how to mix nph and regular insulin?
Wash and dry your hands. Roll the cloudy (intermediate-acting) bottle of insulin between your palms 10 times gently. Do not shake vigorously. Clean the top of vial with an alcohol swab.
Draw the required amount of air (equal to the dosage of cloudy insulin) into the insulin syringe. Inject air into the cloudy insulin vial. Do not draw out any insulin, and remove the syringe and needle.
Using the same syringe and needle, draw the required amount of air (equal to the dosage for clear insulin) into the insulin syringe. Inject air into the clear insulin vial.
With the insulin syringe and needle attached, turn the clear insulin bottle upside down, with the needle bevel within the insulin, withdraw the required amount of clear insulin into the syringe.
Then do the same with the cloudy insulin. Always withdraw clear insulin first before withdrawing cloudy insulin. Ensure the total dose of clear and cloudy insulin is correct. If overdrawn, discard and repeat.
"Not all types of insulin are suitable to be mixed. If in doubt, please check with your pharmacist or diabetes nurse educator," say nurses from the Department of Specialty Nursing at Singapore General Hospital (SGH), a member of the SingHealth group.
See previous page to learn how to draw up insulin into a syringe.
See next page to find out how to administer insulin with a syringe.
WE WANT TO HEAR FROM YOU!
Always draw up regular (clear) insulin before NPH (cloudy). Put the needle in the bottle of regular (clear) insulin. Turn the bottle and syringe upside down. The bottle will be on top.
The goal of this article is to teach you how to mix insulin. Below are a video demonstration and step-by-step instructions on how to do this.
Purpose of mixing insulin: To prevent having to give the patient two separate injections (hence better for the patient).
Most commonly ordered insulin that are mixed: NPH (intermediate-acting) and Regular insulin (short-acting).
Important Points to Keep in Mind:
Remember the mnemonic: RN (Regular to Nph)
Why? It prevents contaminating the vial of clear insulin with the cloudy insulin because if contaminated it can affect the action of the insulin.
Why does this matter because they will be mixed in the syringe? You have 5 to 10 minutes to give the insulin mixed in the syringe before the action of the insulins are affected
1. Check the doctor’s order and that you have the correct medication:
Doctor’s order says: “10 units of Humulin R and 12 units of Humulin N subcutaneous before breakfast daily”
You’re giving a total of 22 units (10 Regular & 12 NPH)
As the nurse, it is important to know the peak times of the insulin you are giving because this is the most likely time the patient could experience HYPOGLYCEMIA.
Learn these insulin mnemonics to remember the onset, peak, and duration times.
2. Wash your hands and don gloves!
3. Roll the “cloudy” insulin vial in between the palms of the hands to mix the ingredients because if you don’t mix the contents it can alter how much cloudy insulin you are actually drawing up. DON’T SHAKE the vial because this will cause air bubbles!
4. Clean off tops of vials with alcohol prep for 5 to 10 seconds.
5. Remove cap from syringe.
6. Inject 12 units of air into the Humulin-N vial & then remove syringe from vial.
7. Inject 10 units of air into the Humulin-R vial & turn bottle upside down (while syringe still inserted into the bottle) and then withdraw 10 units of clear insulin…REMOVE SYRINGE.
8. Insert syringe into Humulin-N and turn bottle upside down and remove TOTAL UNITS NEEDED by pulling the plunger to 22 units (this will equal removing 12 units of Humulin-N)
9. Recap the needle using the one-hand scoop technique…if not using immediately.
- Wash hands.
- Gently rotate NPH insulin bottle.
- Wipe off tops of insulin vials with alcohol wipe.
- Draw back amount of air into the syringe that equals total dose.
- Inject air equal to NPH dose into NPH vial.
- Inject air equal to regular dose into regular vial.
- Invert regular insulin bottle and withdraw regular insulin dose.
