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Difficulty: HardPharmacological Therapies

A practical nurse is preparing to administer a mixed dose of short-acting (Regular) and intermediate-acting (NPH) insulin to a client with type 2 diabetes mellitus. Place the following steps for drawing up the insulins in the correct chronological order.

  1. 1Roll the vial of intermediate-acting insulin between the palms of the hands.
  2. 2Inject a volume of air equal to the prescribed dose into the intermediate-acting insulin vial.
  3. 3Inject a volume of air equal to the prescribed dose into the short-acting insulin vial.
  4. 4Invert the vial and withdraw the prescribed dose of short-acting insulin.
  5. 5Insert the syringe into the intermediate-acting insulin vial and withdraw the prescribed dose.

Answer

The correct sequence is to roll the intermediate-acting insulin, inject air into the intermediate-acting insulin, inject air into the short-acting insulin, withdraw the short-acting insulin, and finally withdraw the intermediate-acting insulin.
When mixing insulins, the standard safety protocol is 'clear before cloudy' (short-acting before intermediate-acting). This prevents the intermediate-acting insulin from contaminating the short-acting vial. The sequence ensures proper mixing of the suspension (rolling), equalization of pressure in both vials (injecting air into cloudy, then clear), and safe withdrawal (drawing clear, then cloudy).

Step-by-Step Solution

1
Roll the vial of intermediate-acting insulin between the palms of the hands.
The suspension is mixed evenly.
NPH insulin is a suspension that settles. Rolling mixes it without creating bubbles that could lead to inaccurate dosing.
2
Inject a volume of air equal to the prescribed dose into the intermediate-acting insulin vial.
Pressure is equalized in the NPH vial.
Injecting air prevents a vacuum, making it easier to withdraw the medication later. Doing this first prevents contamination of the needle with clear insulin.
3
Inject a volume of air equal to the prescribed dose into the short-acting insulin vial.
Pressure is equalized in the Regular insulin vial.
Injecting air prepares the vial for withdrawal. Since the needle is already in this vial, the nurse can immediately proceed to the next step.
4
Invert the vial and withdraw the prescribed dose of short-acting insulin.
The clear insulin is drawn into the syringe first.
Drawing clear (short-acting) insulin before cloudy (intermediate-acting) insulin prevents the longer-acting insulin from contaminating the short-acting insulin vial.
5
Insert the syringe into the intermediate-acting insulin vial and withdraw the prescribed dose.
The total mixed dose is now in the syringe.
The cloudy insulin is drawn last to complete the mixture safely.

Key Concept

Safe administration and preparation of mixed insulins (Clear before Cloudy)
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Topics

Pharmacological Therapies

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