06.06 Insulin Mixing

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Insulin Pens for Diabetes Mellitus (Image)
Insulin Pump (Image)
Insulin Syringe (Image)
140 Must Know Meds (Book)
Mixing NPH and Regular Insulin for Injection (Picmonic)
Medication Administration Pro-Tips (Cheat Sheet)

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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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