A practical nurse is preparing to administer a mixed dose of intermediate-acting (NPH) and short-acting (Regular) insulin to a client with diabetes mellitus. Arrange the following steps in the correct chronological order for mixing these insulins in a single syringe.
- 1Clean the rubber stoppers of both insulin vials with alcohol swabs.
- 2Inject an amount of air equal to the prescribed dose into the NPH insulin vial.
- 3Inject an amount of air equal to the prescribed dose into the Regular insulin vial.
- 4Invert the Regular insulin vial and withdraw the prescribed dose into the syringe.
- 5Insert the needle into the NPH insulin vial and withdraw the prescribed dose.
Answer
The correct sequence for mixing insulins is: clean both vials, inject air into the NPH vial, inject air into the Regular vial, draw up the Regular insulin, and finally draw up the NPH insulin.
When mixing short-acting (Regular) and intermediate-acting (NPH) insulin, the correct sequence ensures that the fast-acting insulin is not contaminated with the longer-acting insulin. The standard mnemonic is 'clear before cloudy.' After cleaning the vials, air is injected into the NPH vial first, followed by air into the Regular vial. The Regular (clear) insulin is drawn up first while the needle is already in the vial. Finally, the NPH (cloudy) insulin is drawn up to complete the exact total dose.
Step-by-Step Solution
Key Concept
Safe Medication Administration: Mixing Insulins (Clear before Cloudy)