Combining NPH and Regular Insulin: A Nurse’s Step-by-Step Guide for Single Syringe Administration

As a nurse, efficient medication administration is a crucial aspect of patient care. When a physician orders a combination of 36 units of NPH (Neutral Protamine Hagedorn) insulin and 12 units of regular insulin, planning for single syringe administration is both practical and effective. In this article, we’ll provide a step-by-step guide on how to prioritize and safely administer these two types of insulin using one syringe.

Understanding NPH and Regular Insulin:

Before we delve into the procedure, it’s essential to grasp the differences between NPH and regular insulin:

  1. NPH Insulin:
    • Intermediate-acting insulin.
    • Cloudy appearance.
    • Typically administered to provide basal insulin coverage.
    • Onset: 1-2 hours, Peak: 4-12 hours, Duration: 18-24 hours.
  2. Regular Insulin:
    • Short-acting or fast-acting insulin.
    • Clear appearance.
    • Administered before meals to control post-meal blood sugar spikes.
    • Onset: 30 minutes to 1 hour, Peak: 2-4 hours, Duration: 5-8 hours.

Step-by-Step Guide for Single Syringe Administration:

To ensure accurate and safe administration of both NPH and regular insulin using a single syringe, follow these priority steps:

  1. Hand Hygiene:
    • Begin with proper hand hygiene. Wash your hands thoroughly to prevent contamination.
  2. Gather Supplies:
    • Collect all necessary supplies, including the vials of NPH and regular insulin, a single-use syringe, alcohol swabs, and a clean, dry surface.
  3. Check Physician’s Order:
    • Verify the physician’s order for the correct doses of NPH and regular insulin. Confirm that the total dosage matches the prescribed amounts (36 units of NPH + 12 units of regular insulin).
  4. Prepare the Insulin Vials:
    • Start by rolling the vial of NPH insulin gently between your hands to mix the suspension. Do not shake it vigorously.
    • Clean the rubber stoppers of both insulin vials with alcohol swabs.
    • Draw air into the syringe equal to the total volume of regular insulin needed (12 units).
    • Inject this air into the vial of regular insulin.
    • Draw up 12 units of regular insulin into the syringe, ensuring accuracy.
  5. Administer NPH Insulin:
    • Next, without removing the syringe from the vial, draw air into the syringe equal to the total volume of NPH insulin needed (36 units).
    • Inject this air into the vial of NPH insulin.
    • Draw up 36 units of NPH insulin into the syringe, ensuring accuracy.
  6. Double-Check the Dosage:
    • Carefully inspect the syringe to ensure that it contains the correct total dosage of insulin (36 units of NPH + 12 units of regular insulin). Verify that there are no air bubbles.
  7. Choose the Injection Site:
    • Select an appropriate injection site. Common sites include the abdomen, thighs, or outer buttocks.
    • Cleanse the chosen site with an alcohol swab and allow it to air dry.
  8. Administer the Insulin:
    • Pinch the skin at the selected site to create a small fold (if applicable).
    • Insert the needle at a 90-degree angle into the skin and release the pinch.
    • Depress the plunger of the syringe steadily to inject the combined insulin dose.
  9. Withdraw the Needle:
    • After administering the insulin, withdraw the needle gently and at the same angle at which it was inserted.
  10. Dispose of Sharps:
    • Safely dispose of the used syringe and needle in a designated sharps container.
  11. Document the Administration:
    • Complete accurate documentation, including the date, time, dosage administered, injection site, and any observations or patient responses.
  12. Educate the Patient:
    • If the patient is conscious and alert, educate them about the administration, including the purpose of each insulin type and potential side effects.

By following these priority steps, nurses can efficiently and safely administer a combination of NPH and regular insulin using a single syringe. This approach optimizes patient care, minimizes discomfort, and ensures precise insulin delivery for individuals with diabetes


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