IM injection Flashcards
1
Q
What are the equipment to take?
A
- Gather 9 equipment from bottom of trolley and put it on the top of trolley:
a. Medicine order form (already in folder on top of trolley)
b. Kidney dish with:
c. Maxalon medication vial
d. Syringe
e. Bigger green 21-Gauge needle
f. Smaller blue 23-Gauge needle
g. 2 alcohol swabs – 1 for cleaning the medication vial and 1 for cleaning the patient’s skin
h. Gauze
i. Plaster - “After gathering my equipment, I will check the expiry date of each equipment.” Look for the expiry date on the equipment packaging OR the boxes for some equipment (eg. for gauze, the expiry date is on the box, but for alcohol swabs, the expiry date is on the packaging itself). Some equipment may not have expiry dates, but just show that you are looking for the expiry date on both the equipment and their boxes, even if there turns out to be no expiry date in the end. You will have a lot of time anyway!
2
Q
How do you prepare the medication?
A
- “I will double check the amount of medication to be administered against the medicine order form.”
- Do 2 things to the medicine vial:
a. Roll the medicine vial between your hands to mix evenly.
b. Tear open first alcohol swab and leave packaging in the kidney dish. Using the alcohol swab, wipe the top of the medication vial 10x in a circular motion, from inside to outside (even though the surface area of the vial is very small, try to move from an inner circle to an outer circle). Verbalize: “Alcohol dry.” - Tear open packaging of bigger green 21G needle halfway so that it will not drop out.
- Insert syringe onto the 21G needle firmly. Pull the needle out of packaging. Leave packaging in the kidney dish.
- Remove the translucent white needle cover, into the kidney dish, using the one-hand-drop-down method. (You can use 2 hands to loosen needle cover initially, but when you drop the cover down, it must be using 1 hand only.) DO NOT THROW THIS NEEDLE COVER AWAY IN CASE YOU MAKE MISTAKES (EG. IF YOU FORGET TO ROLL THE MEDICINE VIAL, YOU HAVE TO CAP BACK THE 21G NEEDLE THEN ROLL THE VIAL).
- Draw in 1ml of air into the syringe.
- Set the Maxalon vial on a flat surface.
- Poke the needle vertically through the top of the Maxalon vial and inject 1ml of air into the vial using the index finger of your dominant hand.
- Hold Maxalon vial between the index and middle fingers of your non-dominant hand and hold syringe+needle with dominant hand. (Non-dominant hand is in a bunny-ear position!)
- Invert the vial.
- Ensure that the tip of the needle is below the liquid line to avoid withdrawing air bubbles.
- Hold this system to eye-level to ensure correct dosage of medication.
- Withdraw slightly more than 1ml of Maxalon using dominant thumb and 3rd/4th finger to pull back on plunger, while non-dominant hand stabilizes the vial plus the body of syringe+needle in the bunny-ear position!
- Use non-dominant hand to continue stabilizing this system while flicking the syringe with dominant hand to allow air bubbles to float to the top. Note that if there are too many air bubbles you can expel the medication back into the vial and withdraw again.
- Turn the vial back upright and set it on a flat surface. NOTE: Remove the syringe+needle from the vial only when it is upright, or else medicine will leak out.
- Discard the used green 21G needle into the sharps bin using the one-hand-drop-down method. (You can use 2 hands to loosen needle away from syringe initially, but when you drop the needle down into the sharps bin, it must be using 1 hand only.)
- Tear open packaging of smaller blue 23G needle halfway so that it will not drop out. Insert syringe onto the 23G needle firmly. Pull the needle out of packaging. Leave packaging in the kidney dish. DO NOT remove the needle cover yet, so that you can catch any extra medication when priming the needle later!
- Hold this system to eye-level to ensure correct dosage of medication again.
- Flick the syringe with dominant hand to allow air bubbles to flow to the top.
- Prime the system and remove air bubbles by pushing up VERY SLOWLY on the plunger until the correct dose of 1ml is reached.
- Now, remove the translucent white needle cover, into the kidney dish, using the one-hand-drop-down method. (You can use 2 hands to loosen needle cover initially, but when you drop the cover down, it must be using 1 hand only.) DO NOT THROW THIS NEEDLE COVER AWAY AS YOU MUST RECAP THE NEEDLE BEFORE APPROACHING THE PATIENT, BECAUSE YOU ARE IN THE MEDICINE PREPARATION ROOM.
- Recap the needle in kidney dish using ONE HAND ONLY (to avoid poking other hand).
3
Q
How do you approach the patient? What else is there to check?
A
a. Introduce myself
b. Explain the procedure to the patient, and inform them that it might be a little painful during the injection
c. Obtain patient consent
d. Ask the patient which is their non-dominant hand
e. Double-check the patient’s full name and NRIC against 4 things: The patient’s verbal identifiers, the medicine order form (read out the full name and NRIC on the form), the patient’s wrist tag on the dummy (read out the full name and NRIC on the wrist tag).”
35. “I will also double-check the following 7 things:
f. Check if the medicine vial has the correct drug name
g. Check for the clarity of the drug
h. Check for the expiry date of the drug (already done earlier but just say it again)
i. Check if the dose of the drug to be given is correct against the medicine order form
j. Check if the time that the drug is to be administered is correct against the medicine order form
k. Check if the route of administration is correct, against the medicine order form (in this case it would be intramuscular route)
l. Check if the patient has ANY DRUG ALLERGIES.”
4
Q
How do you give the injection?
A
- Tear open second alcohol swab and leave packaging in kidney dish. Use the alcohol swab to clean the patient’s skin in a circular motion, from inside to outside. Verbalize: “Alcohol dry.”
- “I will inform patient that we are about to perform the injection and that it will hurt a little.”
- Using dominant hand, pick up the syringe+needle system and let the needle cover slide off. Hold the system using dominant hand in a dart-like fashion.
- Use non-dominant hand to stretch skin taut between the thumb and index finger.
- Dart the needle into the skin quickly at a 90o angle to the skin surface. Ensure the full-length of needle is inside the skin to reach the muscle below the fats.
- Stabilize body of syringe+needle with non-dominant hand.
- Using dominant hand, pull back on the syringe plunger a little to ensure that there is no blood ie. That you are not in an artery or vein.
- Using same dominant hand, push down the plunger slowly using index finger while counting to ten (10s/ml).
- Use non-dominant hand to grab gauze from kidney dish and put it over the needle puncture site.
- Use dominant hand to swiftly withdraw the needle. Discard the needle system in the sharps bin immediately, do not need to recap.
- “I will instruct patient to use their other hand and apply pressure over the puncture site for 1-2min. For patients with a poor coagulation profile, I will increase the time to 3-5min. I will also tell the patient NOT to massage the area or else medicine absorption will be too rapid.”
- Open the plaster packaging. Remove the gauze and place it into the kidney dish. Paste plaster over the puncture site.
5
Q
What do you do after giving the injection?
A
- “I will thank the patient and tell them to inform the nearest medical staff if they experience any reaction to the medication, such as swelling, itchiness, or burning sensation around the needle puncture site.”
- Throw entire kidney dish with all the rubbish into the rubbish bin (there will be a small plastic bag at the side of the trolley that acts as a rubbish bin, and a big rubbish bin with a foot pedal, you can choose from either one).
- Hand rub (from bottle on trolley) – show 7 steps.
- Record the name of drug administered, dosage, and time in the medication order form, and sign your name in the corresponding box (there will be a pen on the trolley).
- “After completing the medication administration procedure, I will monitor for the therapeutic effect of the drug as time passes.”
- Medical hand wash – show 7 steps.
