A nurse is preparing to mix and administer regular insulin and NPH insulin in a single syringe for a client with diabetes mellitus. Arrange the following steps in the correct chronological order to ensure safe and effective medication preparation.
- 1Inject air equal to the prescribed dose into the NPH insulin vial.
- 2Inject air equal to the prescribed dose into the regular insulin vial.
- 3Withdraw the prescribed dose of regular insulin.
- 4Withdraw the prescribed dose of NPH insulin.
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.
When mixing intermediate-acting (NPH, cloudy) and short-acting (regular, clear) insulin, the standard safety protocol is 'clear before cloudy'. First, air is injected into the NPH vial, then air is injected into the regular vial. The regular insulin is then withdrawn first, followed by the NPH insulin. This precise sequence prevents the longer-acting NPH insulin from accidentally contaminating the vial of short-acting regular insulin, which could affect the onset and peak times of future doses.
Step-by-Step Solution
Key Concept
Safe Preparation of Mixed Insulin (Clear Before Cloudy)