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06.06 Insulin Mixing

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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.

Reference Links

Study Tools

Video Transcript

In this video, we’re going to look at how to properly MIX insulins when you’re going to give them SubQ. Typically, we’ll mix an intermediate or long acting insulin like NPH with a shorter acting one like Regular insulin. The big rule to remember is you always draw up clear, THEN cloudy. Or the longer acting before the shorter acting.

First step is to calculate the total required volume of medication needed. In this case we’re going to use an example order of 10 units of NPH insulin and 5 units of Regular Insulin. So that’s 15 units total.
Open both vials and clean the tops of both vials with an alcohol pad.
Now, in your insulin syringe, draw back the total amount of air you need. In this case – 15 units.
Now insert the needle into the NPH vial and inject the NPH dose of AIR into the vial – in this case, 10 units.
Remove the needle from the NPH vial, and insert it into the Regular insulin vial
Inject the Regular Insulin dose of AIR into the vial. In this case – 5 units.
Now, you can invert the Regular Insulin vial and draw back ONLY the prescribed dose of Regular Insulin – 5 units.
Remove the needle from the Regular Insulin vial, and insert it BACK into the NPH vial.
Draw back EXACTLY the prescribed dose of NPH Insulin. So in this case, that’s 10 units, for a total of 15 units.
Now you can remove the needle from the NPH vial and prepare to administer it to the patient.
IF you aren’t administering it right away, recap it and LABEL the medication syringe with the drugs and doses, date/time and your initials.

To recap – you put AIR in NPH, AIR in Regular, draw up regular, then draw up NPH.

This seems silly, but it’s super important to prevent cross-contamination of the vials and get the RIGHT doses for your patient. Now, go out and be your best selves today. And, as always, happy nursing!

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