# Drawing Up Medication

## Overview

This module describes how to draw up medication from ampoules and vials, and how to reconstitute powder medications.

## Drawing up from a vial

1. Perform hand hygiene.

2. Check that you are giving the correct, unexpired medication, and that the vial or ampoule is undamaged.

3. Remove the metal or plastic cover and clean the top of the vial with an alcohol swab and allow to dry.

4. Attach an aspiration needle, ideally a blunt fill needle, to a syringe of twice the volume you want to draw up.

5. Draw up as much air as the volume of medication required.

6. Pierce the top of the vial
   Pierce the top of the vial

   Pierce the top at a 45° angle, gradually straightening to a 90° angle. This minimises coring: cutting out a section of the stopper with the needle, which can subsequently be injected into a patient. It is not clear whether using a blunt or sharp needle further reduces coring.

   and inject the air into the bottle. Inject above the surface of the medication to avoid creating bubbles.

7. Hold the vial upside-down with the bevel of the needle inside the medication and release the plunger to allow the syringe to fill. Expel air bubbles.

8. Withdraw the needle from the vial.

9. Remove and discard the aspiration needle into sharps.

10. Attach the injection needle to the syringe. You are now ready to administer the injection.

## Reconstitution of powders

1. Perform hand hygiene.

2. Check that you are giving the correct, unexpired medication, and that the vial or ampoule is undamaged.

3. Remove the metal/plastic cover, clean the top of the vial with an alcohol swab and allow it to dry.

4. Attach an aspiration needle, ideally a blunt fill needle, to a syringe of twice the volume you want to draw up.

5. Draw up reconstitution fluid (often water or saline).

6. Pierce the top of the vial
   Pierce the top of the vial

   45° angle, gradually straightening to a 90° angle. This minimises coring: cutting out a section of the stopper with the needle, which can subsequently be injected into a patient. It is not clear whether using a blunt or sharp needle further reduces coring.

   and inject the reconstitution fluid.

7. Roll the vial between the palms to mix the powder and the fluid. Avoid shaking the vial, which forms foam.

8. Hold the vial upside-down with the tip of the needle inside the medication (fluid) and release the plunger to allow the syringe to fill. Expel air bubbles.

9. Withdraw the needle from the vial.

10. Remove and discard the aspiration needle into sharps.

11. Attach the injection needle to the syringe. You are now ready to administer the injection.

## Drawing up from an ampoule

1. Perform hand hygiene.

2. Check that you are giving the correct, unexpired medication, and that the vial or ampoule is undamaged.

3. Clean the neck of the ampoule with an alcohol swab and allow it to dry.

4. If there is fluid stuck in the ampoule neck, gently flick it with your finger to drop the fluid down into the body of the ampoule.

5. If there is a dot on the ampoule, hold it with the dot facing you. Put one thumb on the dot, and the other on the body of the ampoule, with thumb tips facing each other.

6. On the other side of the ampoule, place your index fingers together, sides of the tips touching each other.

7. Break the ampoule away from you by rolling on your index fingers so that their nails touch each other and your thumbs separate.

8. Dispose of the top in a sharps bin.

9. Attach an aspiration needle, ideally a blunt filter needle, to a syringe of twice the volume you want to draw up.

10. Hold the ampule at an angle with the tip of the aspiration needle inside the medication and draw up the required amount.

11. Discard the aspiration needle and vial into sharps.

12. Attach the injection needle to the syringe. You are now ready to administer the injection.

Plastic ampoules may be opened simply by twisting the neck.

## Troubleshooting

I’ve been cut before. How can I protect myself?

Rather

hold

hold

the neck of the ampoule with a piece of gauze. Alternatively, use an ampoule opener if one is available. If there is no ampoule opener available, disassemble a syringe with a barrel large enough to just fit over the top of the ampoule. Use the syringe barrel placed over the top of the ampoule to lever it open.

## Risks

1. Sharps injury to the healthcare provider

2. Medication contamination

## References

1. West H. Injections. In: Dehn R, Asprey D, eds. Essential Clinical Procedures. 3rd ed. Philadelphia: Elsevier; 2013.

2. Mulder M, Joubert A, Olivier N. Practical guide for general nursing sciences. 2nd ed. Pearson: Cape Town; 2020.