1
Q
what is parental administration
A
- administartion by injection
2
Q
how must parental meds be administered? why?
A
- must be performed with aspectic technique
- bc once the pt’s skin is pierced, the patient is at a risk of infection
3
Q
how can we prevent infection during parental administration (4)
A
- to prevent contamination of the solution, draw the med quickly –> do not let it sit open
- to prevent needle contamination, do not let it touch a conatminated surface
- to prevent syringe contamination, avoid touching the inner part of the barrel & keep the tip covered with a cap or needle
- wash soiled skin with water & soap and then clean the skin with an alcohol wipe from the center of the site and move outward in a 5cm radius
4
Q
what is a syringe
A
- consists of a close-fitting plunger & cylindrical barrel with a tip designed to fit the hub of a hypodermic needle
- used to draw the med
5
Q
what are the 2 categories of syringes
A
- Leur-Lok
2. non-Leur-lok
6
Q
what is a leur-lok syringe? what does it prevent?
A
- syringe that requires a special needle
- the needle is twisted onto the tip & lock in place
- prevents the inadvertent removal of the needle
7
Q
what is a non-leur-lok syringe?
A
- require needles that slip onto the syringe
8
Q
how are syringes filled?
A
- filled by aspiration (drawing back) by pulling the plunger outward
9
Q
describe how you can handle a syringe to maintain sterility?
A
- handle the outside of the syringe barrel, and the handle of the plunger
- do not tip the inside of the barrel, the shaft of the plunger, the hub or the needle
10
Q
what size range do syringes come in?
A
- anywhere from 0.5 mL to 60 mL
11
Q
what size syringe is used for subcut or intramusclar injection?
A
1-3 mL
12
Q
what size of syringe is not often used for injection? why? what are larger syringes used for?
A
- use of a syringe larger than 5mL
- larger fluid volume = discomfort
- larger syringes are used administer IV solution or to irrigate wounds
13
Q
what sizes are insulin syringes available in? how are they calibrated?
A
- sizes from 0.3 - 1 mL
- calibrated in units
14
Q
how many units in a 0.3 mL insulin syringe? 1 mL? what are these called?
A
- 0.3 mL = 30 units = low-dose syringe
- 1mL = 100 units = U-100
15
Q
what is the tuberculin syringe? what is it’s capacity?
A
- syringe with a long, thin barrel with a preattached thin needle
- capacity = 1 mL
16
Q
what can tuberculin syringes be used for?
A
- small amts of meds (ID, subcut)
17
Q
list and describe the parts of a syringe (3)
A
- plunger –> what you used to push the med in and out
- barrel –> what actually contains the fluid
- tip –> what the needl attaches to
18
Q
what are the 3 parts of a needle?
A
- the hub –> fits onto the tip of the syringe
- shaft –> the long part of the needle, connects to the hub
- bevel –> tip of the needle, always slanted
19
Q
what length do needles vary from?
A
- 0.6 to 7.6 cm
20
Q
how are needles chosen? (2)
A
according to:
- patient’s size & weight
- the type of tissue the med is being administered into
21
Q
in general, a shorter needle is used for…? a longer needle for…?
A
- shorter = child or slender adult, subcut
- longer = intramusclar injections
22
Q
how is needle diameter measured?
A
- by gauage
23
Q
what does a small gauge mean? large?
A
- small gauge = larger diameter
- large gauge = smaller diameter
ex. 22 gauge has a bigger diameter than 28
24
Q
how is gauge size selected?
A
- depends on viscosity of the fluid to be injected
25
what gauge does an IM injection usually used? what is most common? needle length? vol for deltoid? vastus lateralis & ventrogluteal?
- gauge can be anywhere from 18-27
- 22-25 most common
- needle length = 1" (2.5 cm) to 1.5" (3.8cm)
- deltoid = up to 2 mL
- others = up to 3 mL
26
what size gauge is used for subcut? needle length? what volume of liquid?
- 25-31
- length = 1/2" (1.3 cm) to 5/8" (1.6cm)
- vol = 0.5 - 1mL
27
what size gauge is used for intradermal? needle length? volume?
- gauge = 26-31
- length = 3/8" (1cm) to 5/8 (1.6 cm)
- volume = 0.1 mL
28
what is the angle of insertion for IM injections?
90
29
what is the angle of insertion of subcut injections?
- 45 or 90
30
what is the angle of insertion for ID injections?
5-15
31
what is an ampule
- glass container with a consitricted neck that contains single doses of liquid meds
32
what needs to be done to the neck to use an ampule? what kind of needle must be used?
- the neck must be snapped off
| - uses a filtered syringe to avoud getting glass into the med
33
what is a vial
- a single or multi dose container with a rubber seal at the top
- uses a metal cap to protect the med until it is ready to be used
34
what kind of meds can be stored in vials?
- liquid or dry
35
what kind of system is a vial? what does this mean?
- closed system = air must be injected to the vial to allow easy withdrawal of the solution
36
describe the steps in preparing an ampule (2)
- tap the top of the ampule to get any fluid out of the neck
- place a gauze or unopened alcohol wipe around the neck and snap the neck away from your hands
37
describe the steps/important point in drawing meds from an ampule (6)
- draw the med quickly (to avoid contamination) using a filtered needle
- hold the amp upside down or flat on a surface
- place the needle in, do not allow it touch the rim of the ampulse
- aspirate the med into the syringe by pulling back on the plunger
- keep the needle tip under the surface of the liquid
- remove the needle from the ampule, draw back on the plunger (allows fluid within the needle to enter the barrel) & then push the plunger upward to eject the air (do not eject fluid!)
38
describe the steps/important point in drawing meds from an ampule (8)
- draw the med quickly (to avoid contamination) using a filtered needle
- hold the amp upside down or flat on a surface
- place the needle in, do not allow it touch the rim of the ampulse
- aspirate the med into the syringe by pulling back on the plunger
- keep the needle tip under the surface of the liquid
- remove the needle from the ampule, draw back on the plunger (allows fluid within the needle to enter the barrel) & then push the plunger upward to eject the air (do not eject fluid!)
- cover the needle with a safety cap
- replace the filtered needle with the needle you will use for injection
39
what do you do if air bubble are aspirated while drawing meds from an ampule
- do not expel air into the ampule --> it will break the seal
- remove the needle from the ampule, hold the syringe pointing up, and tap the side of the syringe to remove the bubbles
40
what do you do if you have excess fluid when drawing meds from an ampule (3)
- dispose of it in a sink
- hold the syringe vertically with a slight slant towards the sink
- slowly eject the excess fluid
41
describe the steps to draw a med from a vial (9)
- remove the cap covering the vial
- firmly & briskly wipe the rubber seal with an alcohol swab & let dry
- find your needle, remove the cap, and pull back on the plunger to draw an amount of air equal to the volume of med you'll be administering
- place the needle into the vial on a flat surfacethru the center of the rubber seal
- inject the air into the vial's airspace to pevent bubbles
- hold the vial upside down, keep the tip of the needle under the fluid level & obtain the amt of solution needed
- remove needle & hold at 90* angle to ensure you have the correct volume
- pull back on plunger to remove fluid from needle & then push up to eject air , do not lose fluid
- change needle to appropriate needle for injection
42
how do you remove bubbles/ excess air when drawing meds from a vial?
- place the needle into the vial's airspace & tap on the side of the syringe barrel
- eject excess air into the vial
43
describe the steps to draw med from a vial containing a powder
- remove cap covering both the vial of powder & proper dilutent
- wipe both seals with alcohol swab & dry
- draw the dilutent into the syringe using the same steps for normal fluid meds out of a vial
- insert the tip of the needle thru the sea of the vial with the powder; inject & remove needle
- mix the med by rolling it in your palms, do not shake
- draw the new med following the same steps
44
what should we check before injecting meds? (6)
- MAR
- pt name
- med name, route, dose, time of amdin
- pt's medical & medication history
- allergies
- expirary date
45
what should we observe during/after the infection? what about specifically for subcut or IM
- verbal & nonverbal response
- subcut = circulatory shock, reduced local tissue perfusion
- IM = muscle strophy, reduced blood flow, circulatory shock
46
describe the general steps to injecting med: (8)
- perform necessary med checks, med prep, and hand hygeine
- describe the steps & let them know they may feel a slight stinging sensation
- select an appropriate injection site & inspect the site for any bruises, inflammation, edema
- assist the pt to a comfortable position
- locate the injection site using landmarks
- clean the site with an alcohol wipe
- hold a swab or gauze with non dom hand
- administer the injection
47
what are some things to consider when choosing a site for subcut (2)
- palpate the site for masses or tenderness
| - for insulin, rotate the injection site daily
48
what are some things to consider when choosing a site for IM (3)
- integrity & size of muscle
- palpate for tenderness or hardness
- if injection is given frequently, rotate the site
49
what are some things to consider when choosing a site for ID
- note any lesions or discoloration
50
what position do you want pt's to be in for subcut
- relax the arm, leg, or abdomen depending what site yu are using
51
what position do you want pts to be in for IM
- position them depending on the site chosen
52
what position do you want pts in for ID
- extend the elbow & support the elbow and forearm on flat surface
53
describe the steps to adminsiter a med subcut (5)
- for average sized pt: spread the skin tightly or pinch the skin with nondom hand
- inject the needle firmly & quickly at 45-90*
- hold skin fold unti the needle has been withdrawn from skin
- for obese pt: pinch the skin & inject at 90
- administer the med slowly
54
describe the steps to administer a med IM
- pull the skin down about 2.5-3.5 cm with the ulnar side of hand to create a z-track
- continue to hold the z-track until the med is injected
- inject med at 90
55
how fast should you adminster med? why?
- 1mL/10 sec
| - to avoid pain & tissue trauma
56
what do you do with IM meds to ensure you did not place the needl into an vein?
- after the needle places the skin, pull back on the plunger to look for blood
- if no blood appears, inject the med slowly, wait 10 sec, then remove the needle
57
describe the steps to administer a med ID (5)
- with nondom hand, stretch the skin over the injection site with thumb & forefinger
- insert the needle bevel up at 5-15* until resistance is felt (the needle tip can be seen thru the skin)
- inject the med slowly, should feel resistance
- notice the small bleb of ~6m in diameter on the skin surface
- withdraw the needle
58
describe the steps to injecting meds post-injection (7)
- remove the needle
- wipe the site with gauze or an alcohol wipe, apply gentle pressure but do not massage
- assist pt to comfortable position
- discard the needle, remove gloves
- hand hygeine
- pbserve the patient for 3-5 min for adverse reactions
- continue to observe the pt & site periodically & during med onset, peak, and duration
59
what are some recommendations to prevent needle stick injuries (5)
- never recap needles
- never move an exposed needle tip towards an unprotected hand
- immediately disposed of needles
- maintain a needle stick injury reporting protocol
- plan safe handling & disposal of needles before beginning procedure
60
how can we help minimize patient's discomofrt with injections? (6)
- use a sharp bevelled needle in smallest length & gauge
- postion the pt comofrtbaly to reduce muscular tension
- divert the pt's attention
- insert the needle quickly & smoothly
- hold the syringe steady
- inject the med slowly &steadily
61
what is a subcutaneous injection
- the administration of meds in loose CT under the dermis (into the fat)
62
how fast are meds given subcut absorbed? why?
- subcut tissue is not as richly supplied with blood as muscle
= med given subcut are absorbed more slowly than meds given by IM
63
list the injection sites for subcut (5)
- outer, posterior aspect of upper arms (like where the fat hands down when you lift your arm)
- the abdomen from below the costal margins to iliac crests
- anterior aspects of the thigh
- scapular areas of upper back
- upper ventral or dorsal gluteal areas
64
what is the most frequently recommended site for heparin injection
- abdomenn
65
a subcut injection site should be free of...
- skin lesions
- bony prominences
- large underlying muscles or nerves
66
give 2 examples of meds given subcut
- insulin
| - heparin
67
what are the recommended sites for insulin injection? which has the quickest absoprtion?
- abdomen --> quickest
- upper arm
- anterior & lateral portions of the thigh, buttocks, and abdomen
68
patients with diabetes who inject insulin should practice.... why?
intrasite rotation:
- rotating injection sites within the same body part
- this provides greater consistency in the absorption
note: no injection site should be used againf or at least 1 month
69
how do you determine whether to do a 90 or 45* angle for subcut
- if you can grasp 5 cm of tissue = 90
| - if you can grasp 2.5 = 45
70
what volume of doses should be given subcut? why?
- small doses --> 0.5-1 mL
| - bc the tissue is sensitive to irritating solutions & large volumes
71
what is a pro and con to IM injections
- pro = quick absorption
| - con = many risks = make sure the injection is justified
72
list 2 things administered IM
- flu & pneumonia vaccines
73
what volume of med can be used IM? why?
- normal pt can tolerate 3 mL into a larger muscle w severe discomofrt
- children, older adults, and thin patients can tolerate 2
- small children & older infants = 1 mL
- no more than -.5 for smaller infants
- bc it is less sensitive to irritating & sensitive meds
74
what influences needle size for IM
- body weight
| - amt of adipose tissue
75
describe what you should do before IM injection
- assess muscle integrity --> should have no tenderness
| - palpate for hardened lesions
76
how can we reduce pain during IM injections?
- put the pt in a relaxed position to reduce muscle strain
- distraction
- apply pressure to the site
77
what are the 3 sites of injection for IM
1. ventrogluteal
2. deltoid
3. vastus lateralis muscle
78
what are the characteristics of the ventrogluteal site for IM (5)
- deep site
- away from major nerves or blood vessels
- identified easily w bony landmarks
- preferred site for meds that are larger in vol
- offers less chance of contamination for incontinent patients & infants
79
describe how to landmark the ventrogluteal site
- place the palm of your hand over the greater trochanter on the pt's hip
- use right hand for left hip, and left for right
- point your thumb towards the groin
- point your index finger towards the anterior superior iliac spine
- extend ur middle finger along the iliac crest toward the buttocks
- injection site = in middle of the triangle ur fingers form
80
what position should the pt be in for ventrogluteal? what helps to relax the muscle?
- their side or back
| - flexing the knee & hip
81
describe the characteristics of the vastus laterlis muscle for IM (4)
- lacks major nervs & blood vessels
- facilitates rapid drug absorption
- used frequently in infants (younger than 12 m) receiving immunizations
- may also be used in older children & toddlers receiving immunications
82
describe how to landmark the vastus lateralis muscle
- place on hand above the knee
- and one hand below the greater trochanter
- use middle third for injection
83
what position do we want pts in for vastus lateralis amdin
- sitting
| - lie flat with legs extended
84
what are the characteristics of the deltoid muscle site frr IM (6)
- easily accessible
- not well developed in most pts
- not used in infants or children w underdeveloped muscles
- use of the muscle involves potential for injury to the brachial artery & radial and ulnar nerves
- recommended site for hep B vaccine & rabies injections
- only for small med volumes
85
describe landmarking of the deltoid muscle
- expose the upper arm & shoulder
- palpate the lower edge of the acromion process
- move 3-5 cm below (3 fingerwidths below)
86
what position should a pt be in for injection into the deltoid muscle
- may sit, stand, or lie down
87
what is the technique used for IM admin called? why is it used?
Z-track method
- it minimizes local skin irritation by sealing the med into the muscle tissue
- also causes less discomfort & fewer lesions
88
describe how to do the z-track method
- pull the overlying skin & subcut tissue 2.5-3.5 cm laterally to the side
- hold the skin with your nondom hand
- check for blood using aspiration
- if no blood, slowly inject the med
- leave the needle in the skin for 10 sec to allow the med to disperse evenly
- then withdraw the needle & release the skin
89
what are ID injections often used for?
- skin testing
| ex. allergy & tuberculin tests
90
why are some meds administered ID?
- the meds are potent so they are administered ID where blood supply is reduced & med absorbs slowly
- if it entered to quick, they could have an anaphylactic rxn
91
what 2 ideal locations for ID
- inner forearm
| - upper back
92
what should the skin look like for ID injections
- should be able to see the injection site clearly to detect changes in color & tissue integrity
- lightly pigmented, free of lesions, relatively hairless
93
what should appear when you inject an ID med? what does it mean if it doesnt
- a small bleb
| - if it doesnt, then the med may have entered the subcut tissue & the results would be valid
94
what is the angle of insertion for ID
5-10
NURS 2532
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