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.
How to Withdraw Medication from a Vial
- 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)
- Wash hands
- 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
- needle with beveled tip
- blunt-tip needle (decreases needle sticks during medication prep)
- filter needle (some medications that need to be reconstituted from their powder form and removed from the vial may need this…but check with protocols and the drug manufacture if this is needed)
- 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.
- Prepare the vial for medication withdrawal: First, flip off the top of the vial, if present.
- Then open an alcohol prep pad and clean the exposed top of the vial for 30 seconds and let it dry.
- 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.
- 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.
- 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 coring? It occurs when parts of the rubber stopper enter the vial. These parts could possibly be injected into the patient.
- To prevent coring of the rubber stopper with a needle when penetrating the vial, perform the following: Note the bullseye design of the stopper. You’re aiming for the middle part.
- Therefore, hold the barrel of the syringe at a 45 degree angle with the bevel positioned upward in the center of the bullseye (the bevel is the opening of the needle’s tip). Apply pressure to the needle tip and as the needle begins to penetrate the stopper push down while simultaneously rotating the needle to a 90 degree angle in one smooth motion. Then inject the air from the syringe into the vial’s space of air.
- After injecting the air into the vial keep the needle access device in the vial and invert the vial by using the same hand positions (non-dominate hand holding the vial in the inverted position and dominate hand holding the syringe).
- Confirm that the needle device is now in the fluid space so you will be withdrawing liquid rather than air. Remember when the vial goes from the upright position to the inverted position, the fluid and air space switches positions with the fluid being closest to the vial’s opening.
- Withdraw the appropriate amount of medication from the vial into the syringe by making sure the plunger seal matches the correct volume markings on the barrel. Remember when withdrawing the medication use the plunger flange…avoid touching the plunger’s shaft.
- Check for air bubbles in the syringe’s barrel. If present, lightly flick the syringe’s barrel with your fingers. The air bubbles will move to the top of the syringe. To remove the air in the syringe make sure the needle device is in the air space, and push the plunger forward to expel the air into this space. Then place the needle device back in the fluid space and pull back any mediation with the plunger into the vial to match the amount ordered. Confirm you have withdrawn the correct amount of medication and that no air bubbles are present in the syringe’s barrel.
- Pull out the access device from the vial and detach it using the one-hand scoop technique or other sharps safety technique required by your healthcare facility. Be sure to properly dispose of the vial access device. You will need a new needle or administration device for administering the medication to the patient. This is also the case if a blunt-tip fill needle or filter needle were used to withdraw the medication.
- 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.
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