A practical nurse is preparing a combined subcutaneous injection of regular insulin and NPH insulin for a client whose pre-meal capillary blood glucose level is 185 mg/dL. To ensure safe medication preparation and avoid cross-contamination, arrange the following steps in the correct chronological sequence.
- 1Perform hand hygiene and gently roll the NPH insulin vial between the palms.
- 2Cleanse both vial stoppers with alcohol swabs and inject air equal to the NPH dose into the NPH insulin vial.
- 3Inject air equal to the regular insulin dose into the regular insulin vial and leave the syringe in place.
- 4Invert the regular insulin vial and withdraw the prescribed dose of regular insulin.
- 5Insert the needle into the NPH insulin vial and withdraw the prescribed dose of NPH insulin.
Answer
The correct sequence is to roll the NPH vial, inject air into the NPH vial, inject air into the regular vial, withdraw the regular insulin, and finally withdraw the NPH insulin.
When mixing insulins, the standard safety protocol is 'clear before cloudy' (regular insulin before NPH insulin). This ensures that the short-acting, clear insulin is not contaminated by the intermediate-acting, cloudy insulin. The precise preparation sequence involves injecting air into the NPH vial first, then injecting air into the regular vial, drawing up the regular insulin, and finally drawing up the NPH insulin.
Step-by-Step Solution
Key Concept
Insulin Mixing Procedure (Clear Before Cloudy)