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Cancel anytime. Ampules contain single doses of injectable medication in a liquid form. An ampule is made of glass with a constricted, prescored neck that is snapped off to allow access to the medication. A colored ring around the neck indicates where the ampule is prescored. Medication is easily withdrawn from the ampule by aspirating with a filter needle and syringe. Filter needles must be used when preparing medication from a glass ampule to prevent glass particles from being drawn into the syringe (Alexander et al., 2009; Nicholl and Hesby, 2002). A vial is a single- or multi-dose plastic or glass container with a rubber seal at the top. Vials may contain liquid or dry forms of medications. Some vials have two chambers separated by a rubber stopper. One chamber contains the diluent solution; the other contains the dry medication. Before preparing the medication, push on the upper chamber to dislodge the rubber stopper and allow the powder and the diluent to mix. Unlike an ampule, a vial is a closed system. You must inject air into the vial to permit easy withdrawal of the solution. Delegation ConsiderationsThe skill of preparing injections from ampules and vials cannot be delegated to nursing assistive personnel (NAP). Chapter 7. Parenteral Medication Administration Parenteral refers to the path by which medication comes in contact with the body. Parenteral medications enter the body by injection through the tissue and circulatory system. Injection medications are absorbed more quickly and are used with patients who are nauseated, vomiting, restricted from taking oral fluids, or unable to swallow. Parenteral medications can be effective and safe when prepared and administered correctly. However, because they are invasive and absorbed readily and quickly into the body, there are numerous risks associated with administering them (Perry et al., 2014). There are four routes for parenteral medications (also see Figure 7.1). Each type of injection requires a specific skill set to ensure the medication is prepared properly and administered into the correct location (Perry et al., 2014). The four types of injections are:
To administer parenteral medications safely, it is imperative to understand how to prevent an infection, prevent medication errors, prevent a needle-stick injury, and prevent discomfort to the patient. Tables 7.1 to 7.4 address specific practices to eliminate safety hazards to patients and health care workers. Preventing Infection During an InjectionAccording to Seigel et al, (2007), research has shown that unsafe injection practices have resulted in patient exposure to infections leading to outbreaks of infectious diseases. These unnecessary exposures were the result of deficient health care practices. Injectable medications must be given in a safe manner to maintain sterility of equipment and prevent the transmission of infectious diseases between patients and health care workers. Table 7.1 summarizes how to prevent an infection during an injection. Table 7.1 Preventing Infection During an Injection
Safe Medication AdministrationMedication errors have a substantial impact on health care in Canada (Butt, 2010). When preparing and administering medication, and assessing patients after receiving medication, always follow agency policy to ensure safe practice. Review Table 7.2 for guidelines for safe medication administration. Table 7.2 Guidelines for Safe Medication Administration
Promoting Safety and Comfort of a Patient During an InjectionInjections can be given safely and effectively, and harm can be prevented if proper injection technique is used. Most complications related to injections are associated with intramuscular injections, but may occur with any route. Complications can occur when an incorrect site is used, or with an inappropriate depth or rate of injection (Malkin, 2008). To promote patient safety and comfort during an injection, review the guidelines in Table 7.3. Table 7.3 Promoting Patient Safety and Comfort During an Injection
Preventing Needle-Stick InjuriesHealth care providers can be at risk for needle-stick injuries in any health care setting. The most common places for needle-stick injuries to occur are in the operating room and patient rooms. Tasks that place the health care provider at risk include recapping needles and mishandling IV lines. Table 7.4 provides guidelines to prevent needle-stick injuries. Table 7.4 Recommendations for Prevention of Needle-Stick Injuries
Preparing Medications from Ampules and VialsSpecific equipment, such as syringes and needles, is required to prepare and administer parenteral medications. The selection of the syringe and needle is based on the type and location of injection; amount, quality, and type of medication; and the body size of the patient. Many syringes come with needleless systems or needles with safety shields to prevent injuries (Perry et al., 2014). Aseptic technique is paramount to the preparation and administration of these medications. Parenteral medications are supplied in sterile vials, ampules, and prefilled syringes. Ampules are glass containers in 1 ml to 10 ml sizes that hold a single dose of medication in liquid form. They are made of glass and have a scored neck to indicate where to break the ampule (see Figure 7.2). Medication is withdrawn using a syringe and a filter needle. A blunt fill needle with filter (see Figure 7.3) must be used when withdrawing medication to prevent glass particles from being drawn up into the syringe (see Figure 7.4). Never use a filter needle to inject medication (Perry et al., 2014). Figure 7.2 Breaking open an ampuleFigure 7.3 Blunt fill needle with filterFigure 7.4 Using a blunt fill needle with filter with an ampuleRead this information about ampules to review how to prepare medication from an ampule. Video 7.1A vial is a single- or multi-dose plastic container with a rubber seal top, covered by a metal or plastic cap (see Figure 7.5). A single-use vial must be discarded after one use; a multi-dose vial must be labelled with the date it was opened. Check hospital policy to see how long an open vial may be used. The vial is a closed system, and air must be injected into the vial to permit the removal of the solution (Perry et al., 2014) (see Figure 7.6). Figure 7.5 Preparing medications from a vialFigure 7.6 Vial with safety needle insertedRead this information about vials to review how to prepare medication from a vial and reconstitute medication. Video 7.2A syringe (see Figure 7.7)is a sterile, single-use device that has a Luer lock (see Figure 7.8) or non-Luer lock tip, which influences the name of the syringe. Syringes come in various sizes from 0.5 ml to 60 ml. Syringes may come with or without a sterile needle and will have a safety shield on the needle. Figure 7.7 Labelled syringeFigure 7.8 Luer lock needleInsulin is only given using an insulin syringe (see Figure 7.9). Insulin is ordered in units. It is important to use the correct syringe and needle for the specific injection. Always examine the measurement scale on the syringe to determine that you have the correct syringe (Lynn, 2011). Read this information about syringes to review the different types of syringes. Needles are made of stainless steel, are sterile and disposable, and come in various lengths and sizes. The needle is made up of the hub, shaft, and bevel. The bevel is the tip of the needle that is slanted to create a slit into the skin. The hub fits onto the tip of the syringe. All three parts must remain sterile at all times. The length of the needle will vary from 1/8 in. to 3 in., depending on the injection. The gauge of a needle is the diameter of the needle. Gauges can vary from very small diameter (25 to 29 gauge) to large diameter (18 to 22 gauge). A needle will have its gauge and length marked on the outer packaging; choose the correct gauge and length for the injection ordered (Lynn, 2011) (see Figures 7.10, 7.11, and 7.12). Read this information about needles to review needles and how to “scoop cap”. Figure 7.10 Variety of needles with different gauges and lengthsFigure 7.11 Types of needles with safety shieldsFigure 7.12 Needle with safety cap
What equipment is needed when drawing medication from an ampule?The use of a filter needle is required when drawing up medication or solution from a glass ampule. This allows any glass particles to be filtered out of the solution before using that solution in a patient or final product.
Which supply item should be used to withdraw contents from an ampule?As mentioned previously, because of the potential for glass to enter the solution being withdrawn, a filter needle or filter straw must be used when withdrawing or expelling contents from an ampule. All ampules are intended for single-dose only. Vials are made of either plastic or, more commonly, glass.
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