Injection Lab COPY Flashcards
What are some purposes of injections? (delivery of substances to patient via needle)
- drugs
- vaccines
- skin test antigens
what are the 4 indications of injections
- if a drug is poorly absorbed or is degraded by stomach acids/GI enzymes
- Emergency Situations when a rapid and predictable drug response is desired
- if a patient is uncooperative, unconscious, or unable to take drug via and enteral route.
- when localized drug therapy is desired.
what are the 4 reasons injections are undesirable (described in the slide as contraindications)
- parental formulations are more expensive
- parenteral formulations must be sterile
- skilled or trained persons must administer them
- it may be difficult to remove the dose if there is an adverse or toxic reaction.
define parenteral
any route other than alimentary tract
what are the 3 types of injections
intramuscular (IM)
Subcutaneous (SC or SubQ)
Intradermal (ID)
what are the two determinents of needle size
length and gauge
gauge bore is the barrel size (outside diameter)
length is the length from the hub of the needle to the tip
which gauge is a larger needle 15g or 27 g
15g
what gauge is most commonly used for the following:
blood withdrawl
IM
SubQ
IED
blood withdrawl - 18g
IM - 22g
SubQ - 25-27g
ID - 27g
Choices of needles length and gauge are dependant on what four things
anatomy (depth and structures)
age of patient
volume of injectate
muscle size
idk if we need to know this but i mean might as well
example: a 4 month old infant vaccination given in the anterolateral thigh would use what length and gauge
5/8-1 inch length
25-27g
Not sure if we need to know this either but whatevs
example: toddler and older children injection given in deltoid or thigh should use what length and gauge
5/8-1inch (longer if in thigh)
22g-27g
just in case ya dont know cuz i had to google it
what is an ampule?
a sealed glass capsule containing a liquid, especially a measured quantity ready for injecting. this is SINGLE DOSE ONLY
heres a pic lol
also just in case
what is a single or multiple dose vial
single dose vials are used for a single patient and a single procedure
multi dose vials can be used for multiple patients.
not sure what the difference is between a single dose vial and a ampule tbh
dry mix vial
vial containing powder to which a sterile diluent of solvent must be added
prefilled cartridge package.
a cartridge that is prefilled with medication and ready for use.
Assemble and Draw medication steps
- wash hands
- remove plastic cap from vial and clean rubber stopper with alcohol prep pad
- connect needle and syringe
- pull plunger of syringe to “cc” mark needed (drawing AIR into the syringe)
- put needle of syringe into rubber stopper of vial
- turn vial and syringe upside down, inject air into cial and make sure needle is IN the medication
- Pull plunger of syringe out until mediaction is drwan up to correct “cc” mark
- with large bubbles, tap side of syringe while needle is pointing upright, air bubbles will rise, expel with plunger.
should you inject air into the vial while it is right side up or upside down
right side up
should you draw out medication from the vial while it is right side up or upside down
upside down
where do you deposit IM injections
deep into muscle tissue where is can be readily absorbed
Describe the rate of absorption of IM injections
faster than SQ but slower than IV
indications for IM injections
drug not easily absorbed orally
when an intermediate rate of onset and duration is preffered
when parenteral delivery is necessary
contraindication for IM injections
site of dermatitis or cellulitis
what needle gauge and length range is used for IM injections
19-22 gauge; 1and 1/2 inch
susceptible to change with drug viscosity and depth of insertion.
what are the IM sites
gluteal, deltoid, and vastus lateralis.
note: with gluteus maximus choose the needle size based on pt’s deposits of fat because if the needle is too short the injection will be made into the fat instead of the msucle
Describe where an IM injection goes in the deltoid
lateral side, 3-4cm below acromion
this is 3 finger breadths below acromion
What are parameters for IM injection sites. (when are they preferred and why)
- use with <2cc of solution
- only NON irritating solutions
- more used in adults than infants
- easy access
- rapid absoprtion
Describe where an IM injection goes in the vastus lateralis
lateral thigh, not really sure how to describe this but heres a picture.
the slide says “antero-lateral;upper” for the injection site but this pic just shows laterally so im not sure tbh
What are parameters for IM injection sites. (when are they preferred and why)
- preferred in infants over adults but can be used in adults
- preferred for kids < 3 yrs because this is the largest muscle in this age
-volume .5-2.0 cc - not a lot of nerves and vessels here
why is the vastus lateralis IM injection painful
you have to go through the fascia lata
Describe where an IM injection goes in the gluteus maximus
use upper/outer quadrant of buttock (avoid sciatic and superior gluteal mucles)
What are parameters for IM injection sites. (when are they preferred and why)
-common and preferred for >2 years of age
-used for larger volumes of medications
-skin is thin and easy to pierce.
what three main things should be taken into account when determining where to give an IM injection
- patient age (vastus lateralis preferred in infants/small children, gluteus preferred in >2 years
- patient body mass
- amount of medication given (deltoid if <2 cc, gluteus maximus can take larger volumes)
Describe the steps to giving an IM injections
this is so much lmao , just get the general idea
- identify patient
- wash hands and put on gloves
- select a 2-5 ml syringe with an 18-22gauge needle 1-2 inches in length
- using aseptic technique withdraw appropriate amount of medication from vial or ampule
- select and expose injection site
- prep with alcohol wipe (start at site and circle out)
- with thumb and index finger of non dominant hand, press down and stretch skin at injection site.
- hold syringe like a dart at 90 degree angle
- insert needle straight into skin (quick firm motion)
- check for blood return (dont wanna inject into vein)
- slowly push plunger in until syringe is empty
- remove needle quickly, apply pressure, bandage, record time date and dose of injection site.
compilcations of IM injection
Injection into a vessel (can cause toxic rxn, vessel injury, hematoma.
Injection into a nerve (can cause pain, paraesthesia, nerve damage)
needle breaking off into muscle
sterile or septic abscesses
compilcations of IM injection
Injection into a vessel (can cause toxic rxn, vessel injury, hematoma.
Injection into a nerve (can cause pain, paraesthesia, nerve damage)
needle breaking off into muscle
sterile or septic abscesses
where in the skin is SC injections given
into adispose tissue beneath skin
where in the skin is SC injections given
into adispose tissue beneath skin
indiactions for SC Injections
when you want slower absoprtion of medication and longer duration of action
contraindications of SC injections
Dermatitis or cellulitits
site for SC injections
upper outer arm, anterior surface of thigh, lower portion of abdomen, upper portion of back
sites can be rotated when injections are given frequently. SC injections can be used for both short and long term injections
max amount of medication forSC injection and what size needle range
max is 2ml
needles are 5/8-1 inch long and 23-25 for adults, 25-27g for infants
common meds for SC
heparin and insulin
instructions for SC injection
this is also alot, just get general idea.
-Identify patient
-Wash hands & put on gloves
-Select 2-3 ml syringe & 24 to 26 g. needle that is 3/8 to 1 inch long depending on amount of sub-q fat
-Select & expose injection site
-Prep with alcohol wipe (start at site circling out) & allow to dry
-Using aseptic technique, withdraw appropriate amount of medication from vial or ampule
-With non-dominant hand pinch subcutaneous tissue into roll between thumb & forefinger
-Insert needle in one quick motion w/bevel up at 45 degrees to skin - at midpoint of roll
-Advance needle to about 3/4 of total length
-Release roll of skin
-Aspirate to ensure that needle is not in vessel
-If blood appears, withdraw needle, prepare new syringe & repeat procedure
-Inject slowly
-Withdraw needle gently but quickly at same angle
-Cover site with gauze pad & gently massage site to distribute med; bandage
-Dispose of needle & syringe in proper receptacle - NEVER RECAP NEEDLES
-Record med given (including lot # & expiration date); where, how (specific injection method), and when it was given; and by whom
what is the general site for intradermal injections
ventral surface of forearm beneath the epidermis
(exceptions include the rabies vaccine which is given in deltoid area, and skin allergy testing which can be done on the back.)
this has little systemic absorption with only local effects
max volume to be given ID
1 ml/cc of solution
indications for ID injections
testing for hypersensitivity
extrinsic allergens
injection for TB sensitivity
contraindications for ID injections
dermatitis
cellulitis
previous positive TB skin reaction becasue there is no retest necessary
ID injection equiptment needed
alcohol wipes
tuberculin syringe
27g 1/2 inch needle
Danger of ID injections
severe local skin reactions in hypersensitive persons
instructions for TB ID injection
this is different than a normal ID injection
-Angle syringe along the long axis of arm (parallel)
-Inject with bevel facing up
-Entire bevel penetrates skin
-Raise a ‘‘bleb’’ with injectate solution under skin for a small amount
instructions for SC injection
this is also alot, just get general idea.
-Prepare skin with alcohol & let skin dry
-Fill syringe with desired solution amount (0.1cc maximum)
-Hold skin taut between thumb & index finger
-Hold needle bevel up & almost parallel to skin
-Insert needle into dermis for 2/3 of length
-Inject slowly (see wheal or bleb form)
-Withdraw needle.
-Discard needle appropriately.
-Record type of injection, date, time, site(s)
All the parameters for gauges, lengths of needles and amounts used for each type of injection are so wonky, just be aware that the slidews are very inconsitent. the last slide says this (flip card)
Subcutaneous
⅝ “ needle
25 gauge
(max amount: up to 1cc)
Intramuscular
1 ¼ - 1 ½ needle
22 gauge
(max amount: up to 3cc)
Intradermal
⅜ -⅝ ‘’ needle
26 -27 gauges
(amounts: tenths of a cc)
