Mixing drugs in a syringe using two multidose vials
I have never mixed two compounds in a syringe before. I wanted to learn more about the technique and the proper way to do so. Thus, I consulted the Lippincott's Nursing Procedures and Skills Database.
Here is what they said,
Introduction: "Combining two drugs in one syringe avoids the discomfort of two injections. One such method involves combining drugs from two multidose vials (for example, regular and long-acting insulin). However, such combinations are contraindicated when the drugs aren't compatible and when the combined doses exceed the amount of solution that can be absorbed from a single injection site."
Here are the Implementations (How to do it)
-Calculate the dose to be given.
-Perform hand hygiene.
-Using an alcohol pad, wipe the rubber stopper on the first vial to decrease the risk of contaminating the medication as you insert the needle into the vial.
-Pull back the syringe plunger until the volume of air drawn into the syringe equals the volume to be withdrawn from the drug vial.
-Without inverting the vial, insert the needle into the top of the vial, making sure that the needle's bevel tip doesn't touch the solution. Inject the air into the vial and withdraw the needle. This step replaces air in the vial, thus preventing creation of a partial vacuum on withdrawal of the drug.
-Repeat the steps above for the second vial. Then after injecting the air into the second vial, invert the vial, withdraw the prescribed dose, and then withdraw the needle.
-Wipe the rubber stopper of the first vial again and insert the needle, taking care not to depress the plunger. Invert the vial, withdraw the prescribed dose, and then withdraw the needle.
-Change the needle on the syringe, if indicated.
** Special Considerations**
- Insert a needle through the vial's rubber stopper at a slight angle, bevel up, and exert slight lateral pressure. This way you won't cut a piece of rubber out of the stopper, which can then be pushed into the vial.
-When mixing drugs from multidose vials, be careful not to contaminate one drug with the other. Ideally, the needle should be changed after drawing the first medication into the syringe. This isn't always possible because many disposable syringes don't have removable needles.
-Never combine drugs if you're unsure of their compatibility, and never combine more than two drugs. Although drug incompatibility usually causes a visible reaction, such as clouding, bubbling, or precipitation, some incompatible combinations produce no visible reaction even though they alter the chemical nature and action of the drugs. Check appropriate references and consult a pharmacist when you're unsure about specific compatibility. When in doubt, administer two separate injections.
-Some medications are compatible for only a brief time after being combined and should be administered within 10 minutes after mixing. After this time, environmental factors, such as temperature, exposure to light, and humidity, may alter compatibility.
-To reduce the risk of contamination, most facilities dispense parenteral medications in single-dose vials. Insulin is one of the few drugs still packaged in multidose vials. Be careful when mixing regular and long-acting insulin. Draw up the regular insulinfirst to avoid contamination by the long-acting suspension. (If a minute amount of the regular insulin is accidentally mixed with the long-acting insulin, it won't appreciably change the effect of the long-acting insulin.) Check your facility's policy before mixing insulin.
**References**
1. The Joint Commission. Comprehensive Accreditation Manual for Hospitals: The Official Handbook. Standard MM.04.01.01. Oakbrook Terrace, Il.: The Joint Commission, 2010.
2. The Joint Commission. Comprehensive Accreditation Manual for Hospitals: The Official Handbook. Standard MM.06.01.01. Oakbrook Terrace, Il.: The Joint Commission, 2010.
3. The Joint Commission. Comprehensive Accreditation Manual for Hospitals: The Official Handbook. Standard NPSG.07.01.01. Oakbrook Terrace, Il.: The Joint Commission, 2010.
4. Nettina, S.M. Lippincott Manual of Nursing Practice, 9th ed. Philadelphia: Lippincott Williams & Wilkins, 2010. 5. Taylor, C., et al. Fundamentals of Nursing: The Art and Science of Nursing Care, 6th ed. Philadelphia: Lippincott Williams & Wilkins, 2008
After I read this I was concerned about mixing compounds in one syringe.
Do these rules apply to AAS?
If so, to which AAS should not be combined in a syringe together? (Example: long and short esters?)
Is it better and safer to do multiple injections?
These are the specifics that I am not clear on and hope that other vets of the site can shed some light on this. Because it's not like I can ask my local pharmacist.
F.Y.I My next cycle is, Test E, EQ, and I'm kick starting it with Test Prop.
Thanks!
I have never mixed two compounds in a syringe before. I wanted to learn more about the technique and the proper way to do so. Thus, I consulted the Lippincott's Nursing Procedures and Skills Database.
Here is what they said,
Introduction: "Combining two drugs in one syringe avoids the discomfort of two injections. One such method involves combining drugs from two multidose vials (for example, regular and long-acting insulin). However, such combinations are contraindicated when the drugs aren't compatible and when the combined doses exceed the amount of solution that can be absorbed from a single injection site."
Here are the Implementations (How to do it)
-Calculate the dose to be given.
-Perform hand hygiene.
-Using an alcohol pad, wipe the rubber stopper on the first vial to decrease the risk of contaminating the medication as you insert the needle into the vial.
-Pull back the syringe plunger until the volume of air drawn into the syringe equals the volume to be withdrawn from the drug vial.
-Without inverting the vial, insert the needle into the top of the vial, making sure that the needle's bevel tip doesn't touch the solution. Inject the air into the vial and withdraw the needle. This step replaces air in the vial, thus preventing creation of a partial vacuum on withdrawal of the drug.
-Repeat the steps above for the second vial. Then after injecting the air into the second vial, invert the vial, withdraw the prescribed dose, and then withdraw the needle.
-Wipe the rubber stopper of the first vial again and insert the needle, taking care not to depress the plunger. Invert the vial, withdraw the prescribed dose, and then withdraw the needle.
-Change the needle on the syringe, if indicated.
** Special Considerations**
- Insert a needle through the vial's rubber stopper at a slight angle, bevel up, and exert slight lateral pressure. This way you won't cut a piece of rubber out of the stopper, which can then be pushed into the vial.
-When mixing drugs from multidose vials, be careful not to contaminate one drug with the other. Ideally, the needle should be changed after drawing the first medication into the syringe. This isn't always possible because many disposable syringes don't have removable needles.
-Never combine drugs if you're unsure of their compatibility, and never combine more than two drugs. Although drug incompatibility usually causes a visible reaction, such as clouding, bubbling, or precipitation, some incompatible combinations produce no visible reaction even though they alter the chemical nature and action of the drugs. Check appropriate references and consult a pharmacist when you're unsure about specific compatibility. When in doubt, administer two separate injections.
-Some medications are compatible for only a brief time after being combined and should be administered within 10 minutes after mixing. After this time, environmental factors, such as temperature, exposure to light, and humidity, may alter compatibility.
-To reduce the risk of contamination, most facilities dispense parenteral medications in single-dose vials. Insulin is one of the few drugs still packaged in multidose vials. Be careful when mixing regular and long-acting insulin. Draw up the regular insulinfirst to avoid contamination by the long-acting suspension. (If a minute amount of the regular insulin is accidentally mixed with the long-acting insulin, it won't appreciably change the effect of the long-acting insulin.) Check your facility's policy before mixing insulin.
**References**
1. The Joint Commission. Comprehensive Accreditation Manual for Hospitals: The Official Handbook. Standard MM.04.01.01. Oakbrook Terrace, Il.: The Joint Commission, 2010.
2. The Joint Commission. Comprehensive Accreditation Manual for Hospitals: The Official Handbook. Standard MM.06.01.01. Oakbrook Terrace, Il.: The Joint Commission, 2010.
3. The Joint Commission. Comprehensive Accreditation Manual for Hospitals: The Official Handbook. Standard NPSG.07.01.01. Oakbrook Terrace, Il.: The Joint Commission, 2010.
4. Nettina, S.M. Lippincott Manual of Nursing Practice, 9th ed. Philadelphia: Lippincott Williams & Wilkins, 2010. 5. Taylor, C., et al. Fundamentals of Nursing: The Art and Science of Nursing Care, 6th ed. Philadelphia: Lippincott Williams & Wilkins, 2008
After I read this I was concerned about mixing compounds in one syringe.
Do these rules apply to AAS?
If so, to which AAS should not be combined in a syringe together? (Example: long and short esters?)
Is it better and safer to do multiple injections?
These are the specifics that I am not clear on and hope that other vets of the site can shed some light on this. Because it's not like I can ask my local pharmacist.
F.Y.I My next cycle is, Test E, EQ, and I'm kick starting it with Test Prop.
Thanks!
