Learn safe and sterile techniques for withdrawing and preparing medications from ampoules and vials, including step-by-step procedures, equipment handling, and nursing best practices to prevent contamination and ensure accurate dosing.
Description
Ampoule
Ampoule is a glass container usually designed to hold a single dose of a drug. It is made of clear glass and has a distinctive shape with a constrictive neck.
Ampoules vary in size ranging from 1 ml to 10 mL or more. Most ampoule necks have colored marks around it indicating where they are pre-scored for easy opening.
Vial
A vial is a small glass bottle with a sealed rubber cap. Vials come in different sizes from single to multi-dose vials. They usually have a metal or plastic cap that protects the rubber seal.
Articles
- Medication in an ampoule or vial.
- Syringe, needle.
- Small gauze piece.
- File.
- Medication chart /medication card.
- Kidney tray.
- Alcohol Swabs.
Procedure
| Nursing action | Rationale | |
| 1 | Before procedure Check patient’s name and medication order, including medication name, dose and route of administration. | Ensures correct administration of medication. |
| 2 | Perform hand washing and assemble equipment. | Reduces transmission of microorganisms. |
| 3 | Check medication order and check label for the name of medication, dose and date of expiry. | Medication potency may increase or decrease when outdated. |
| 4 | Prepare medication accordingly. |
AMPOULE PREPARATION
| Nursing action | Rationale | |
| 1. | During procedure Tap top of ampoule lightly and quickly with finger until fluid moves down from neck of ampoule. | Drains any fluid that collects above neck of ampoule into lower chamber. |
| 2. | Place small gauze piece or cotton swab around neck of ampoule. | Placing gauze piece around neck of ampoule protects nurse’s fingers from trauma as glass tip is broken off. |
| 3. | Partially file the neck of the ampoule, if necessary, for a clean break. | |
| 4. | Snap neck of ampoule quickly and firmly away from hands. | Protects nurse’s fingers and face from shattering glass. |
| 5. | Place the ampoule on a flat surface. Insert needle into center of ampoule opening. Do not allow needle tip or shaft to touch rim of ampoule. | Broken rim of ampoule is considered contaminated. |
| Aspirate medication into syringe by gently pulling back on plunger. | Withdrawal of plunger creates negative pressure within syringe barrel, which pulls fluid into syringe. | |
| 7. | Keep needle tip under surface of liquid. Tilt ampoule to bring all fluid within reach of the needle. | Prevents aspiration of air bubbles. |
| 8. | If air bubbles are aspirated, do not expel air into ampoule. | Air pressure may force fluid out of ampoule and medication will be lost. |
| 9. | Expel excess air bubbles: Remove needle from ampoule. Hold syringe with needle pointing up. Tap side of syringe to cause bubbles to rise toward needle. Draw back slightly on plunger and then push plunger upward to eject air. Do not eject fluid. | Withdrawing plunger too far will remove it from barrel. Holding syringe vertically allows fluid to settle in bottom of barrel. Pulling back on plunger allows fluid within needle to enter barrel so fluid is not expelled. |
| 10. | If syringe contains excess fluid, use kidney tray for disposal. Hold syringe vertically with needle tip up and slanted slightly toward kidney tray. Slowly eject excess fluid into kidney tray. Recheck fluid level in syringe by holding it vertically at eye level. | Medication is safely dispersed into kidney tray. Position of needle allows medication to be expelled without flowing down needle shaft. Rechecking fluid level ensures proper dose. |
| 11. | Cover needle with its safety sheath or cap. Replace the needle with another needle for injection. | Prevents contamination of needle. The outer surface of the needle may be coated with medication which may cause tissue irritation, if used for injection. |
Preparation from Vial
| Nursing action | Rationale | |
| 1. | Prepare the medication vial for withdrawing drug mix the solution, if necessar by rotating the vial between the palms of the hands, not by shaking. | Some vials contain aqueous suspensions, which settle when they stand. In some instances, shaking is contraindicated because it may cause the mixture to foam. |
| 2. | Remove cap covering top of unused vial to expose sterile rubber seal. In a multi-dose vial, which has been used before, cap is already removed. Firmly and briskly wipe surface of rubber seal in a circular motion with alcohol swab and allow it to dry. | Seals must be swabbed with alcohol before preparing medication. Allowing alcohol to dry prevents needle from being coated with alcohol and mixing with medication. |
| 3. | Pick up syringe and remove needle cap. Pull back on plunger to draw amount of air into syringe equivalent to volume of medication to be aspirated from vial. | Air must be injected into vial to prevent build-up of negative pressure in vial when aspirating medication. |
| 4. | With vial on flat surface, insert tip of needle with beveled tip entering first through center of rubber seal. Apply pressure to tip of needle during insertion. | Center of seal is thinner and easier to penetrate. Injecting beveled tip first and using firm pressure prevents cutting of rubber seal which could enter vial or needle. |
| 5. | Inject air into the vial keeping the bevel of the needle above the surface of the medication. | The air will allow the medication to be drawn out easily because negative pressure will not be created inside the vial. Avoids creating bubbles in the medication. |
| 6. | Invert vial while keeping firm hold on syringe and plunger. Hold vial between thumb and middle fingers of non-dominant hand. Grasp end of syringe barrel and plunger with thumb and forefinger of dominant hand to counteract pressure in vial. | Inverting vial allows fluid to settle in lower half of container. Position of hands prevents forceful movement of plunger and permits easy manipulation of syringe. |
| 7. | Keep tip of needle below fluid level. | Prevents aspiration of air. |
| 8. | Allow air pressure from the vial to fill syringe gradually with medication. If necessary, pull back slightly on plunger to obtain correct amount of solution. | Positive pressure within vial forces fluid into syringe. |
| 9. | When desired volume has been obtained, position needle into vial’s a space, tap sides of syringe barrel carefully to dislodge any air bubbles. | |
| 10. | Remove needle from vial by pulling back on barrel of syringe taking care not to pull the plunger. | Accidentally pulling plunger rather than barrel causes plunger to separate from barrel, resulting in loss of medication. |
| 11. | Hold syringe at eye level at 90° angle to ensure correct volume and absence of air bubbles. Remove any air bubbles if present. Draw back slightly on plunger then push plunger upward to eject air. Do not eject fluid. Recheck volume of medication. | Holding syringe vertically allows fluid to settle in bottom of barrel. Pulling back on plunger allows fluid within needle to enter barrel so fluid is not expelled. Air at top of barrel and within needle is then expelled. |
| 12. | Change needle to appropriate gauge and length according to route of medication. | Inserting needle through a rubber stopper may dull beveled tip. New needles are sharper and will not track medication through tissues. |
| 13. | For multi-dose vial, make label that includes date of mixing concentration of medication per milliliter, and nurse’s initials. | Ensures that future doses will be prepared correctly. |
VIAL CONTAINING A POWDER (RECONSTITUTING MEDICATIONS)
| NURSING ACTIONS | RATIONALE | |
| 1. | Remove cap covering vial of powdered medication and cap covering vial/ampoule of proper diluent. Firmly swab both seals with alcohol swab and allow it to dry. | Maintains sterility and allows alcohol to dry. |
| 2. | Withdraw an equivalent amount of air from the vial before adding the solvent unless otherwise indicated in the directions by the manufacturers. | Reduces pressure inside the vial when injecting the diluent. |
| 3. | Draw up diluent into syringe from vial or ampoule. | Prepares diluent for injection into vial containing powdered medication. |
| 4. | Insert tip of needle through center of rubber seal of vial containing powdered medication. Inject diluent into vial. Remove needle. | Diluent begins to dissolve and reconstitutes medication. |
| 5. | Mix medication thoroughly by rolling in palms. Do not shake. | Ensures proper dispersal of medication throughout the solution. Shaking produces bubbles. |
| 6. | Reconstituted medication in vial is ready to be drawn into new syringe. Read label carefully to determine dose after reconstitution. | Once diluent has been added, concentration of medication determines dose to be given. |
| 7. | Clean work area and perform hand washing | Controls transmission of infection. |
Special Considerations
- Some medications and some institutions require that a filter needle be used when preparing medications from a vial. Check agency policy to determine if use of filter needle is indicated.
- Mixing insulins – if the patient is to receive 10 units of regular insulin and 30 units of NPH insulin, follow this procedure:
- Inject 30 units of air into the NPH vial and withdraw the needle (there should be no insulin in the needle). The needle should not touch the insulin.
- Inject 10 units of air into the regular insulin vial and immediately withdraw 10 units of regular insulin.
- Reinsert the needle into the NPH insulin vial and withdraw 30 units of NPH insulin. By using this method, you avoid mixing NPH insulin with the regular insulin.
REFERENCES
- Annamma Jacob, Rekha, Jhadav Sonali Tarachand: Clinical Nursing Procedures: The Art of Nursing Practice, 5th Edition, March 2023, Jaypee Publishers, ISBN-13: 978-9356961845 ISBN-10: 9356961840
- Omayalachi CON, Manual of Nursing Procedures and Practice, Vol 1, 3 Edition 2023, Published by Wolters Kluwer’s, ISBN: 978-9393553294
- Sandra Nettina, Lippincott Manual of Nursing Practice, 11th Edition, January 2019, Published by Wolters Kluwer’s, ISBN-13:978-9388313285
- Annamma Jacob, Rekha, Jhadav Sonali Tarachand: Clinical Nursing Procedures: The Art of Nursing Practice, 5th Edition, March 2023, Jaypee Publishers, ISBN-13: 978-9356961845 ISBN-10: 9356961840
- Omayalachi CON, Manual of Nursing Procedures and Practice, Vol 1, 3 Edition 2023, Published by Wolters Kluwer’s, ISBN: 978-9393553294
- Sandra Nettina, Lippincott Manual of Nursing Practice, 11th Edition, January 2019, Published by Wolters Kluwer’s, ISBN-13:978-9388313285
- Adrianne Dill Linton, Medical-Surgical Nursing, 8th Edition, 2023, Elsevier Publications, ISBN: 978-0323826716
- Donna Ignatavicius, Medical-Surgical Nursing: Concepts for Clinical Judgment and Collaborative Care, 11th Edition ,2024, Elsevier Publications, ISBN: 978-0323878265
- Lewis’s Medical-Surgical Nursing, 12th Edition,2024, Elsevier Publications, ISBN: 978-0323789615
- AACN Essentials of Critical Care Nursing, 5th Ed. Sarah. Delgado, 2023, Published by American Association of Critical-Care Nurses ISBN: 978-1264269884.
- Ernstmeyer K, Christman E, editors. Nursing Fundamentals [Internet]. 2nd edition. Eau Claire (WI): Chippewa Valley Technical College; 2024. PART IV, NURSING PROCESS. Available from: https://www.ncbi.nlm.nih.gov/books/NBK610818/
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