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Difficulty: EasyPharmacological and Parenteral Therapies

An adult client requires a morning dose of both short-acting (regular) and intermediate-acting (NPH) insulin. The nurse is drawing up both medications into a single syringe. Place the steps of this preparation process in the correct chronological sequence.

  1. 1Roll the NPH insulin vial gently between the palms of the hands.
  2. 2Inject a volume of air equal to the prescribed dose into the NPH insulin vial.
  3. 3Inject a volume of air equal to the prescribed dose into the regular insulin vial.
  4. 4Withdraw the prescribed volume of regular insulin.
  5. 5Withdraw the prescribed volume of NPH insulin.

Answer

The correct chronological sequence is to roll the NPH insulin vial, inject air into the NPH vial, inject air into the regular insulin vial, withdraw the regular insulin, and finally withdraw the NPH insulin.
The standard sequence for mixing insulins ensures the safety and purity of the short-acting medication. By injecting air into the NPH first, then air into the regular, the nurse can draw up the regular insulin ('clear') before the NPH insulin ('cloudy'). This universally accepted 'clear before cloudy' principle prevents the NPH insulin from inadvertently altering the rapid-acting profile of the regular insulin vial.

Step-by-Step Solution

1
Roll the NPH insulin vial between the palms.
The cloudy suspension is mixed evenly.
Rolling prevents the formation of air bubbles that can occur if the vial is shaken, ensuring an accurate dose.
2
Inject air into the NPH insulin vial and withdraw the needle.
The vial is pressurized without withdrawing any medication.
Injecting air first equalizes pressure and prevents regular insulin from being pushed into the NPH vial later.
3
Inject air into the regular insulin vial and leave the needle inserted.
The clear insulin vial is pressurized and ready for withdrawal.
This sets up the syringe to immediately draw the regular insulin.
4
Withdraw the exact dose of regular insulin.
The clear insulin is safely inside the syringe.
Drawing the clear (regular) insulin first guarantees that it will not be contaminated by the cloudy (NPH) insulin.
5
Insert the needle back into the NPH vial and withdraw the exact dose.
The combined insulin dose is ready for administration.
This completes the mixture. Care must be taken not to push any regular insulin into the NPH vial during this step.

Key Concept

Insulin Mixing Procedure (Clear before Cloudy)
Estimated Time:45s
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Topics

Pharmacological and Parenteral Therapies

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