1.3 Procedures for Assembling Syringe and Drawing Medication
The administration of medicine by injection requires equipment (needles and syringes) that is sterile, accurate in measuring dosage, convenient to use, and that will produce as little discomfort and/or hazard for the patient as possible. A needle and syringe are used to introduce suitable liquid preparations of drugs directly into the body tissue or blood vessels. Because of the accuracy of these methods of administration, these injections provide the patient with a more precise amount of drug and a more rapid onset of drug action than with oral medications.
Patient safety is a critical factor for the basic medical specialist. Aseptic techniques must be strictly maintained during the preparation and administration of a drug. Foreign particles or other types of contamination on a needle could be injected directly into the body. Infection may be introduced through the needle hole in the skin. Irreparable damage to major nerves or other structures may occur due to improper technique. Needles and syringes are controlled items. The medical specialist is responsible for the security and control and ultimate disposal of this equipment.
Steps in the Procedure for Assembling the Needle and Syringe
a. Determine Type of Medication, Time of Administration, and Route of Injection. This step is to determine the type of needle needed.
b. Perform Patient Care Handwash. Wash hands according to instructions provided in your previous training whether you are in the clinic or field environment.
c. Gather Required Equipment.
Figure 1-5. Injection Chart
d. Inspect Packaging for Defects. Check to determine if the package has been opened or if it has any holes. If you note any water or discoloration that may indicate water has damaged the syringe, or if you suspect that the package has been tampered with in any way, discard the package and obtain sterile equipment.
e. Unpack the Syringe. Remove the syringe from its packaging without contaminating any sterile parts. The sterile parts of the syringe are the needle adapter and the shaft of the plunger, which goes into the barrel. Any contamination could cause infection to the patient.
(1) Syringe in flexible wrapper.
(a) Peel the sides of the wrapper apart to expose the rear end of the syringe.
(b) Grasp the syringe by the barrel with the free hand.
(c) Pull the syringe from the packaging.
(d) Dispose of empty packaging in appropriate receptacle.
(2) Syringe in hard plastic tube (cartridge package).
(a) Press straight down on top of the tube with your thumb or use twisting motion.
(b) Press until you hear a distinct click. The click indicates the seal has not previously been broken. If you don't hear the click, discard the syringe and get another tube.
(c) Lift the top (cap) off the tube (cartridge) and put it down on your working surface.
(d) Grasp the syringe by the barrel with a free hand.
(e) Pull the syringe from the tube (cartridge) on your working surface. Be careful not to contaminate the needle adapter of the syringe.
(f) Put the empty tube (cartridge) on your working surface.
(g) Using the free hand, hold the syringe between the first two fingers with the needle adapter forward, pointing away from the back of the hand.
f. Inspect Plunger of Syringe.
(1) Grasp syringe with the nondominant hand and pull plunger back and forth checking for smooth and easy movement.
(2) Visually check the rubber stopper (inside the syringe) to ensure that it is attached securely to the top end of the plunger, forming a seal. The rubber stopper may become stuck or detached from the top end of the plunger, breaking the seal.
(3) Discard the syringe and select another if the plunger is stuck or does not move smoothly. Repeat steps c through e above.
g. Unpack Needle. Remove the needle from its packaging without contaminating it. Any contamination of the needle may cause infection to develop in the patient.
(1) Peel the sides of wrapper apart and expose the rear end of the needle.
(2) Grasp the cover of the needle and remove from wrapper, taking care not to touch the hub.
(3) Discard the empty wrapper in the appropriate place.
h. Assemble Needle and Syringe.
(1) Remove the protective cover from the needle adapter on the syringe. Holding the syringe in the nondominant hand and the needle by the protective cover in the dominant hand, insert the needle adapter into the needle hub.
(2) Tighten the needle with a one-fourth turn to ensure that it is attached securely to the needle hub.
(3) Do not touch the needle adapter or the hub to avoid contamination of the sterile surface.
i. Remove Protective Cover from Needle.
(1) Hold the needle and syringe in an upright position.
(2) Grasp the protective cover with the nondominant hand.
(3) Pull the protective cover from the needle straight off with an upward motion. Do not use a twisting motion as this may cause the needle to come off the needle hub.
j. Inspect Needle.
(1) Visually inspect the needle for the following flaws:
(a) Burrs. Rough edges on the needle that could tear the patient's skin during the injection.
(b) Barbs. Hook-like edges that extend away from the needle edge and could cause injury to the patient.
(c) Needle damage. Bent or broken needle.
(d) Contamination. Rust or foreign particles on needles.
(2) If the needle has any of these defects, discard and obtain a sterile needle.
k. Replace Cover. Place the protective cover back onto the needle.
l. Place Assembled Needle and Syringe on Work Surface.
Steps in the Procedure for Preparing and drawing medications into a Syringe
In this section, we will continue describing the procedures for giving an injection. These procedures will differ according to the type of medicine and from the type of vial.
a. Verify Medication. The medical specialist should check the doctor's order or the therapeutic documentation care plan for the type, route, and dose of medication to administer.
b. Perform Patient Care Handwash. Wash hands according to instructions provided in your previous training-whether you are in the clinic or field environment.
c. Gather Equipment. The following should be placed on the medication tray.
d. Assemble Needle and Syringe.
e. Check Drug Container Label. The medical specialist verifies medication against the therapeutic documentation care plan.
f. Examine Rubber Stopper. The rubber stopper should not be damaged. There should not be any small cores or plugs torn from the stopper due to improper injection of needles (see figure 1-6). Follow the examination procedures below:
(1) If vial is new, remove metal protective cap.
(2) Examine the rubber stopper for defects such as small cores or plugs torn in the stopper.
(3) If a defective stopper is identified, hold the vial to the light to examine for any foreign particles and to detect any changes in the color and consistency of the medication.
(4) Check the date that the multidose vial was opened and the expiration date on the medication.
(5) Follow the directions on the container regarding expiration date and follow local policy regarding use of multidose vials.
(6) Check to determine if the medication was stored properly; e.g., refrigeration.
(7) The dosage should be verified against the doctor's orders or therapeutic documentation care plan.
Figure 1-6. Results of correctly and incorrectly inserting a needle in a stoppered vial.
g. Check Medication for Defects.
h. Prepare and Draw Premixed Medication. The medical specialist prepares and draws medication from a stoppered vial (a vial that has been opened) in the following manner:
Figure 1-7. Examination of a rubber stopper.
i. Prepare and Draw Powdered Medication.
(e) Place the protective cover on the needle.
j. Ampule. Follow this procedure for the ampule.
Figure 1-9. Tapping medication down.
Figure 1-11. Withdrawing medication.
k. Clear Syringe of Air Bubbles. Use the following procedures (see figure 1-12) to clear the syringe of any air bubbles.
l. Cover needle with plastic protective cover to maintain sterility until the injection is performed.
Figure 1-12. Clearing bubbles from barrel.
|David L. Heiserman, Editor||
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Revised: June 06, 2015