IM, subcutaneous injections Flashcards
Before administering the injection, what 4 things must you confirm with the patient at start of appointment?
Full name
Date of birth
That they are due to receive an injection
Consent
When confirming with the patient what injection they are receiving, what 3 factors must you confirm?
What drug is due to be administered
Where they are getting the drug administered and by which route
If they have any allergies
Why must you ask if the patient has any known and new allergies before administering any injection/drug?
They could’ve forgotten to mention allergy or developed new allergy after their PMH was recorded
If they are allergic to the drug in the injection they could go into anaphylaxis which can be fatal
Before filling the syringe with the injection, what 5 things must you confirm against the prescription chart?
Indications for the drug
You have the correct type of syringe for the ordered route of drug administration
Correct drug dose in vial, as it matches chart
Correct date and time for administration on prescription chart
Possible contraindications on BNF
What are the 4 sites for IM injection
Deltoid: Upper, medial shoulder
Vastus lateralis and rectus femoris: anterolateral thigh
Ventrogluteal: Lateral side of buttock, above greater trochanter and below iliac crest (hip) (upper outer quadrant of buttock)
Dorsogluteal: Middle of buttock
Which IM injection site is least recommended and why?
Dorsogluteal: Middle buttock
Risk of damaging sciatic nerve and superior gluteal nerve
Risk of damaging superior and inferior gluteal arteries
Which 2 IM injection sites are the most recommended and why?
Deltoid: Not near major nerves or blood vessels, also easiest area for patient to expose
Vastus lateralis and rectus femoris: Not near major nerves or blood vessels, easiest for self-administration
What are the 5 sites for subcutaneous injections?
Lower part of lateral upper arm
Peri-umbilical area of abdomen
Upper lateral thigh
Upper half of buttock
Back
How do you choose what syringe to use for injections?
Look at dose required on prescription chart, then choose syringe with same/higher volume
eg. Can use 3ml syringe to administer 2ml of drug
Syringe volume stated on packaging and syringe itself
How do you transfer the drug from the ampoule into the syringe?
Attach blunt fill or blunt filter drawing needle to end of syringe
When drawing the drug up from ampoule into the syringe, when should you use a blunt fill or blunt filter drawing needle?
Blunt fill: ampoule has rubber bung over opening, so glass or other small fragments already won’t be drawn up
Blunt filter: ampoule doesn’t have rubber bung or top needs to be snapped off, so filter makes sure that glass doesn’t get drawn up
What method do you use to open a glass ampoule, and what should you do before to make sure that no liquid is lost?
Flick sealed ampoule so that all liquid collects at bottom
Snapback method: Hold in non-dominant hand with dot facing you, hold tip in dominant thumb and pointer finger then snap of backwards
Immediately discard of glass tip in sharps bin
How should you position the open ampoule in order to draw up the drug into the syringe, and how much should you draw up?
Place open ampoule on flat surface and insert blunt filter needle straight in, then draw up drug slowly by pulling plunger of syringe
Draw up total liquid drug in ampoule so that there is more than the required dose
After the drug has been drawn up into the syringe, how do you get rid of air bubbles and adjust the dose?
Hold upside down so that blunt drawing needle is pointing up
Flick syringe until air bubbles disappear
Slowly push plunger so that excess drug is ejected from needle
After the correct drug dose has been collected in the syringe, what do you do with the blunt drawing needle?
Put safety cap on if it has one, remove from syringe and discard in sharps bin
Place syringe back in its paper packaging so that it is kept sterile
Before touching any equipment, how should you make sure that your hands are clean with 2 steps?
Wash with antiseptic soap/hand sanitizer using proper hand-washing technique
Put on sterile gloves
What are the 3 colours of injecting needles that can be used?
Orange
Green
Blue
What is the length and gauge of the green injecting needle, and when is it used?
40mm length, 21G/0.8mm gauge
Deep IM injection in large adults
What is the length and gauge of the blue injecting needle, and when is it used?
30mm length, 23G/0.6mm gauge
IM injection in small adult or large child
What is the length and gauge of the orange injecting needle, and when is it used?
Always 25G/0.5mm gauge
25mm length: IM injection to deltoid or smaller child OR 45 degree SC injection
16mm length: 90 degrees SC injection
Before administering the injection, how should you prepare the skin?
Clean the area with an alcohol/antiseptic wipe and wait to dry
How can you tell if the injection site is suitable, by looking at the skin?
Skin is suitable if it is clear, has no bruises, skin lesion, abscesses, oedema
When administering an IM injection, at what degree to the skin should you insert the needle, and at what speed?
90 degrees
Insert needle quickly
What method is used for administering IM injections?
Z track method:
- Use thumb of non-dominant hand to pull down the skin so that it is taut
- Quickly insert needle at 90 degrees to skin
- Inject drug at 1ml per 10 seconds until total volume is injected
- Wait 10 seconds before quickly withdrawing needle from skin
- Release stretched skin
What method is used to administer subcutaneous injections?
Lifted skinfold method:
1. pinch 2-inch fold of skin between thumb and pointer finger of non-dominant hand
- hold syringe like dart and quickly insert into skin fold at 90 degrees
- Inject drug at 1ml per 10 seconds
- wait 10 seconds then withdraw needle from skin
- release skinfold
After the drug has been injected, how do you dispose of the syringe and needle?
Put on safety cap if it has one, discard in sharps bin immediately
Don’t need to dissemble needle and syringe
Should you put a cotton wool over the needle wound?
Only if it is bleeding, but isn’t necessary
Before recording in the prescription chart that you have administered the injection, what should you do?
Clear the area
Remove gloves and put in clinical waste bin
Wash/sanitize hands
How do you record in the prescription chart that you have administered the injection?
Put your initials in box with most appropriate date and time band
