 Welcome to nursing school explain in this video on mixing insulins. Now the two insulins that we can mix in one insulins range is regular insulin and NPH and because the two insulins have a different onset peak and duration we have to be very careful that we don't contaminate drawing up one insulin and inadvertently putting it in the other because then the onset peak and duration are mixed and we no longer have what we expect to be in there and that could adversely affect the patient. So we always need to double check that we administer the correct dosages but also this technique for mixing insulins in once a range is a very particular one. First of all regular insulin is clear we also refer to it as clear insulin and then NPH comes kind of cloudy. This here is a demo dose but it's very similar to the actual insulin. So as you can see on the bottom there's some precipitation so I want to make sure I roll the vial first to kind of mix it up. What you don't want to do is shake it because that might create some air bubbles and if you've ever drawn insulin up before it's not that easy to get these air bubbles out. So I'm gonna mix this up. I probably have to mix it again once I'm a little bit more ready to go. So then of course I'm always gonna perform hand hygiene and don my gloves. I want to also tell you that today we're gonna draw up five units of regular and 10 units of NPH. So first things first this is a brand new vial so I'm gonna open up the cap use my alcohol wipe and clean the top of that rubber stopper vigorously for about 10 to 15 seconds. I always like to keep the alcohol wipe on top and then use a second one to clean the other vial that way I know which one has been cleaned and which one is ready to go. Now the tricky part here because we want to mix the insulins in the syringe only and not in the vial and we always have to insert air into any vial before we withdraw the medication there is a certain order that we have to go by. So we're going to it is less harmful let's put it this way it's less harmful if the regular insulin gets in the NPH because regular insulins onset peak and duration are shorter than the NPH but if I was to put NPH in the regular insulin now I expect this insulin to last for maybe four to six hours but I have some NPH in there now this insulin is going to last a lot longer which really if you think about it might make the patient hypoglycemic so I want to be extra careful that I don't get any NPH into the regular insulin so I've cleaned them both and there is a saying it goes cloudy clear clear cloudy so think about it a nice bright day it's cloudy in the morning it gets clear during the day it stays clear in the afternoon and it gets cloudy in the evening there are other acronyms you can use for that but just think about what you don't want to happen clearly we don't want any one of the insulins to be mixed in the other vial but the worst-case scenario would be getting the longer acting into the shorter acting vial so we're going to we said use ten units of NPH and five units of regular insulin which makes a total of 15 units but because I need to insert the air first with my insulin insulins syringe I'm going to draw up the ten units first that I'm going to insert into the NPH so I'm just going to take it here the mixing up right now doesn't matter because I'm not really dealing with the liquid I'm just inserting the air and I do not want to turn this vial upside down because then I could get insulin on or liquid onto the needle that I could then inadvertently carry over to the other one so I'm going to insert the five units the ten units here and then insert the five units in the regular vial now because I'm going to draw up the clear first so for the air cloudy then clear for drawing up clear and then cloudy so I inserted the five units I can invert my vial and draw up the five units and I'm pretty lucky here I don't have any air bubbles so double checking it might be a small one right there so I'm just gonna flick this and see if there's anything on the move okay so no air bubbles and now I need to draw up the NPH so now I need to be very careful not to push any of this regular insulin in the NPH vial so I cannot draw back on the plunger once the needle has been inserted in the NPH vial draw it up vigorously because that might create some turbulence and let some of the fluid go back so I need to do this very slowly and I need to also only go to the 10 to the 15 unit mark because then I have my total of five regular and 10 NPH drawn up if I were to go a little bit further than the 10 units then I don't know exactly what my mix ratio is I clearly have too much NPH and I have to discard the syringe and start over so this is very critical so we've already inserted the air so now I'm going to withdraw the 10 units and I'm seeing it's become a little bit cloudy what a sediment has settled there so I'm gonna just gently swirl and shake the vial and that is mostly to help with the concentration otherwise if it's not dissolved correctly you're also not going to get the correct dose okay I have a little more sediment here so I'm just going to set my syringe aside carefully and swirl this a little bit more until it's completely dissolved now since I'm not sure if I touched the top of the rubber stopper I'm just gonna give this another little wipe here and continue to swirl because I don't want it to settle sometimes it's a little bit of a give and take so now I am ready to withdraw my 10 units very carefully so no air inserted because I've already done that so I'm gonna put the needle in and then carefully withdraw the 10 units the 10 additional units so now I need to go down to 15 okay so I'm at 15 I don't see any air bubbles so I withdraw my needle carefully recap my needle with the one-handed technique to make sure I don't accidentally stab myself and go hypoglycemic take a vial and help to push it on there and then I can actually move this little safety device over to the side a little bit so that you can see that I have a total of 15 units right here and the 15 is right there and that is the correct mix of my insulin five units of regular and 10 units of nph then I go ahead and I label the syringe appropriately do all my patient rights and go administer it to my patient thanks so much for watching this video on mixing insulin which is a super important skill like I said not not many times used anymore but also check my other skills videos about medication administration thanks for watching see you soon