Medication preparation from a vial

Definition

Medical preparation from a vial is the method of preparing a drug contained in a vial into a usable form that is safe and effective for human delivery.

Purpose

• To facilitate safe and effective delivery of medications.
• To transform the medication from solid form to fluid form where appropriate.
• To prepare and transport the medication to equipment more suitable for final delivery.

Precautions

There are several precautions that health care providers need to keep in mind when preparing medications. These precautions protect both the practitioner and the patient. Risks most common to the health care provider include needlestick injuries from the equipment used to prepare the medication and the risk of splashing harmful drugs onto the skin, eyes and other mucous membranes, by which the body may uptake all or part of the drug. These are generally caused by incorrect methods of medication preparation. Failure to maintain sterility and contamination of the medication are the largest possible risks for the patient during this procedure. Strict adherence to guidelines set out by the health institution as well as those guidelines recommended for preparing particular medications provided by the manufacturers are vital to ensure safe preparation of any medication.

Description

Nearly all medications used for injections are distributed by manufacturers in sterile containers called vials. Some medications in these vials are in liquid form, whereas others are in solid form. Those in solid form usually break down readily in liquid form, losing their effectiveness. The solid (often powder) medication is then prepared by the health care provider shortly before use. Liquid medications are usually stable at room temperature and retain their quality. Many do not require further preparation or dilution to use, depending of course, on the route of administration chosen. It is considered safe practice to first read the manufacturer's documentation before preparing any drug for the first time or in cases where there is difference of opinion between health care providers in how the medication should be prepared from the vial. Workplace policy for delivery of particular drugs should also consult, as these can vary from institution to institution.

Preparation

Preparation of solid/powder medication from a vial:

• Check the medication order to ensure the right drug, the right dosage, the right medication chart for your patient, the correct time, the correct date, and the correct route of administration.
• Ensure familiarity with the correct dilution or mixing fluid to be used for the drug, for example, sterile water or normal saline.
• Gather the items to be used to prepare the medication from the vial. Usually for basic drug delivery, this requires a syringe, needle, dilution fluid, an alcohol swab, and the medication vial.
• Remove the protective cover from the vial and rub the penetrable surface with an alcohol swab. (This procedure is not standard at all institutions.)
• Wash the hands and don protective clothing (gloves, gowns, face mask, etc.) if you are drawing up hazardous drugs such as those used in chemotherapy.
• Maintain an aseptic technique throughout the preparation. While gloves are not always necessary, do not touch any parts of the equipment that deliver the medication directly to the patient.
• Draw up the dilution fluid into the syringe.
• Attach a needle to the same syringe (if not attached already) and insert directly into the vial.
• Inject all or a portion of the dilution fluid (depending on the manufacturer's recommendations) into the vial. Do not withdraw the syringe or needle from the vial.

• While holding the vial, syringe and needle (still inserted into the vial) in one hand, shake the vial vigorously to allow the dilution fluid and solid form medication to mix. Keep shaking the vial vigorously until all solid elements of the medication have been fully dissolved.
• Withdraw the contents of the vial back into the syringe. Remove all the fluid content of the vial to ensure the patient receives the full dose.
• Remove the needle and syringe from the vial.
• Remove the needle used for preparing your medication and attach a new sterile needle for delivery of the drug.
• Check the drug vial and medication order again for the correct drug and dosage requirements. The prepared medication should then be verified by a second health care provider (if required by the institution) for accuracy.
• Dispose of the used needle and vial safely and according to institution policy. Your prepared medication should now be safe for patient delivery.

Aftercare

It is essential to correctly dispose of items used during medication preparation. Needles should be disposed of in needles or sharps containers, and vials should be disposed of in the appropriate manner. If hazardous chemicals are spilled, these should be cleaned according to protocol before any other staff member enters the area.

Complications

Needlestick injuries and splashing of medication onto the health care provider are common risks. Complications for the patient may arise if the medication was contaminated through improper preparation on behalf of the health care provider.

Results

Correct methods result in a medication successfully prepared for safe and effective delivery.

Health care team roles

Medication may be prescribed by a physician or advanced practice nurse. Medication may be prepared from the vial by a variety of health care professionals, including doctors, nurses, and emergency medical personnel. Medication preparation usually takes place in a professional health care environment, such as a hospital, clinic, or physician's office.

Resources

BOOKS

Elkin, M. K., A. G. Perry and P. A. Potter. Nursing Interventions and Clinical Skills. St. Louis: Mosby-Year Book, Inc., 1996.

Kozier, B., G. Erb, K. Blais, et al. Techniques in Clinical Nursing. Canada: Addison-Wesley Nursing, 1993.

Dean Andrew Bielanowski, R.N.