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3SP: Surgery/Injections > Injection Routes > Flashcards

Injection Routes Flashcards

1
Q

Routes of injections

A

IM
Periorbital
IV
Subconjunctival

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2
Q

Fastes absoprtion to slowest absorption

A

Intravenous > Inhalation > Intraperitoneal > Intramuscular > Subcutaneous > Oral > Topical

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3
Q

6 rights of medication administration

A
  1. The right patient
    -always confirm ID with full name and DOB
  2. The right DRUG
    – Always confirm correct drug, confirm name when you receive order, prep it, and before
    you administer it
  3. The right ROUTE
    – Always confirm the route in which you are to give the medicine
  4. The right TIME
    – Always confirm when the patient is to get the medicine (usually immediately in office)
  5. The right DOSE
    – Always confirm the dose matches what was ordered or if it is correct
  6. The right DOCUMENTATION
    – Always immediately and completely document all details in the medical record,
    including how the drug was tolerated
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4
Q

Steps to administer injections

A

• Wear gloves and prep skin
• Choose the appropriate needle
– Deeper the injection = Larger the gauge & longer the needle
• IM: 1-1½ inch 20-23 gauge
• SQ & Subconj: 1/2 ȯ 5/8 inch 25-27 gauge
• Aspirate
– Pull back on plunger prior to injection
– Ensure the needle is in the proper structure (i.e. muscle, vein, tissue)

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5
Q

Complications of injections

A 
– Severe pain
– Tingling or numbness
– Redness, warmth, swelling, or drainage
– Prolonged bleeding
– Allergic reaction
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6
Q

Uses of IM injections

A

deliver a medication deep into the muscle,

allowing it to absorb quickly into the bloodstream

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7
Q

When to use IM instead of IV

A

when some drugs irritate the veins, when veins cannot
be located, when oral medication can destroy the GI system, or when a faster
absorption rate is required

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8
Q

Administration of IM injections

A

Deltoid, vastus lateralis, ventrogluteal, dorsogluteal

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9
Q

Quantity of IM injection

A

– Deltoid & Thigh: <2mL
– Gluteal muscles: <5mL
– Infants: <0.5mL; Children <5: 1mL; Children >5: <2mL

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10
Q

Administration of IM injection into the deltoid

A
  • Feel for the acromion process (top of upper arm)
  • Two finger widths below the acromion process
  • Squeeze or pull down to create tension on the triangle (decrease pain upon injection
  • Give the injection within the triangle

Anaphylaxis and vaccines

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11
Q

Administration of vastus lateralis muscle of the thigh

A
  • Divide the upper thigh into three parts - locate the middle of the sections
  • Injection goes within the outer top portion

Anaphylaxis and medication

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12
Q

Administration of injection into the ventrogluteal muscle of the hip

A

• Safest for adults and children >7 months old (deep & far from major structures)
• Place heel of hand on the hip
– Fingers pointing upwards toward their head
• Thumb towards groin
• Pelvis under the pinky finger
• spread index and middle finger into a V
• Inject into the middle of the

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13
Q

Dorsogluteal muscle of the buttocks injection

A
  • Historically most common, though dangerous due to major structures
  • Do NOT use this for infants or children <3 years old (underdeveloped muscles)
  • Expose one side of the buttocks
  • Draw an imaginary line from the coccyx to the side of the body
  • Find the middle of the line and go up 3 inches • Draw another line down across the first (halfway down the buttock)
  • The upper-outer square has a curved bone
  • The injection goes below the curved bone
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14
Q

Optometric use of IM injections

A

Infections
-gonococcal=IM Rocephin

Muscular disturbances and migraines
-blepharospasm, hemifacial sopams, EOM disturbances

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15
Q

Periorbital injection

A

Injections into the periorbital area skin can be either intradermal (creates a wheal)
or subcutaneous (deeper into the dermis)
– Eyelid = ALWAYS intradermal
• The eyelid has little dermis
• The eyelid is the thinnest skin in the body

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16
Q

Eyelid injection is always

A

Intradermal

17
Q

Anatomy of eyelid and periorbital injection

A

– Tissue is very thin (4-5 cell layers thick)
– Uniform depth
– Takes 5-7 days to replicate
– Very little fat
• Less atrophy and resultant dimples – Potential space between epidermis and dermis
• Small amount of anesthetic for large space – Try to stay 2mm from the margin and 2mm from the brow if possible

18
Q

Malar mound s

A

AKA festoons

Droopy lower lids

19
Q

Supraorbital nerve block

A

• Palpate to find supraorbital foramen
– 2-3cm lateral to midline of face at inferior edge of supraorbital ridge
• Insert the needle laterally right above the eyebrow
– Bevel up***
– Aspirate to ensure location
– Inject ~1mL of anesthetic
• Place a finger below the superior orbital rim
– Prevents ballooning of anesthetic
• Gently massage
• Uses:
– Upper eyelid lacerations

20
Q

Infraorbital nerve block

A

Unconventional method
• Palpate to find infraorbital foramen
– 2-3cm lateral to midline of face at inferior edge of infraorbital ridge
• Place a finger over the foramen to ensure the needle
does not go into the canal
• Insert the needle laterally to the side of your finger
– Bevel up*** – Aspirate to ensure location – Inject ~1mL of anesthetic
• Gently massage
• Uses:
– Lower eyelid lacerations

21
Q

Lesion removal periorbital

A 
– Intradermal injection
• Mark lesion before injection to ensure original
borders 
• Insert the needle laterally at 5-10*
– Bevel up*** – Aspirate to ensure location – Inject ~1mL of anesthetic
• Gently massage
• Uses:
– Individual lesion removal
22
Q

Injecting while advancing the needle

A

IV injection with systemic side effects can happen

-inject only while withdrawing the needle

23
Q

Failure to wait for anesthetic or hemostatic effect

A

Inadequte anesthesia or hemostasis

Wait 4-5m after injection for medication to work

24
Q

Injecting directly into an infected areas

A

Inadequate anesthesia and potential spread of infection

Inject around the area and do NOT use epinephrine

25
Q

Injecting into a suspected cancerous lesion

A

Potential to spread cancer

Avoid injecting into suspected cancerous lesion

26
Q

Injecting too much anesthetic

A

Distorts tissue and borders

Use small volumes or a nerve block

27
Q

Optometric uses of periorbital injection

A 
– Lesion removal (periorbital)
– Laceration and suturing (periorbital)
– Various lid procedures
• Permanent punctal occlusion, epilation, entropion repair – Chalazion removal – Steroid injections – PPD testing
• Tuberculin testing
28
Q

IV injection

A

• An intravenous injection is used to deliver a
medication quickly into the bloodstream and is
the fastest method of drug absorption

29
Q

Venipuncture

A

sampling

blood or one time dose medication

30
Q

Venous cannulation

A

repeated sampling, IV

medication/fluid/blood/nutritional support

31
Q

Administration of IV

A

Dorsum of hand and antecubital fossa

32
Q

IV procedures are typically for

A

Diagnostic purposes

33
Q

IV administration

A

– Locate and clean site to be punctured
– Apply tourniquet (half up the extremity proximal to puncture)
• Tie to where you can undue with one hand – Anchor the vein by grabbing with nondominant hand a few inches distal to the vein
• Pull skin away from puncture location (stops rolling veins) – Using dominant hand advance needle into vein at 25* angle
• Bevel up*
• Aspirate to ensure location – Remove tourniquet – Inject medication – Apply cotton swab with nondominant hand and remove needle

34
Q

Optometric uses of IV

A

FA
Indocyanine green angiography
Tension testing

35
Q

Subconjunctival injections

A

Injections into the subconjunctiva allow for: – Increased penetration of water soluble drugs
• Allows drugs better absorption (antibiotics)
• Allows for drugs that need slow absorption (steroids) – Short term high concentration of medication to
anterior segment – A supplement to topical therapy – When topical medication cannot be used
frequently – Treatment in inflammation and infection

36
Q

Administration of subconjunctival injection

A

– Position patient lying comfortably
– Instill adequate anesthetic drops
• 5 minute intervals over 30 minutes (max 6 drops) – Draw medication with 21G needle/switch to 25G needle for
injection – Tenting method: With a toothed forceps tent the conjunctival,
separating it from the underlying sclera making a tent pocketȅ – Advance needle against globe, away from the cornea
• Bevel up*** • Inject slowly creating a ballooning effect
– Withdraw the needle slowly in the direction in which you
entered

37
Q

Optometric uses of subconjunctival injection

A

– Steroid injections
• Recurrent uveitis • Severe allergic conjunctivitis
– Antibiotic injections
• Smoldering infections – These are to be done only AFTER topical medication has failed or in conjunction, but never as a
first line treatment**

3SP: Surgery/Injections (10 decks)

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