A practical nurse is preparing to administer a combined dose of NPH insulin and regular insulin in a single syringe for a client with diabetes mellitus. In what order should the nurse perform the following steps to safely mix these medications?
- 1Inject a volume of air equal to the prescribed dose into the NPH insulin vial.
- 2Inject a volume of air equal to the prescribed dose into the regular insulin vial.
- 3Keep the needle in the regular insulin vial, invert it, and withdraw the prescribed dose.
- 4Insert the needle into the NPH insulin vial and carefully withdraw the prescribed dose.
Answer
The correct sequence is to first inject air into the NPH vial, then inject air into the regular vial, withdraw the regular insulin, and finally withdraw the NPH insulin.
The established standard for mixing NPH (cloudy) and regular (clear) insulins is to inject air into the cloudy vial, inject air into the clear vial, withdraw the clear insulin, and then withdraw the cloudy insulin. This strict sequence ensures that the rapid or short-acting insulin vial is never contaminated with intermediate-acting insulin, maintaining the purity and expected pharmacokinetics of the clear insulin for future use.
Step-by-Step Solution
Key Concept
When mixing insulins, the standard protocol is 'clear before cloudy' to prevent the contamination of short-acting insulin with intermediate-acting insulin.