How to Combine Two (2) Medications in One (1) Syringe

ASSESSMENT

• Situations
  • 2 compatible medications
  • Compatibility
    • Charts
    • Observation of combined drugs
    • Do not combine more than 2 drugs in one syringe
• Containers
  • Vials
  • Ampules
  • Pre-filled cartridge
  • Pre-filled syringe
• Combining Order
  • Vial 1 → Vial 2
  • Vial 1 → Ampule 2
  • Ampule 1 → Carpuject/Tubex 2
  • Vial 1 → Carpuject/Tubex 2
• Injection Site
  • Based on volume of medication
    • Deltoid 0.1 – 2 mL
    • Dorsogluteal 1 – 5 mL
    • Ventrogluteal 1 – 5 mL
    • Vastus lateralis 1 – 5 mL
  • Client preference
  • Site accessibility
  • Specific routines or policies
    • Heparin always given in abdomen
    • Vaccines specify site for effectiveness
• Size of syringe
  • <  0.5 mL
    • Tuberculin syringe
    • Calculate in 1/100
  • 0.5 – 3 mL
    • 3 mL syringe
    • Calculate in 1/10
  • > 3 mL
    • 5 mL syringe
    • Calculate in 1/10
• Size of Needle
  • Length
    • 3/8”, ½”, 5/8” for SQ
    • ¼ – ½” for ID
    • 1-2” for IM
  • Guage
    • Larger number = smaller diameter
    • 25-27g = SQ
    • 19-23g = IM

PLANNING

• Use of Standard Precautions
  • Wash hands
  • Cleanse tops of multidose vials
  • Keep needle and syringe plunger sterile
  • Wear gloves to administer
  • Never recap used needles
  • Dispose in proper container
  • Wash hands
• Equipment
  • Medication
    • Vial
    • Ampule
    • Cartridge
  • Syringe
  • Proper size needle
  • Alcohol wipes
  • MD orders/MAR

IMPLEMENTATION

• Safe procedure for using Tubex
• Safe procedure for using Carpuject
• Procedure for combining in one syringe

DOCUMENTATION

• Time
• Initials
• Site using appropriate code
• Response