Which action would the nurse take when withdrawing medication from a multidose vial?

Learn how to withdraw medication from a vial!

Drawing up medication from a vial is an essential skill a nurse must learn to do. Medications that are given IV, IM, or subcutaneous routes are stored in a vial.

This article will also cover prevention of rubber stopper coring, changing out the vial access device with a new device prior to administration, different types of vial access devices (filter needle, blunt-tip fill needle, needle with beveled tip), air instillation to prevent a vacuum from forming inside the vial, and more.

Also, check out how to withdraw medication from a glass ampule.

1. Gather supplies:

• Physician’s order
• Medication vial
• Alcohol prep
• Syringe (size depends on the amount of medication you’re administering)
• Vial access device that attaches to syringe’s needle adaptor to help withdraw medication from the vial
• Extra needle if your administering IM or need a needle to give IV…(most IV administration is needleless)
  

1. Wash hands
2. Set-up the syringe and vial access device, if needed (some are already prepared).

• You can use different vial access devices to withdraw medication from a vial: needle device, blunt-tip needle device, or a filter needle
• Attach the access device by twisting it onto the syringe’s needle adaptor (tip: make sure you have twisted it on securely or it can become disconnected during the withdrawal of the medication). Keep it in the packaging with the cap on until ready to use.
  

1. Prepare the vial for medication withdrawal: First, flip off the top of the vial, if present.
   
2. Then open an alcohol prep pad and clean the exposed top of the vial for 30 seconds and let it dry.
   
3. While it’s drying remove the capped syringe from the packaging and uncap it. Keep the cap in its packaging and set aside for future use. Prepare to instill air in the syringe.
4. To do this pull back on the syringe’s plunger (take care not to contaminate the shaft of the plunger, only touch the plunger flange). You need to instill the same amount of air that is equal to the volume of medication you will be removing from the vial. Why? Instilling air in the vial prior to medication removal helps prevent a vacuum from forming inside the vial. For example, if not enough air is injected in the vial prior to the removal of the medication, it will be difficult removing the medication, and this is especially true for multi-dose vials that are used more than once.
   • Therefore to do this, pull back on the plunger via its flange until the plunger seal lines line up with the volume markings on the barrel labeled for the prescribed amount. Example: order says 2mL….draw-up 2mL of air in the syringe.
     

1. After instilling air into the syringe, inject the air into the vial by holding the vial steady on a flat surface with your non-dominate hand and with your dominate hand hold the syringe at its barrel. When using a needle to pierce the top of the rubber stopper use a technique that helps prevent coring. What is vial coring? It occurs when parts of the rubber stopper enter the vial. These parts could possibly be injected into the patient.

• • WHY is the needle changed out…why can’t I use it to give the medication? The needle loses it integrity and becomes less sharp after penetrating the rubber stopper. This would cause pain to the patient during administration. Furthermore, medication residual can be on the needle during withdrawal from the vial, and if administered to the patient with the residual present on the needle, it can cause issues to the surrounding tissues.
• Perform hand hygiene.
• Double check syringe, physician’s order, etc. and then administer the medication to the patient.

References:

Medication Preparation Questions | Injection Safety | CDC. Cdc.gov. (2021). Retrieved 20 January 2021, from https://www.cdc.gov/injectionsafety/providers/provider_faqs_med-prep.html.Roth, J. (2007).

How to Enter a Medication Vial Without Coring. Anesthesia & Analgesia, 104(6), 1615. https://doi.org/10.1213/01.ane.0000260552.76585.53