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Good Practice Statement for the Preparation of Injections in Near-Patient Areas, including Clinical and Home Environments
APPENDIX 7 EXAMPLE STANDARD OPERATING PROCEDURE FOR THE PREPARATION OF INJECTIONS IN NEAR-PATIENT AREAS IN HEALTHCARE PREMISES
Note: This guidance has been endorsed by the Scottish Pharmaceutical Aseptic Services Specialist Interest Group as an example of 'best practice'.
Introduction
The procedure detailed below recommends the steps that should be taken for the safe preparation of medicines in a ward or department.
It is intended for use with planned work only and is not necessarily relevant to emergency situations.
In all cases staff should refer to local policies, for example for handwashing techniques, where applicable.
Before starting the procedure, all relevant information leaflets should be read and any specific safety or handling/reconstitution instructions noted.
Any relevant labels should be prepared prior to preparation. Worksheets, where relevant, should be completed immediately after completion of the preparation process.
A new needle should always be used when administering to a patient.
1. General
1.1 Use aseptic technique throughout to keep the injection free from microbial contamination.
1.2 Use a 'no-touch' technique, i.e. avoid touching areas where bacterial contamination may be introduced, e.g. syringe tips, needles, vial tops, etc.
1.3 Gather all equipment required, ensure area is clear, quiet and uncluttered.
1.4 Clean the surface where preparation is to take place using an appropriate cleansing agent as recommended in local policy.
1.5 Check form, drug, dose and diluent against the prescription and the product information. (Note that some forms of medicines are similar, e.g. plastic ampoules and nebules.)
1.6 Check the expiry dates of all ingredients and equipment to be used.
1.7 Check the integrity of all packaging.
1.8 Peel wrappers from needles and syringes - do not push through wrappers as this will result in heavy particulate contamination.
1.9 Check route of administration against the prescription.
1.10 Check that the medicine has not already been given.
2. Handwashing
2.1 Wash hands with an antiseptic cleansing solution or with liquid soap and water followed by an antiseptic cleansing solution or as directed in local policy.
2.2 Do not use bars of soap as they are reservoirs for bacteria.
3. Gloves
3.1 Wear gloves recommended in local policies to avoid contamination of the injection being prepared and to protect the operator from inadvertent skin contamination.
4. Swabbing
4.1 Swab vial closures and infusion ports with alcohol wipes as recommended in local policy and allow to dry.
4.2 Note that where vials are protected by tamper-evident plastic or metal covers, this does not ensure sterility of the vial closure - swab all closures.
5. Withdrawing liquid from an ampoule into a syringe
5.1 Swab the neck of the ampoule using an alcohol wipe and allow to dry.
5.2 Snap open the neck of the ampoule using agreed local procedure.
5.3 Using a 'no-touch' technique, carefully withdraw required dose, filtering if applicable (e.g. when using glass ampoules) into a syringe. Tilt the ampoule if necessary so that all the required contents can be removed.
5.4 Tap the syringe lightly to concentrate any air bubbles.
5.5 Remove the needle and fit a sterile blind hub (sterile protective cap) to the syringe if required.
6. Withdrawing liquid from a vial into a syringe
6.1 Remove the tamper-evident seal if applicable and swab the top of the vial with an alcohol wipe. Allow to dry.
6.2 Keeping the needle cover on, draw the syringe plunger back to the desired volume.
6.3 Remove needle cover and insert the needle into the rubber bung.
6.4 Invert the vial and, keeping the needle in the liquid, gradually depress the plunger pushing air into the vial.
6.5 Note - if a large volume of liquid is required, use a 'push and pull' technique adding the liquid in aliquots of 5ml to avoid pressure building up with the risk of aerosol spray.
6.6 Release the plunger so that the liquid enters the syringe.
6.7 Tap the syringe lightly to concentrate any air bubbles and push them back into the vial. Ensure that the needle with syringe attached remains firmly in the vial during this process to avoid pulling atmospheric air into the syringe.
6.8 Fill syringe with desired volume of liquid, draw in a slight excess of air, then carefully remove the needle from the bung to prevent sprayback (or follow local procedure).
6.9 Expel any excess air, remove needle and fit a sterile blind hub if required.
7. Reconstitution of drug in powder form and removal from vial into a syringe
7.1 Swab vial top and/or ampoule neck with an alcohol wipe and allow to dry.
7.2 Using the procedures indicated in 5. (as shown on the previous page), draw up the required volume of diluent.
7.3 Inject this into the vial. The syringe will fill with air which has been displaced by the liquid added to the vial (unless the vial has been vacuum filled).
7.4 Note - if a large volume of liquid is required, use a 'push and pull' technique, adding the liquid in aliquots of 5ml to avoid pressure building up with the risk of aerosol spray.
7.5 With the needle and syringe attached to the vial, shake the contents of the vial carefully to dissolve the powder (unless otherwise indicated in the product information leaflet).
7.6 Fit new needle and draw up the required volume of liquid from vial using procedures indicated in 6.2 - 6.9 (as shown on this page).
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