Injection Preparation from Ampules and Vials

Verify patient and prescription data on

  • MAR against medication order. Check medication's name on vial/ampule against MAR; check its expiration date
  • Perform hand hygiene and gather medication and supplies.

Ampule preparation

  1. Tap top of ampule lightly and quickly until fluid moves from neck of ampule.
  2. Holding small gauze pad or unopened alcohol swab around neck of ampule, snap it quickly and firmly away from hands.
  3. Into center of ampule opening, insert filter needle that reaches bottom of ampule. Do not touch rim of ampule.
  4. Aspirate medication into syringe by gently pulling back on plunger and tipping ampule to bring all fluid to needle. Keep needle tip under surface of liquid. If air bubbles are aspirated, do not expel air into ampule.
  5. Remove needle from ampule. With needle pointing up, tap syringe to cause bubbles to rise. Draw back slightly on plunger; then push it up to eject air. Do not eject fluid.
  6. If syringe contains excess fluid, slowly eject it into sink. Recheck volume in syringe.
  7. Cover needle with safety sheath or cap. Replace filter needle with needle for injection.

Vial containing a solution

  1. If vial is unopened, remove cap. Wipe rubber seal with alcohol swab and let it dry.
  2. Remove cap from needleless vial access device. Pull back on syringe plunger to draw air into syringe equal to volume of medication to be aspirated from vial.
  3. Insert needleless vial access device or tip of safety filter needle through rubber seal.
  4. Inject air into the vial, holding onto plunger with firm pressure.
  5. Invert vial in one hand; grasp end of syringe barrel and plunger with other hand.
  6. Keep tip of needleless vial access device or filter needle below fluid level.
  7. Let air pressure from vial fill syringe with medication. If needed, pull back slightly on plunger to obtain correct amount of medication.
  8. Tap side of syringe to dislodge air bubbles. Eject air left at top of syringe into vial.
  9. To remove needleless vial access device or filter needle, pull back on syringe.
  10. With needle up, ensure correct volume and lack of air bubbles. Tap barrel to dislodge bubbles. Draw back on plunger; then push it up to eject air — not fluid. Recheck volume.
  11. For patient injection, change needleless vial access device or filter needle for appropriate needle, based on administration route.
  12. For multidose vial, make label that includes date of opening, mixing (if necessary), concentration of drug per milliliter, and nurse's initials.

Vial containing a powder (reconstituting medications)

  1. Remove caps from vials of powder and diluent. Swab seals with alcohol; let them dry.
  2. Draw up diluent into syringe following steps 4b to 4j.
  3. Insert tip of needleless vial access device through rubber seal of powdered medication vial. Inject diluent into vial. Remove needleless device from vial and cover with its cap.
  4. Mix medication thoroughly. Roll in palms. Do not shake.
  5. Draw reconstituted medication from vial into syringe. Check label for concentration after reconstitution.
  6. Draw up medication into syringe following steps 4b to 4l.
  7. Dispose of soiled supplies properly. Clean work area and perform hand hygiene.