A nurse is preparing to mix regular insulin and NPH insulin in a single syringe for a client with diabetes mellitus. Arrange the following steps in the correct sequence for drawing up these medications.
- 1Roll the NPH insulin vial between the palms of the hands.
- 2Inject air equal to the prescribed dose into the NPH insulin vial.
- 3Inject air equal to the prescribed dose into the regular insulin vial.
- 4Withdraw the prescribed dose of regular insulin.
- 5Withdraw the prescribed dose of NPH insulin.
Answer
The correct sequence is: Roll the NPH vial, inject air into NPH, inject air into regular, withdraw regular insulin, and finally withdraw NPH insulin.
The standard procedure for mixing insulins follows the 'clear before cloudy' rule. First, the NPH (cloudy) suspension is gently mixed by rolling. Then, air is injected into the NPH vial, followed by air into the regular (clear) vial. The regular insulin is drawn up first to prevent its contamination by the NPH insulin, ensuring the rapid-acting properties of the regular insulin are maintained in the vial for future use. Finally, the NPH insulin is carefully drawn up to reach the total combined dose.
Step-by-Step Solution
Key Concept
Safe Preparation of Mixed Insulins