Assemble a Needle and Syringe and Draw Medication
Review of how to properly assemble and draw medication into a needle and syringe. It is important to maintain aseptic technique to prevent contamination of the needle and/or syringe and to minimize the chance of infection.
Parts of a Needle and Syringe
Needle
(1) Parts
(a) Lumen - hollow cavity inside of needle
(b) Bevel - cutting edge of needle
(c) Hub - point of attachment to syringe
(d) Cannula (shaft) - needle length
(e) Protective cover
(2) Needle characteristics
(a) Stainless steel, sharp and shiny
(b) Standard lengths are from 1/4 inch to 3 inches
(c) Length is determined from the tip of the point to the junction of the shaft and hub
Syringe
(1) Barrel - clear plastic or glass that has calibrated scales on it. The inside of barrel is sterile
(2) Plunger - movable portion inside of barrel. The rubber portion and the shaft are sterile
(3) Needle adapter - portion of syringe where needle attaches, this part is also sterile
(4) Calibrated scales - markings vary from .01 ml on 1 cc syringes to 0.2 ml on 3-5 cc and 05 ml on 10 cc and larger syringes, always check the calibrated markings
Inspecting Equipment for Contamination and/or Deterioration
Paper wrappers
Checked for tears, water spots, and signs of deterioration or contamination
If any of these signs are present, discard, and replace
Plastic caps on needles and syringes should NOT have been opened prior to use.
If needle or syringe covers appear to be loose, discard and replace
Equipment
(1) Sterile syringe(s)
(2) Appropriate size needles, to include extra needles
(3) Alcohol sponge (alcohol prep pad)
(4) Proper container for disposal of needle/syringe (sharps container)
(5) Correct medication, ampule or vial
Assembling needle and syringe
(1) Remove syringe from package without contaminating sterile parts (needle adapter or plunger)
(a) If the syringe is packaged in a flexible wrapper, peel the sides of the wrapper apart to expose the rear end of the syringe barrel
(b) If the syringe is packaged in a hard plastic container, press down and twist the cap until a distinct "pop" is heard
(c) If the "pop" is not heard, the seal has been previously broken, and the equipment must be discarded
(2) Ensure plunger of syringe moves freely by grasping the flared end of the syringe and pulling the plunger back and forth. If the syringe does not move freely, replace it with another sterile syringe
CAUTION: The shaft of the plunger is sterile. Contamination could cause infection in the patient. Touch only the end of the plunger when testing for free movement.
(3) Remove needle from package without contaminating sterile parts (needle hub or shaft)
(a) If the needle is packaged in a flexible wrapper, peel the sides of the wrapper apart to expose the needle hub
(b) If the needle is packaged in a hard plastic container, twist the cap until a "pop" is heard. Remove the cap to expose the needle hub
(c) If the "pop" is not heard, the seal has been previously broken, and the equipment must be discarded
CAUTION: All parts of the needle are sterile. Be careful not to touch the hub to prevent contamination. Only the outside of the needle cover may be touched.
(4) Join needle and syringe by inserting needle adapter of the syringe into the needle hub, without contaminating either part. Tighten the needle by turning one fourth of a turn to ensure that it is securely attached. If the syringe has threads, you may need to turn more than the quarter turn.
(5) Hold the needle and syringe upright and remove the protective cover from the needle by pulling it straight off
CAUTION: Do not twist the protective cover because it may pull the needle off the hub.
(a) Visually inspect the needle for burrs, barbs, damage, and contamination
(b) If the needle has any defects or damage, replace the needle with another sterile needle
(6) Place the protective cover back on the needle being careful not to stick yourself or to contaminate the needle. Place the assembled needle and syringe on the work surface
(7) When you assemble a needle and syringe, you are responsible for maintaining sterility and security of the equipment
Compare drug name on the container with the doctor's orders
Compare drug concentration with the doctor's orders
Check expiration date on medication container
The medication label must be verified three times
(1) When obtaining medicine container from place of storage
(2) When withdrawing medication from the container
(3) When returning the medication container to storage
If any of the following defects are noted on a vial, follow directions IAW local SOP or return to pharmacy
(1) Examine the rubber stopper for defects, such as small holes resulting from wear and tear
(2) Hold the vial to the light to check for foreign particles and changes in color and consistency of medication to be drawn
(3) Check expiration date and date medication was opened on a multidose vial
WARNING: Refer to manufacturer’s instructions for expiration of medication prior to and after opening vial. Follow local SOP if discrepancies are noted between SOP and manufacturer's instructions. If in doubt, consult supervisor, nurse on duty, or pharmacy.
(4) Determine whether the medication is stored properly, e.g., shelf or room temperature vs. refrigeration
(5) Refer to manufacturer's instructions for proper storage of medication
Prepare and draw medication
(1) Select the appropriate needle
(a) Length will depend on the following factors
(i) Type of injection to be given (intramuscular, subcutaneous, intradermal)
(ii) The size of the patient (thin, obese)
(iii) The site of injection
(b) Choice of needle gauge depends upon the viscosity (thickness) of the medication
(2) The gauge of the needle is indicated by the numbers 14 through 28. The higher the number, the smaller the diameter (bore) of the needle
(a) Small-bore needles are indicated for thin medications (watery medications)
(b) Large bore needles are indicated for thick medication
Drawing Medication from an Ampule
(1) Lightly tap the upright ampule to force any trapped medication from the ampule neck and top
(2) Clean neck of ampule with alcohol sponge (prep pad)
(3) Wrap neck of ampule with same sponge (prep pad)
(4) Grasp ampule with both hands and snap the neck by bending it away from the break line (the narrowest portion of ampule neck is the weakest point and breaks easily); DIRECT BREAKING AMPULE AWAY FROM SELF AND OTHERS
(5) Hold ampule to light - inspect for minute glass particles. If glass is present, discard and replace
(6) Pick up assembled needle and syringe in dominant hand and remove protective cover with free hand
CAUTION: Filter needles are used when drawing this type of medication. Follow local protocol.
(7) Hold ampule vertically with non dominant hand or place the ampule upright on a flat surface. Insert the needle and withdraw the medication
(8) Withdraw the prescribed medication, being careful not to touch the outside edge or bottom of the ampule with the needle
(9) Withdraw the needle and verify the correct dosage
(10) Expel any air bubbles present in the syringe
(11) Hold the syringe with the needle pointing up and pull back on the plunger slightly to clear all the medication from the needle shaft
(12) Tap the barrel lightly to force bubbles to the top of the barrel
(13) Pull the plunger back slightly and push it forward until the solution is in the needle hub, clearing it of bubbles
(14) Verify the correct dosage
(15) Recap the needle without contaminating it or sticking yourself with it
(16) Recheck ampule label and physician's orders to verify that the correct medication and dosage is drawn
WARNING: Anyone accidentally stuck with a needle must follow infection control protocol for needle sticks immediately!
Drawing Medication from a Stoppered Vial Which Contains a Prepared Solution
(1) Remove protective metal cap
(2) If this is a multidose vial, the metal cap may have already been removed
(3) Cleanse the rubber stopper with an alcohol sponge (alcohol prep pad)
CAUTION: Premixed medications may have to be shaken or "rolled" in your hands to ensure that the medication is re-suspended in the solution. Check medication label for instructions.
(4) Pick up the assembled needle and syringe with dominant hand and remove the protective cover with nondominant hand
(5) Slowly draw plunger to the prescribed cc mark of medication
(6) Pick up the vial with free hand and insert the needle into rubber stopper. Ensure the needle tip passes completely through
CAUTION: A filter needle may be used for this procedure. Follow local protocol.
(7) Push the plunger fully into barrel to inject air from syringe into vial
(8) Invert the vial keeping the needle and syringe inserted
(9) Pull the plunger back to the desired cc mark, withdrawing the prescribed medication
(10) Withdraw needle from vial
(11) Expel any air that may be in syringe
(12) Verify correct dosage against the doctor's orders
(13) Hold syringe at eye level
(14) Ensure forward edge of plunger is exactly on the prescribed cc mark
(15) Recap needle carefully or change needle if necessary
(16) Return vial to proper area
(a) Storage if it is a multi dose vial. Ensure date and time vial opened is recorded on the vial label
(b) Dispose of single dose vial or if vial is empty IAW local SOP
Receive doctor's orders (medication, route, dosage)
Select correct medication and correct diluent from storage area
(1) Normally, the powdered medication is packaged with its diluent in the same box. If no diluent is present, check the powdered medication label for diluent to be used
(2) Remove protective metal cap on stoppered vials (medication and reconstitution fluid)
(3) Clean the stoppers on both vials with alcohol sponges
Withdraw correct amount of diluent required to reconstitute medication
CAUTIO: If the vial with powdered medication contains air, the diluent may be difficult to inject. Air may have to be withdrawn to allow the diluent to be injected.
Reconstitute medication
(1) Hold powdered medication vial horizontally, insert the needle through the stopper, and inject the diluent
(2) Withdraw needle from stopper
(3) Gently invert the vial several times until all the powder is dissolved
CAUTION: Check the medication vial label or package insert. Some medications can only be inverted gently, some require vigorous mixing.
Check medication for abnormalities that may be present.
(1) Refer to enclosed manufacturer's insert for acceptable variations in medication.
(2) If insert is unavailable or if you have any questions, check with supervisor or nurse on duty prior to injecting patient with medication.
Change the needle (or needle and syringe) to the appropriate size for route of administration and withdraw reconstituted solution from vial
(1) Pull the plunger back to the predetermined medication amount
(2) Insert needle into reconstituted solution
(3) Inject the air in the syringe into the vial
(4) Withdraw the prescribed amount of medication; keep needle immersed in solution when drawing medication into barrel of syringe
(5) Withdraw the needle from the vial
(6) Verify the correct dosage
Check syringe for air bubbles
Demonstration
Assembling needle and syringe
(1) Remove syringe from package without contaminating sterile parts
(a) If the syringe is packaged in a flexible wrapper, peel the sides of the wrapper apart to expose the rear end of the syringe barrel
(b) If the syringe is packaged in a hard plastic container, press down and twist the cap until a distinct "pop" is heard
(c) If the "pop" is not heard, the seal has been previously broken, and the equipment must be discarded
(2) Ensure plunger of syringe moves freely by grasping the flared end of the syringe and pulling the plunger back and forth. If the syringe does not move freely, replace it with another sterile syringe
CAUTION: The shaft of the plunger is sterile. Contamination could cause infection in the patient. Touch only the end of the plunger when testing for free movement.
(3) Remove needle from package without contaminating sterile parts (needle hub or shaft)
(a) If the needle is packaged in a flexible wrapper, peel the sides of the wrapper apart to expose the needle hub
(b) If the needle is packaged in a hard plastic container, twist the cap until a "pop" is heard. Remove the cap to expose the needle hub
(c) If the "pop" is not heard, the seal has been previously broken, and the equipment must be discarded
CAUTION: All parts of the needle are sterile. Be careful not to touch the hub to prevent contamination. Only the outside of the needle cover may be touched.
(4) Join needle and syringe by inserting needle adapter of the syringe into the needle hub, without contaminating either part. Tighten the needle by turning one fourth of a turn to ensure that it is securely attached. If the syringe has threads, you may need to turn more than the quarter turn.
(5) Hold the needle and syringe upright and remove the protective cover from the needle by pulling it straight off
CAUTION: Do not twist the protective cover because it may pull the needle off the hub.
(a) Visually inspect the needle for burrs, barbs, damage, and contamination
(b) If the needle has any defects or damage, replace the needle with another sterile needle
(6) Place the protective cover back on the needle being careful not to stick yourself or to contaminate the needle. Place the assembled needle and syringe on the work surface
(7) When you assemble a needle and syringe, you are responsible for maintaining sterility and security of the equipment
Compare drug concentration with the doctor's orders
Check expiration date on medication container
The medication label must be verified three times
(1) When obtaining medicine container from place of storage
(2) When withdrawing medication from the container
(3) When returning the medication container to storage
If any of the following defects are noted on a vial, follow directions IAW local SOP or return to pharmacy
(1) Examine the rubber stopper for defects, such as small holes resulting from wear and tear
(2) Hold the vial to the light to check for foreign particles and changes in color and consistency of medication to be drawn
(3) Check expiration date and date medication was opened on a multidose vial
WARNING: Refer to manufacturer’s instructions for expiration of medication prior to and after opening vial. Follow local SOP if discrepancies are noted between SOP and manufacturer's instructions. If in doubt, consult supervisor, nurse on duty, or pharmacy.
(4) Determine whether the medication is stored properly, e.g., shelf or room temperature vs. refrigeration
(5) Refer to manufacturer's instructions for proper storage of medication
(1) Select the appropriate needle
(a) Length will depend on the following factors
(i) Type of injection to be given (intramuscular, subcutaneous, intradermal)
(ii) The size of the patient (thin, obese)
(iii) The site of injection
(b) Choice of needle gauge depends upon the viscosity (thickness) of the medication
(2) The gauge of the needle is indicated by the numbers 14 through 28. The higher the number, the smaller the diameter (bore) of the needle
(a) Small-bore needles are indicated for thin medications (watery medications)
(b) Large bore needles are indicated for thick medication
Proper assembly and inspection of the needle and syringe is extremely important for ensuring sterility of equipment and preventing the chance of infection. Assembly of this equipment is necessary for drawing and administering medication, which you will learn later in this block of instruction.