AOM 2

Question 1

When do we use smaller/ larger gauge needles?

Answer 1

Smaller (larger lumen): for more viscous medication
Larger (smaller lumen): produce less tissue trauma

Question 2

What gauge needles are used in ID, SC & IM?

Answer 2

ID: 26-27
SC: 24-26 (insulin: 29-30)
IM: 20-23

Question 3

What factors affect choice in needle shaft length?

Answer 3

client size & weight, type of injection

Question 4

How to choose shaft length for IMI, SC & CVP (central venous pressure) insertion?

Answer 4

IMI: 1 - 1.5 inches
SC: 5/8 - 3/8 inch
CVP: 1&7/8 inches

Question 5

Describe reconstitution for vials

Answer 5

Adding diluent of sterile water/ NS by marking date & time on the label
required when medication is in powder form

Question 6

intradermal injection: volume of drug, type of syringe (+gauge and shaft length), indication

Answer 6

Volume: ~0.1mL
Type of syringe: tuberculin syringe
Gauge: 25-27
Shaft length: 1/4 - 5/8 inch
Indication: allergy testing, tuberculosis screening

Question 7

common injection sites for ID, angle of needle injection

Answer 7

Inner lower arm, upper chest, back beneath the scapulae
needle enters skin at 5-15 degree angle

Question 8

Subcutaneous injection: volume of drug, type of syringe (+gauge and shaft length), indication

Answer 8

Volume: 0.5-1mL
Type of syringe: 2mL/ insulin/ tuberculin syringe
Gauge: 25
Shaft: Adult - 5/8 inch inserted 45 degrees or 3/8 inch inserted 90 degrees; Child - 1/2 inch inserted at 45 degrees
*Pinch tissue, select needle length half the width of skinfold
Indication: Vaccines, insulin, low molecular weight heparin (eg Clexane)

Question 9

Subcutaneous injection common site

Answer 9

abdomen, outer posterior aspect of upper arms
anterior aspect of thighs, upper ventrogluteal & dorsogluteal areas

Question 10

Why do injection sites need to be rotated?

Answer 10

Minimize tissue damage, aid absorption, avoid discomfort

Question 11

Intramuscular injection: volume of drug, type of syringe (+gauge and shaft length), indication

Answer 11

Volume: =<3mL in gluteus medius & gluteus maximus; 1-2mL in less developed muscles; 0.5-1mL in deltoid
Type of syringe: 3/5mL syringe
Gauge: 21-22
Shaft length: 1 1/2inches
Indication: require comparatively quick absorption of medication

Question 12

intramuscular injection common sites

Answer 12

Ventrogluteal, dorsogluteal, deltoid,
vastus lateralis (infants & younger children), rectus femoris

Question 13

Vastus lateralis (IMI) landmark for adult & child

Answer 13

Adult: Between greater trochanter of femur and lateral femoral condyle (above knee) -> middle third lateral part
Child: Anterior lateral aspect of thigh (prefer middle third)

Question 14

How to locate rectus femoris site (IMI)? (+disadvantages)

Answer 14

Anterior aspect of thigh, one of the muscles of quadriceps muscle group (only for adults)
*clients can have their own injection
Disadvantage: significant discomfort for some

Question 15

How to locate deltoid (MI)? (+ max volume)

Answer 15

Lateral aspect of upper arm, small muscle close to the radial artery & nerve
Upper border: below fourth fingers across the deltoid muscle with 1st finger on acromion process
Lower border: top of axilla
*fast absorption, but 1mL max (eg hep b vaccine)

Question 16

3 factors to minimize Needle Stick Injury

Answer 16

1. Equipments, eg needleless HB system, injection trolley w/ sharp box nearby
2. Secure work environment, eg sufficinet lighting, proper client prep to gain coorperation, clear up area prevent tripping over obstacles
3. Technique, eg do not remove needle cap w/ force to avoid rebound force, do not recap used needles, one-handed technique

Question 17

4 post-exposure treatment after NSI

Answer 17

encourage bleeding
clean the area w/ soap & water
initiate first aid & seek treatment
go to A&E for follow up if needle is contaminated