Republic of the Philippines

CAMARINES SUR POLYTECHNIC COLLEGES

Nabua, Camarines Sur

COLLEGE OF HEALTH SCIENCES

Name of Student: _________________________________ Grade: _________

Year & Section: ___________________________________ Date: __________

PROCEDURE CHECKLIST
INSULIN ADMINISTRATION WITH VIAL AND SYRINGE
Instruction: Below is the grading scale which will be used in rating your performance.
5 Excellent 95 - 100
4 Very Satisfactory 88 - 94
3 Satisfactory 82 – 87
2 Fair 76 – 81
1 Needs Practice 70 – 75

PURPOSES
• To know how to properly prepare and administer Insulin
• To understand the importance of Insulin therapy
• To evaluate the effectiveness of insulin after administration

ASSESSMENT
Before administration of Insulin, determine:
o The policies and procedures for the facility
o The client’s understanding of the procedure
o Assess the client’s skin at the puncture site to determine if it is intact and the
circulation is not compromised. Check color, warmth, and capillary refill.
o Review the client’s record for medications that may prolong bleeding such as
anticoagulants, or medical problems that may increase the bleeding response.

PLANNING

EQUIPMENT
• Gloves, Insulin bottle, Insulin syringe, Alcohol wipes, Cotton ball, Medication Tray
and Sharps container

IMPLEMENTATION

PREPARATION
PROCEDURE 5 4 3 2 1

1 Prior to performing the procedure, introduce self and

verify the client’s identity using agency protocol.
Explain to the client what you are going to do, why it is
necessary, and how he or she can participate.

2 Perform hand hygiene and observe other appropriate

infection prevention procedures.
3 Provide for client privacy.
4 Prepare the equipment: gloves, insulin bottle, syringe,
alcohol wipes, cotton ball, and sharps container.
 Republic of the Philippines
CAMARINES SUR POLYTECHNIC COLLEGES
Nabua, Camarines Sur

COLLEGE OF HEALTH SCIENCES

5 Verify the doctor’s orders. Check the insulin bottle

label and verify the expiration date. Make sure it is the
right insulin. Make sure it is not expired.
6 Put gloves on.
7 If the insulin vial has a plastic cover, take it off. Wipe
the top of the bottle with an alcohol wipe. Let it dry. Do
not blow on it.
8 Take the cap off the needle, being careful not to touch
the needle to keep it sterile. Pull back the plunger of
the syringe to put as much air in the syringe as the
dose of the medicine prescribed.

9 Put the needle into and through the rubber top of the
insulin bottle. Push the plunger so the air goes into the
bottle.
10 Keep the needle in the bottle and turn the bottle
upside down.
11 With the tip of the needle in the liquid, pull back on the
plunger to get the right dose of insulin into the syringe.
12 Check the syringe for air bubbles. If there are bubbles,
hold both the bottle and syringe in one hand, and tap
the syringe with your other hand. The bubbles will float
to the top. Push the bubbles back into the insulin
bottle, then pull back to get the right dose.
13 When there are no bubbles, take the syringe out of the
bottle. Make sure to check the number of units. Put
the syringe down carefully so the needle does not
touch anything.
14 Assist the patient to select an appropriate injection
site.
15 Clean the skin with alcohol wipe or swab. If the skin is
visibly dirty, clean it with soap and water.
16 Pinch the skin and put the needle in at a 45 degree
angle. If the skin tissues are thicker, you may be able
to inject straight up and down. Check with your
provider before doing this.
17 Push the needle all the way into the skin. Let go of the
pinched skin. Inject the insulin slowly and steadily until
it is all in. Leave the syringe in place for 5 seconds
after injecting.
18 Pull the needle out at the same angle it went in. Put
the syringe down. There is no need to recap it.
19 Place the needle and syringe in a safe hard container.
Never reuse needles or syringes.
20 Document dose and administration site appropriately.

EVALUATION
• Evaluate the effectiveness of the Insulin Therapy after its administration.
• Conduct appropriate follow-up such as asking patient’s understanding about the
importance of insulin administration.
 Republic of the Philippines
CAMARINES SUR POLYTECHNIC COLLEGES
Nabua, Camarines Sur

COLLEGE OF HEALTH SCIENCES

• Prepare the client for self-administration of Insulin at home.

REMARKS:__________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________

Date/Time:__________________________
Clinical Instructor: ____________________