Mixing Medications

Front 1

Guidelines for Mixing Medications

Back 1

Client teaching and responsibilities
– Always check compatibility of medications on a compatibility chart
before mixing.
• If uncertain, consult pharmacy.
– Maintain aseptic technique by cleansing vial with alcohol and
maintaining sterility of needle.
– Ensure correct dosage of medication by removing excess air bubbles
in syringe between drawing out of each vial and drawing up the exact
dose from each vial.
– If drawing medications from a multi-dose vial, do not contaminate one
medication with another.
– Perform rights to medication administration comparing MAR to vials

Front 2

Equipment for Mixing Medications

Back 2

• Syringe
• Needles
• Blunt-tip cannula for needleless system
• Filter needle for ampule
• Alcohol pads
• Sharps container
• MAR
• Medication container
• Vial
• Ampule
• Mix-o-Vial
• Prefilled syringe

Front 3

Mixing Medications from Two Multi-Dose Vials

Back 3

• Cleanse vial top with alcohol.
• Draw up and inject amount of air into vial A, not allowing needle to
touch medication.
• Draw up and inject amount of air into vial B.
– Invert vial and draw back correct dose of medication.
– Ensure correct dose by removing air bubbles.
• Insert needle into vial A and draw back exact dose of medication.
• Change needle before injecting client.
• Some facilities recommend changing a needle between drawing
medication out of each vial

Front 4

Reconstitution of Powder Medications

Back 4

Some medications can not be premixed ahead of time and need to be
reconstituted directly before administration.
• Some come in a Mix-o-Vial or a vials containing two compartments.
– One with a diluent such as sterile water or saline.
– One with a medication power.
– A rubber stopper separates the two compartments and is dislodged
by pressing on the top of the vial to mix the medication with diluent.
• Others come in a vial with directions of how much diluent is needed to
mix the medication.

Front 5

Mixing Medications from a Vial and an Ampule

Back 5

• Draw back air into syringe equal to amount of medication to be removed
from vial.
• Insert filter needle and syringe into top of vial cleansed with alcohol and
draw back correct amount of medication.
• Prepare ampule by gently tapping top to allow all fluid to sit in bottom
container.
• Place a small gauze or alcohol pad wrapper around neck of ampule and
snap neck away from you.
• Using a filter needle and maintaining sterility of needle, draw up the
correct amount of the medication from ampule.
• Remove needle from ampule and ensure correct dose.
• Remove filter needle and replace with new needle.

Front 6

Principles for Mixing Insulin

Back 6

• Client teaching and responsibilities
– Always use insulin syringe for drawing up insulin.
– Gently roll insulin in the palm of hands to mix and warm medication.
– Cleanse tops of vials with alcohol.
– Inject air equal to the number of units to be removed from the vial of
the cloudy (intermediate- or long-acting) insulin.
– Remove needle and syringe from vial.
– Inject air into the vial containing the clear or rapid-acting insulin
equal to the number of units to be removed from the vial.
– Invert vial and draw back correct amount of clear insulin.
– Insert needle back into the cloudy insulin and remove correct
amount of medication.

Front 7

Insulin Interactions

Back 7

• Alcohol (Ethanol)
• Gatifloxacin (Tequin)
• SSRIs
• Aspirin
• Albuterol
• Alka-Seltzer
• ACE-inhibitors
• Cold medication