘cored out’ of the cap (see Action figure 5c in Procedure guideline 15.13).
   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 (see Action figure 5d in Procedure guideline 15.13) and tap the syringe to dislodge any air bubbles.
    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