2.5 Medication Administration (PART 4)

Question 1

Administration of Parenteral Medications

Answer 1

• Meds that do not go through digestive tract
• IM injection requires longer needle than ID and SubQ
• More viscous meds require needle with larger lumen (hollow area of needle)
• Size of syringe is determined by amount of medication
• Children and thin adults need thinner needle than obese person or IM injections
• There are special syringes for certain medications such as insulin.

Question 2

Discarding Used Needles

Answer 2

• Do not recap after use on patient
• Place in sharps container
• Use safety guard if available
• If recap is necessary, lay cap on table and slide needle into cap.

Question 3

Surgical Asepsis for Injections

Answer 3

• Use Sterile Techniques
• Attach needle to syringe with cap still on
• Clean skin with alcohol in circular motion starting in the middle and working out.

Question 4

Ampule

Answer 4

• Glass flask with single dose medication
• Break neck of ampule (make sure do not get cut)
• Using unopened alcohol pad will help protect fingers
• Snap away from you with quick motion
• If you cut yourself discard the ampule
• Filter needle is used to extract medication so no glass gets in the medication.
• After using filter needle switch with patient needle

Question 5

Vial

Answer 5

• Plastic/glass container with self sealing stopper.
• Multidose vials are usually good for 24 hours. Label time it was opened
• Wipe rubber stopper with alcohol before every use
• Inject vile with air amounted to the amount you need, then suction up medication

Question 6

Prefilled Syringes

Answer 6

• Provide single dose of medication
• Insert cartridge into reusable holder/injection device
• Check dosage before injection and clear cartridge of air. Dose is usually correct as most cartridges are overfilled.

Question 7

Mixing Insulin in a syringe

Answer 7

• Patient may receive different insulin mixed into the same syringe
• Available in multidose vials and dosage calculated in units.
• U100 = 100 units in 1 mL
• Only use insulin syringe (orange cap)
• Gently roll insulin between palm of hand. Do not shake vigorously

Question 8

Mixing insulin in syringe (cont)

Answer 8

Step 1 - Inject air into long acting insulin
Step 2 - Inject air into fast acting insulin
Step 3 - Withdraw fast acting insulin (clear)
Step 4 - Withdraw long acting insulin (cloudy)

Question 9

Angles for injection

Answer 9

Intramuscular - 90 degrees
Subcutaneous - 45-90 degrees (depending how big)
Intradermal - 5-15 degrees

Question 10

Ventrogluteal Site (IM Injection)

Answer 10

Ventrogluteal Site - Hand over greater trochanter with fingers facing patients head. Right hand for left hip Left hand for right hip. Place index finger on Anterior Superior Iliac Spine then move middle finger dorsally on iliac crest. Injection given in middle of triangle.

Question 11

Vastus Lateralis (IM Injection)

Answer 11

• Divide thigh into 3 horizontal and 3 vertical lines.
• Medication is administered on outer middle third.
• Desirable for infants and children whose glutes are poorly developed.
• Restrain baby between nurses arms to safely deliver injection.

Question 12

Deltoid Muscle Site (IM Injection)

Answer 12

• Lateral aspect of upper arm
• Recommended for adults but can be used for children 3-18 for vaccine. Not babies
• Damage to radial nerve and artery is a risk.
• Limited to 1mL of meds but can be up to 2mL depending on size of muscle
• Palpate bottom of Acromion Process to make a triangle. Administer medication in the middle of the triangle.

Question 13

IM Injection Equipment

Answer 13

• Needle Length Based on Patient
• Gauge determined by medication
• Biological/Aqueous 20-25 gauge
• Oil 18-25 gauge
• Prefilled medications may come with a needle. Make sure needle is a good size for patient

Question 14

Volume for IM Injection

Answer 14

1-5 mL is acceptable.
Less developed muscles limit to 1-2 mL
Varies depended on intended site

Question 15

Z-Track Technique

Answer 15

• Used for administering medications that may cause irritation to subcutaneous tissue.
• Suggested for older adults with decreased muscle mass
• Attach clean needle after syringe is filled to avoid injecting residual medication onto superficial tissue
• Pull skin down 1 inch and hold with nondominant hand
• Insert needle and inject slowly
• ## Apply gentle pressure but not massage

Question 16

Reduce Discomfort of Injection

Answer 16

• Appy pressure at injection site for 10 seconds before insertion
• Use separate needle from filling and injection
• Administer most painful vaccine last for children

Question 17

ID Injection Sites

Answer 17

• Inner surface of forearm
• Upper back
• Scapula

Question 18

ID Injection Equipment/Dosage

Answer 18

Tuberculin syringe (1mL) calibrated in 10ths and 100ths of millimeter
1/4" - 1/2" Needle
25-27 Gauge Needle
- Less than .5 mL Dosage
- Bevel up 5-15 degree angle

Question 19

Subcutaneous Injection Site

Answer 19

• Outer aspect of upper arm
• Abdomen below costal margin to iliac crest
• Anterior aspect of thigh
• Upper back
• Upper ventral/dorso-gluteal area

Question 20

Subcutaneous Equiptment

Answer 20

• Appropriate volume syringe (no more than 1mL)
• 25-30 Gauge, 3/8-1 inch needle
• 3/8-5/8 inch needle most common
• Length based on amount of subcutaneous tissue

Question 21

Subcutaneous Administration

Answer 21

• 45-90 degree angle.
• 45 degree for small patients with low subcutaneous tissue
• Shorter 3/8 needle should be inserted at 90 degrees.
• Longer 5/8 inserted at 45 degrees.
• Pinch skin for thinner patients when longer needle is used. Once needle is inserted release skin.
• Rotate sites if injection side used too frequently

Question 22

Subcutaneous Administration (Cont)

Answer 22

• Small bandages mark injection sites
• Sites can be reissued in areas 1 inch away
• Anticoagulants like Heparin should be should be 2 inches away.
• Subcutaneous meds can be administered continuously with an electronic pump.

Question 23

IV Administration

Answer 23

• Directly into blood stream and Immediate Effect
• Used in emergency situations
• Most dangerous route
• Check patient for adverse effects at least every hour

Question 24

Other forms of IV

Answer 24

Bolus/Push - Administered directly into IV
Intermittent IV Infusion - Mixed with IV solution and administered over short periods of time.
Piggyback Delivery - Place bag higher than primary solution. Primary port stops allowing secondary to flow
Volume Control Administration - Medication is diluted and administered via IV line. Good for children, critically ill, and older adults when volume of fluid is a concern.