06.06 Insulin Mixing

Overview

1. Purpose
   1. NPH and Regular insulin can be combined in one syringe when being administered Subcutaneously
   2. Always draw up clear before cloudy (regular before NPH)
   3. You MUST check blood glucose within 30 minutes or LESS of administering insulin!!!!
2. Example
   1. For illustration purposes, we will use this order:
      1. NPH insulin 10 units subcutaneous
      2. Regular Insulin 5 units subcutaneous

Nursing Points

General

1. Supplies Needed
   1. Insulin syringe
   2. NPH vial
   3. Regular Insulin vial
   4. Alcohol pad x 2
2. Summary
   1. Air into NPH (cloudy)
   2. Air into Regular (clear)
   3. Draw up Regular (clear)
   4. Draw up NPH (cloudy)

Nursing Concepts

1. Steps and Nursing Considerations
   1. Verify provider order
   2. ALWAYS follow 5 rights BEFORE preparing medication
      1. Right Patient
      2. Right Drug
      3. Right Dose
      4. Right Route
      5. Right Time
   3. ALWAYS prepare medications at the patient’s bedside
   4. Gather supplies
   5. Perform hand hygiene
   6. Don clean gloves
   7. Let the patient know what meds they will be receiving
   8. Calculate the total required volume of medication needed
      1. In this case – 10 units of NPH insulin and 5 units of Regular Insulin = 15 units total
   9. Clean the tops of both vials with an alcohol pad
   10. Draw back the total amount of air
       1. In this case – 15 units
   11. With the vial on the table, insert the needle into the rubber stopper of the NPH vial and inject the NPH dose of AIR into the vial
       1. In this case – 10 units
   12. Remove the needle from the NPH vial
   13. With the vial on the table, insert the needle into the rubber stopper of the Regular insulin vial and inject the Regular Insulin dose of AIR into the vial
       1. In this case – 5 units
   14. Invert the Regular Insulin vial and draw back ONLY the prescribed dose of Regular Insulin
       1. In this case – 5 units
   15. Remove the needle from the Regular Insulin vial
   16. Insert the needle BACK into the NPH vial, invert the vial, and draw back EXACTLY the prescribed dose of NPH Insulin
       1. In this case – 10 units → for a total of 15 units
   17. Remove the needle from the NPH vial
   18. If not administering right away, LABEL the medication syringe:
       1. Drug name
       2. Dose / Volume
       3. Date / Time / Initials
       4. **Do not draw up more than one medication at a time without labelling the syringe(s)
       5. **Can use a piece of tape or a patient label/sticker
   19. Follow the appropriate steps for subcutaneous administration
       1. Be sure to check blood glucose before administration

Patient Education

1. Educate about administration of medication.