A practical nurse is preparing to administer a combined dose of regular insulin and NPH insulin in a single syringe to a client with diabetes mellitus. Arrange the following steps for preparing this medication in the correct chronological sequence.
- 1Roll the vial of NPH insulin gently between the palms of the hands.
- 2Inject the required volume of air into the NPH insulin vial without allowing the needle to touch the insulin.
- 3Inject the required volume of air into the regular insulin vial.
- 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.
Answer
The correct sequence is: Roll the NPH vial, inject air into the NPH vial, inject air into the regular insulin vial, withdraw the regular insulin, and finally withdraw the NPH insulin.
When mixing regular (clear) and NPH (cloudy) insulin, the standard safety protocol is 'clear before cloudy'. This prevents the intermediate-acting NPH insulin from contaminating the short-acting regular insulin vial. The sequence of injecting air into the NPH first, then air into the regular, ensures that the needle does not carry regular insulin into the NPH vial during air injection, and prepares the vials for safe withdrawal.
Step-by-Step Solution
Key Concept
Insulin Preparation and Administration Sequence