Devices & Equipment

Assembling devices and equipment:

In preparation for an injection, it is essential to assemble all the devices and equipment first at a clean work area. This generally includes:

Medication order
Alcohol swabs

Sharps disposal container
Medication

Gloves
Syringe and needle of appropriate size

Preparing the devices and equipment

1. After the equipment has been assembled, perform hand hygiene. Medications are usually supplied as a liquid in a single-dose ampule, vial or multi-dose vial. A single-dose vial is intended for use in a single patient. Do not administer medications from single-dose vials to multiple patients. A multi-dose vial contains more than one dose of medication. Multi-dose vials should be dedicated to a single patient whenever possible. If multi-dose vials are used, both the needle and syringe used to access the multi-dose vial must be sterile. Occasionally, they are supplied in a single dose vial in powder form, which has to be reconstituted with either sterile water or saline.

2. Before opening, read the information on the syringe and needle packages. Verify that length and gauge are correct. Check that the seals have not been broken; sterility is assured only if the packages are unopened and undamaged.

3. Open the syringe and needle packages (Fig.1). If the syringe and needle are not one unit, connect the syringe tip to the hub of the needle. Always ensure a secure connection between the needle and syringe. Avoid contamination by not touching the hub of the needle or tip of the syringe.

Proper Aseptic Technique:

Open the packages by holding the peel tabs, and peel them back only enough to expose the hub of the needle (Fig. 1) or the plunger rod of the syringe (Fig. 2).

If presenting to a sterile field or performing a sterile transfer, be sure to peel the tabs back far enough to allow for easy access or release of the product. If necessary, you may open the packages but leave the products inside of them. Do not remove the syringe or needle from the sterile package and place on a non-sterile surface. This will reduce the likelihood of touch contamination. It will also reduce the potential for contamination of the fluid path. Connect the hub of the needle to the tip of the syringe using a clockwise twisting motion (Fig. 3). If using a luer slip tip syringe, be sure to apply force to the needle hub when twisting to ensure a secure fit.

Checking the medication:

It is essential to:

1. Check medication against the medication order.

2. Check time and date the medication is to be given and that it is for the correct patient.

3. Check medication and diluent (if required) to ensure integrity (ie., not cloudy or discoloured, no particulate matter).

4. Check the expiration date and concentration of medication (Fig. 4).

Passive recapping

If recapping is necessary for medication transport, it is preferred that clinicians use a one-handed technique.

The one-handed scoop technique uses the needle itself to pick up the needle shield, and then the shield is pushed up against a hard surface to ensure a tight fit onto the device.

If a hard surface is not available, when the cap covers the needle completely, use the other hand to secure the cap on the needle hub. Be careful to handle the cap at the bottom only (near the hub).

Never use two hands to begin the needle recapping process (Fig. 5).

	Vial	Ampule
1.	Read label on vial/ampule, confirm correct medication/fluid and concentration.
2.	After removing vial cap, clean stopper with alcohol swab.	Tap head of ampule to unseat any fluid lodged at top.
3.	Remove needle shield from a blunt fill needle.	Clean neck with alcohol swab; holding the head of the ampule with swab, snap the neck open. Discard ampule head and swab in sharps collector.
4.	Draw into the syringe a volume of air equal to the amount of medication/fluid needed. Being careful to avoid touching the needle on any surface (to maintain sterility), insert the needle into the stopper and inject air.	Remove needle shield from a blunt filter needle.
5.	Hold vial upside down and draw back syringe plunger to correct dosage.	Tilt ampule down, and insert needle tip into opening. Draw back syringe plunger to correct dosage.

Clean the diluent and medication vial stoppers with an alcohol pad. Draw the diluent into the syringe as you would fill a syringe from a vial. Then inject diluent into powdered medication vial.* After passively recapping needle, invert vial until all powder is dissolved. Use caution when inverting vial; some medications should not be agitated vigorously. Clean vial stopper again, uncap needle and pierce stopper a second time to withdraw the prescribed dose.

6.	Widthdraw needle. Passively recap the needle, then remove and dispose properly; attach a hypodermic safety needle of appropriate size.
7.	Gently tap side of syringe to dislodge air bubbles.
8.	Gently depress plunger to expel air from syringe.
9.	Recheck that correct dose has been drawn into syringe.

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Preparing the Injection