Procedure 27-3 Demonstrate Withdrawing Medication From An Ampule
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nurseoncervixProcedure 27-3 Demonstrate Withdrawing Medication From An Ampule
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nurseoncervixName:______________________________
Date:__________________________
Procedure 27-3
Demonstrate Withdrawing Medication from an Ampule
Objective: The student, using the supplies and equipment listed below, will
demonstrate how to withdraw medication from an ampule correctly.
Supplies: Sterile filter needle/syringe set, ampule of medication, sterile gauze 2x4s or
4x4s, alcohol wipes, gloves, sharps container, patient chart
Affective Behaviors: Affective behaviors provide a professional approach to a skill that
enhances the patient encounter. These behaviors may also display sensitivity to patients
rights and enhance communication. Pay close attention to these skills which will be in
bold, italicized font.
Notes to the Student:
______________________________________________________________________________________________
______________________________________________________________________________________________
______________________________________________________________________________________________
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Skills Assessment Requirements
Read and familiarize yourself with the procedure; complete the minimum practice
requirements. Document each MPR using proper charting technique. Complete each
procedure within a reasonable amount of time, with a minimum of 85% accuracy.
Name:______________________________
Date:__________________________
POINT
VALUE
= 3-6 points
= 7-9
1.
2.
3.
4.
5.
6.
7.
8.
9.
Wash your hands and gather
equipment.
Check to make sure the
medication matches the
physicians order. Calculate the
dosage, if necessary.
Look up information relating to
the medications function, usual
doses, and side effects. Check
for patient allergies.
Check the medication label a
second time against the
physicians order.
Identify the patient, introduce
yourself, and escort the patient
to the treatment area.
Put on your gloves.
Dislodge any medication that
may be trapped in the ampule
neck by holding the ampule by
the neck and
quickly flicking your wrist in a
downward motion.
Disinfect the ampule with an
alcohol swab and check
the label again for correct
medication and dosage.
Completely wrap the neck of
the ampule with the
sterile cotton gauze and snap
off the top by pulling it
toward you. Discard the top in a
sharps container.
With a filtered needle,
withdraw the necessary
medication amount. You can
withdraw the medication
with the ampule either inverted
PRACTICE
TRIAL
GRADED
TRIAL
#1
GRADED
TRIAL
#2
NOTES:
Name:______________________________
Date:__________________________
or not.
Name:______________________________
Date:__________________________
10.
11.
12.
13.
14.
15.
Change needles and discard the
filtered needle into a sharps
container.
Identify the patient.
Administer the medication
according to the physicians
orders.
Discard the used needle into the
sharps container.
Remove the gloves and wash
your hands.
Document the procedure.
Include date, time, site,
medication, route, and amount
administered. Sign the entry
with your name and
credentials. Follow office
policy for recording the
expiration date and lot number.
Name:______________________________
Date:__________________________
Document:
Grading
Enter the appropriate information in the chart below.
Name:______________________________
Date:__________________________
Points Earned
________
Points Possible
________
Percent Grade
________
102
102
YES
YES
NO
NO
N/A
N/A
(Points Earned/Points Possible)
PASS:
________
Instructor Sign-Of
Instructor:___________________________________________ Date:___________
