Preparation of Medication from Vial and Ampule

I. Introduction

Medication formulations vary in preparations. Specifically, parenteral medications are

prepared in dry or liquid preparations and stored in a vial, ampule or pre-filled syringes.
Preparations are formulated according to its specific use and indication.

It is very important to follow the proper steps on medication preparation. This

workbook focuses the procedures on medication preparation, specifically on vial and
ampule preparation.

II. Objectives

At the end of this activity, you should be able to:

1. Learn the concepts and principles on medication preparation.

2. Describe the difference of medication preparation from vial and ampule
3. Discuss the nursing roles and responsibilities in medication preparation.
4. Demonstrate the steps on medication preparation safely and correctly.

III. Concept/s Explanation

Prior to administering medication through injection to a patient, a medication is

prepared following the essential steps and components. Part of the preparation is to
properly check the medication, assess the patient and review the pertinent data or patient
record.

Medication Preparation from a Vial

Medication in a vial are formulated either in liquid or powder form. This type of
preparation is presented in a single-dose or multi-dose vial. Medication is sealed with a
rubber on top and is maintained in a closed-system. A powder form preparation requires a
sterile water or normal saline as diluent to dissolve the medication. In withdrawing the
medication from a vial, it is important to take note that injecting air into the vial is
necessary to allow easy withdrawal of the solution.

Medication Preparation from an Ampule

An ampule is a glass container for medications. Usually, it comes in a single-dose

preparation and varies from small to big amount of liquid solutions – 1mL, 2mL, 10 mL or
more. The appearance of an ampule is, it has a constricted neck which some may have
colored ring or dot on neck. The neck of an ampule must be snapped off correctly to be
able to withdraw the medication.

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Figure 1. Medication in Vial Figure 2. Medication in Ampule

A. Preparation Phase

Initially, it is necessary to prepare the materials needed.

The following materials are:
 Sterile syringe
 Sterile gauze pad
 Alcohol swab
 Sterile needles – filter needle or aspirating needle
 Medication in a vial
 Medication in an ampule
 Diluent (Sterile water of Normal saline)
 Medication Administration Record (MAR)

B. Implementation Phase

On this phase, it is important to review first the physician’s order and check the
MAR. When checking the medication, inspect the appearance and label to include the
name of the drug, route, dosage and expiration date.

Take note of the “Three Checks” on medication preparation. Check the label of
the medication against MAR when doing the following:

 When medication is taken from the cart.

 Before withdrawing the medication from a vial or an ampule.
 After withdrawing the medication from a vial or an ampule.

The next steps are the following:

Medication in a Vial

a. Perform hand hygiene. Prevents transmission of microorganisms.

b. Remove the cap covering of the unused vial. For a multi-dose vial that is
previously used, a cap covering is removed.
c. Disinfect the rubber seal by firmly wiping the surface with an alcohol swab and
allow to dry. To ensure the sterility of the medication. Allowing alcohol to
dry prevents needle from being coated with alcohol.
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 d. Uncap the needle of the syringe. Draw an amount of air equal to the volume of
medication to be aspirated from the vial. Pull back the plunger of the syringe
when withdrawing. Injecting air into the vial prevents negative pressure
when aspirating the medication.
e. Place vial on a flat surface. Insert the tip of the needle through the center of the
rubber seal.
f. With firm pressure, inject air into air space of the vial. Injecting air into air
space of vial prevents formation of bubbles.
g. Using nondominant hand, invert the vial while dominant hand firmly holds the
syringe and plunger. Holding the syringe and plunger firmly allows easy
manipulation.
h. Allow the fluid to flow into the syringe. If necessary, pull back the plunger
slightly and obtain the correct amount of solution. Maintain the tip of the needle
below the fluid level. Maintain holding the vial at eye level. Pressure within
the vial pushes fluid into the syringe. Keeping the tip of the needle below
fluid level prevents aspiration of air.
i. Position the tip of the needle into air space of the vial and gently tap the syringe
barrel to expel any air bubbles.Eject the remaining air at the top of the syringe.
Air bubbles may cause incorrect volume and dose errors.
j. Remove the needle from the vial by holding on the barrel of the syringe. Recap
needle using one-hand scoop technique. Holding the barrel while removing
the syringe may prevent from accidentally pulling the plunger causing
spillage of medication. One-hand scoop technique will prevent needlestick
injury.
k. Hold the syringe at eye level with the tip of needle pointing upward. Check for
air bubbles. If necessary, expel air bubbles by gently tap the barrel. Slightly pull
back the plunger then push plunger to expel air. Do not eject the fluid. Check
the volume of the medication. Positioning the syringe with needle pointing
upward allows fluid to settle in the bottom and air at the top is expelled.
l. If medication will be injected in a patient’s tissue, change the needle to an
appropriate gauge and size. Needle used in aspirating medication from vial
becomes dulled.
m. Perform hand hygiene.

When medication is in powder form, the following steps are:

n. Remove the cap covering of the vials. Firmly wipe the surface of the top of the
vials both medication and diluent.To ensure the sterility of the medication.
Allowing alcohol to dry prevents needle from being coated with alcohol.
o. Aspirate appropriate amount of diluent. (Follow steps d-k).
p. Inject the diluent into the vial of powdered medication.
q. Remove the needle. Roll the vial in palms. Do not shake. Ensures medication
is thoroughly mixed. Shaking of the vial may cause formation of bubbles.
r. When medication is completely reconstituted, withdraw the correct amount of
medication by following Steps d-m. Once medication is reconstituted,
determine the correct dose. Check the label of the medication.

Medication in an Ampule

a. Perform hand hygiene. Prevents transmission of microorganisms.

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 b. Tap the top of the ampule lightly with finger until fluid moves from the neck of
the ampule. Fluid settled above the neck of an ampule moves to the lower
chamber.
c. Disinfect the neck of the ampule with alcohol swab and allow to dry. Prevents
contamination of medication.
d. Place a sterile gauze pad above the neck of the ampule. Using sterile gauze pad
prevents sharp injury when breaking the neck of the ampule.
e. Break the neck of the ampule by snapping quickly and firmly away from hands.
f. Discard the top of the ampule into an appropriate sharp container. Disposing
into a puncture-proof waste bin prevents sharp injury.
g. Hold the ampule at eye level or may place on a flat surface.
h. Using a filter needle, insert the needle into the ampule and aspirate the
appropriate amount by pulling the plunger gently. Ensure not to allow the
needle tip or shaft to touch the rim of the ampule. The rim of an ampule is
considered contaminated. Using filter needle filters glass fragments of an
ampule.
i. Maintain needle tip under surface of fluid. May tip ampule to completely
aspirate the fluid. Prevents aspiration of air bubbles.
j. If air bubbles are present, remove needle from the ampule and expel air bubbles
by holding the syringe with needle pointing up. Lightly tap the side of the
syringe and allow air bubbles to rise toward the needle. Slightly pull back the
plunger and push upward to expel the air. Do not expel fluid. Check the volume
of the medication. Positioning the syringe with needle pointing upward
allows fluid to settle in the bottom and air at the top is expelled.
k. Recap filter needle using one-hand scoop technique. One-hand scoop
technique prevents needlestick injury.
l. Change filter needle with a new sterile needle prior administering the
medication. Filter needle cannot be used for injections.
m. Discard filter needle and ampule into an appropriate sharp container. Disposing
into a puncture-proof waste bin prevents sharp injury.
n. Perform hand hygiene.

IV. Work/Practice Exercise

Performance Evaluation Checklist

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Procedure Title: Preparation of Medication from Vial
NURSING ACTIONS YES NO REMARKS
I. Preparation
1. Prepare the necessary materials.
 Medication Administration Record
(MAR)
 Medication in vial
 Antiseptic swabs
 Sterile syringes
 Sterile needles
 Diluent (Sterile water or Normal
Saline)
II. Implementation
1. Review physician’s order and MAR.
2. Check the medication label against the MAR.
Inspect the appearance and check the
expiration date.
3. Perform hand hygiene.
4. Remove the cap covering of the unused vial.
5. Disinfect the rubber seal by firmly wiping the
surface with an alcohol swab and allow to dry.
6. Uncap the needle of the syringe. Draw an
amount of air equal to the volume of
medication to be aspirated from the vial. Pull
back the plunger of the syringe when
withdrawing.
7. Place vial on a flat surface. Insert the tip of the
needle through the center of the rubber seal.
8. With firm pressure, inject air into air space of
the vial.
9. Using non-dominant hand, invert the vial while
dominant hand firmly holds the syringe and
plunger.
10. Allow the fluid to flow into the syringe. If
necessary, pull back the plunger slightly and
obtain the correct amount of solution. Maintain
the tip of the needle below the fluid level.
Maintain holding the vial at eye level.
11. Position the tip of the needle into air space of
the vial and gently tap the syringe barrel to
expel any air bubbles. Eject the remaining air
at the top of the syringe.
12. Remove the needle from the vial by holding on
the barrel of the syringe. Recap needle using
one-hand scoop technique
13. Hold the syringe at eye level with the tip of
needle pointing upward. Check for air bubbles.
If necessary, expel air bubbles by gently tap
the barrel. Slightly pull back the plunger then
push plunger to expel air. Do not eject the
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 fluid. Check the volume of the medication
against the MAR.
14. If medication will be injected in a patient’s
tissue, change the needle to an appropriate
gauge and size.
15. Perform hand hygiene.
Medication in powder form
16. Remove the cap covering of the vials. Firmly
wipe the surface of the top of the vials
both medication and diluent.
17. Aspirate appropriate amount of diluent.
Follow steps 6-13.
18. Inject the diluent into the vial of powdered
medication.
19. Remove the needle. Roll the vial in palms. Do
not shake.
20. When medication is completely reconstituted,
withdraw the correct amount of medication by
following Steps 6-13.
TOTAL

Total Score :_________________

Rating: _____________________

Student Signature : ____________

C.I. Signature : _________________

Date : _____________________

Performance Evaluation Checklist

Procedure Title: Preparation of Medication from Ampule

NURSING ACTIONS YES NO REMARKS

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I. Preparation
1. Prepare the necessary materials.
 Medication Administration Record
(MAR)
 Medication in ampule
 Antiseptic swabs
 Sterile syringes
 Sterile needles, filter needle
 Sterile gauze pad
II. Implementation
1. Review physician’s order and MAR.
2. Check the medication label against the MAR.
Inspect the appearance and check the
expiration date.
3. Perform hand hygiene.
4. Tap the top of the ampule lightly with finger
until fluid moves from the neck of the ampule.
5. Disinfect the neck of the ampule with
alcoholswab and allow to dry.
6. Place a sterile gauze pad above the neck of the
ampule.
7. Break the neck of the ampule by snapping
quickly and firmly away from hands.
8. Discard the top of the ampule into an
appropriate sharp container.
9. Hold the ampule at eye level or may place on a
flat surface.
10. Using a filter needle, insert the needle into the
ampule and aspirate the appropriate amount by
pulling the plunger gently. Ensure not to allow
the needle tip or shaft to touch the rim of the
ampule.
11. Maintain needle tip under surface of fluid.
May tip ampule to completely aspirate the
fluid.
12. If air bubbles are present, remove needle from
the ampule and expel air bubbles by holding
the syringe with needle pointing up. Lightly
tap the side of the syringe and allow air
bubbles to rise toward the needle. Slightly pull
back the plunger and push upward to expel the
air. Do not expel fluid. Check the volume of
the medication against the MAR.
13. Recap filter needle using one-hand scoop
technique.
14. Change filter needle with a new sterile needle
prior administering the medication.

15. Discard filter needle and ampule into an

appropriate sharp container.
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 16. Perform hand hygiene.
TOTAL

Total Score :_________________

Rating: _____________________

Student Signature : ____________

C.I. Signature : _________________

Date : _____________________

References:

Textbook

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Potter, P., Perry, A.G., et. Al. (2017). Fundamentals of Nursing, 9th Edition. Elsevier Pte. Ltd.

Images
Figure 1: https://www.mcguffmedical.com/heparin-sodium-5000uml-mdv-10ml-vial
Figure 2: https://www.quora.com/How-does-vial-and-ampule-differ

Website
International Nosocomial Infection Control Consortium (INICC). (2017). Care Bundles to
Prevent Central and Peripheral Line-Related Bloodstream Infections.
http://www.inicc.org/media/docs/2017-INICCBSIPreventionGuidelines.pdf

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