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Nursing 242 > INJECTION UNITS (Week 3-5 > Flashcards

INJECTION UNITS (Week 3-5 Flashcards

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1
Q

Mandatory IM site for infants?

A

Vastus lateralis (lateral aspect of anterior thigh)

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2
Q

IM’s used frequently in children?

A

No, insufficient muscle mass + painful

- But used in emerg

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3
Q

Site IM in older children?

A

Deltoid acceptable or ventrogluteal (like adults)

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4
Q

Why is gluteal site very hazardous in children under 1?

A

Muscle does not develop until able to walk, so poses great risk of permanent damage to sciatic nerve.

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5
Q

Ventrogluteal landmarking?

A

Place heel of hand on greater trochanter and index finger angled toward anterosuperior iliac crestm speading middle finger along the crest posteriorly. Angle between index and middle finger = site.

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6
Q

Should you administer an injection to a sleeping child/baby?

How to approach explaining procedure to a child?

A

No, always wake, play with or provide explanation.

Be honest about pain, describe that it won’t be much and will only last for a little bit (so knows has limitations)

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7
Q

Approach to giving injection in children?

A
  • Give topical anesthetic if wanted (30 mins prior)
  • Explain procedure: be brief, don’t give time for anticipation to worsen pain
  • If necessary, ask for help in restraining
  • Can say “ouch” as distraction technique
  • Always comfort + hold child after painful procedure (or have parent do it)
  • Record med & site of injection so can ensure rotation
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8
Q

Site for infusion pumps in children?

Common drugs given this way?

A

Abdomen (protects pump and allows it to be out of sight)

- Insulin, heparin, deferoxamine

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9
Q

Important consideration for children who are not yet toilet trained regarding infusion pumps?

A

Should not be used because risk contamination with urine + feces.

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10
Q

How often do infusion pump sites need to be changed?

A

At least every 1-2 days to prevent infection.

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11
Q

How early can children use their own autoinjection syringes?

A

age 5-6

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12
Q

Typical use of ID injections?

A

Skin testing: TB + allergy testing

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13
Q

Why are ID meds administered this way?

A

Potent medications so inject where blood supply is reduced (slow absorption occurs) → can experience anaphylactic rxn if entry bloodstream too quickly

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14
Q

Ensure skin is ______ prior to administering ID

A

free of lesions, injuries + relatively hairless

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15
Q

Typical ID sites?

A

Inner forearm 3-4 fingers below antecubital space, one hand above wrist)
+ upper back

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16
Q

ID:

  • What needle length?
  • Gauge?
  • Degree of insertion?
  • Max fluid amounts?
A
  • TB or small needle, 3/8 to 5/8in
  • 25-27 gauge (fine)
  • 5-15 degree angle
  • 0.01-0.1mL (only administer up to 0.1 for children)
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17
Q

How do you know if you have potentially entered subQ tissue when giving an ID?

A
  • Doesn’t form bleb

- Site bleeds when needle withdrawn

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18
Q

Should pt experience any discomfort at site after ID injection?

A

No

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19
Q

What should you see appear when giving an ID injection?

A

Small, light bleb approx 6mm, 1/4in will form

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20
Q

Technique for ID injection?

A
  • Stretch skin over site with nondominant hand
  • With needle almost against skin, insert slowly at 5-15 angle until resistance felt. Advance into epidermis approx 3mm (1/8in) → will see bulge of needle tip
  • Inject med slowly, normally will feel resistance (if not too deep, remove and try again)
  • See bleb form
  • Remove needle
  • Apply alcohol swab gentle over site
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21
Q

Results for TB testing:

  • When to evaluate?
  • What are you looking for in what populations?
A
  • Evaluated at 48-72 hours
  • Look for induration (hard, dense, raised area) around site of:
  • ->15mm or more in pt with no known risk factors for TB
  • ->10mm or more from pt who are recent immigrants, IV drug users, residents and employees of high risk settings, pt with certain chronic diseases, children less than 4 yrs, and infants, children, and adolescents exposed to high risk adults
  • -> 5mm or more in pt with HIV, have fibrotic changes or prior chest X-ray indicating previous TB infection, organ transplants, or immunosuppressed
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22
Q

What is the parental route of choice for chronic pain?

A

SubQ butterfly

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23
Q

Indications for SUBQ butterfly?

A
  • Circumstances that preclude or compromise oral admin
  • Pain or symptom crisis requiring rapid and reliable med admin and absorption
  • Poor or variable compliance (dementia, delirium, restless, agitated)
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24
Q

Benefits of SubQ butterfly?

A
  • Avoids multiple injections
  • Avoids turning + repositioning client
  • Allows better rest during the night
  • Absorbs effectively
  • Simple and inexpensive method of delivery which may be used in the hospital or home care setting
  • If client is at home, can teach family members to give by this route
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25
Q

Possible complications of subQ butterfly?

A
  • Skin irritation
  • Infection
  • Pain at the site
  • Bleeding, bruising, or swelling
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26
Q

When should a subQ butterfly be changed?

A
  • at least once a week + at first sign of inflammation, erythema, leakage, bruising or swelling.

(Palliative pts often kept in longer)

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27
Q

If breakthrough pain results fro poor absorption in subQ butterfly, what to do?

A

Often remedied by changing site

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28
Q

If the concentration of a med to be administered by subQ butterfly is changed, what must be done?

A

New site must be established

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29
Q

What additional med must be drawn in subQ butterfly to prime the IV connector?

Is this added each time med is given?

A
  • ONE LINK: add 0.28mL
  • No, ONLY with initial dose
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30
Q

Max volume for subQ butterfly in adults and adolescents?

A

Adult: 2mL
Adolescent: 1.5-2mL

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31
Q

Can more than one med be administered through the same catheter with subQ butterflies?

A

No, must use separate catheter because is already primed with one med.

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32
Q

What problem can occur when more than 1mL of med is administered via subQ butterfly frequently?

A

Can make site “boggy”, causing poor absorption and necessitating more frequent site changes

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33
Q

Preferred sites for subcut butterfly injections?

A
  • Abdomen (below costal margin, above iliac crests, away from waistline)
  • Posterior flank
  • Subclavicular
  • Anterior aspects of thigh
  • Upper arm
34
Q

Preferred site for subcut butterfly in children and elderly?

A

Subclavicular

  • b/c is less painful + less restricting of movement
  • insufficient subQ at other sites in elderly
35
Q

How do you choose a site for subcut butterfly?

A
  • Condition of skin (ability to grasp skin fold, no previous radiation to area, comfort, intact skin, free of infection, bruising + scar tissue)
  • Away from bony prominences + large underlying muscles + nerves
36
Q

According to VIHA, how many times should a subcut site be cleansed with alcohol swabs prior to injection?

A

3 times (5cm, circular motion moving outward)

37
Q

Bevel points ___ when injecting subcut butterfly?

A

Up

38
Q

Injection angle for subcut butterfly?

A

30 degrees

39
Q

How big of a skin roll should you make for subcut?

A

1.25-2.5cm.

40
Q

WHat info to include on label of dressing over subcut butterfly?

A
  • Date
  • Drug + drug [ ] used to prime
  • Initials
41
Q

Angle to inject IM?

A

90 degrees

42
Q

What factors influence needle size selection for IM?

A

Viscosity of med
Injection site
Patient’s weight
Amount of adipose tissue

43
Q

How to determine needle gauge for IM?

A

Based on viscosity of med

44
Q

Gauge (IM) to be used for:

1) Immunizations and meds in aqueous solutions:
2) Viscous/oil based med
3) Children

A

1) 20-25
2) 18-21
3) 22-25

45
Q

IM Needle Length for:

1) Thin person
2) Average weight/BMI
3) Pt over 70kg
4) Pt over 90kg

A

o Thin person = 5/8 to 1 inch
o Average = 1 inch
o Pt over 70kg = 1-1 ½ inch
o Pt over 90kg = 1 ½ inch

46
Q

IM NEEDLE length based on site?

1) Ventrogluteal
2) Vastus Lateralis
3) Deltoid

A

Ventrogluteal = 1 ½ inch
Vastus Lateralis = 5/8 to 1in
Deltoid 1- 1 ½ inch

47
Q

IM Needle length based on child’s age:

1) Infants
2) Toddlers
3) Older children
4) preterm or small infants
5) obese

A

1) Infants: 1inch
2) Toddlers: 1 – 1 ¼
3) Older children: 1 ½ to 2in
4) preterm or small infants: smaller needle
5) obese: up to 1.5 inch

48
Q

Recommended IM sites for children?

A

o Anterolateral thigh for up to 12 months
o Deltoid 18months +
o Ventrogluteal for children of all ages

49
Q

Fluid amounts for IM?

A

o 2-5mL safe in large muscles….typically never over 3mL in single injection, however, because does not absorb well
o Older adult + thin → 2mL
o Older infants + children → 1mL
- Older children with larger muscles up to 2mL

50
Q

Advantages of Z-track method?

A
  • prevents leakage of med into subQ
  • seals med in muscle
  • minimizes irritation
  • proven to be less painful
51
Q

Technique for Z-track method

A

o Pull overlying skin and subQ tissue approx 2.5cm to 3.5cm (1-1/2inch) laterally to side with ulnar side of nondominant hand

o Hold position while putting in med, release after withdrawing

o Keep inserted into skin for 10 sec to let med absorb

52
Q

Important to rotate IM sites?

A

Yes, to prevent hypertrophy

53
Q

Why to avoid emancipated or atrophied muscle for IM?

A

does not absorb well

54
Q

Do you aspirate with IM injections?

A

Yes, required for all but vaccines

55
Q

How to pick IM site?

A

free of pain, infection, necrosis, bruising, and abrasions; consider underlying bones, nerves, blood vessels, and volume of med

56
Q

Advantages of ventrogluteal site?

A
  • Deep + situated away from major nerves + blood vessels
  • Easily identified by bony landmarks
  • Preferred site for larger vol, more viscous, irritating
  • Recom for pediatric IM site for children of all ages
57
Q

Which site is preferred site for larger vol, more viscous, irritating meds?

A

Ventrogluteal?

58
Q

Vastus lateralis is preferred site for?

A 
o biotics (immunizations) to infants, toddlers + children 
& recommended for pediatrim IM site for infants up to 12 months
59
Q

Landmarking for vastus lateralis?

A

Extends on adult from handbreadth above knee to same before greater trochanter of femur - use middle third of muscle for injection

60
Q

Advantages of vastus lateralis?

A

o Absence of major blood vessels + nerves

o Rapid drub absorption

61
Q

How to have pt relax muscle to use vastus lateralis for IM?

A

have knee slightly flexed, foot externally rotated; or have sit

62
Q

Special considerations for deltoid site for IM?

A
  • Not well developed in many adults – can damage underlying nerves
  • Use only for SMALL AMOUNTS (2mL or less)
63
Q

How to landmark ventrogluteal site?

A
  • Have pt lie on supine or lateral position
  • Place heel of hand on greater trochanter, wrist almost perpendicular to femur
  • Use right hand for left hip or vice versa
  • Point thumb toward pt groin
  • Point index finger to anterior superior iliac spine
  • Extend middle finger back along iliac crest toward buttock
  • Sit is middle of v-shaped triangle formed by of index finger, middle finger + iliac crest.
64
Q

When deltoid is used for IM?

A
  • Routine for immunizations in toddlers, older children, and adults (but vastis lateralis preffered site for immunizations for infants, toddlers + children)
  • or if other sites inaccessible
65
Q

Landmarking for deltoid?

A

o Inject 3-5cm (3 finger widths) below acromion process

66
Q

Before choosing IM site, should palpate for?

A

tenderness + hardness

67
Q

Speed to inject IM meds?

A

10 sec/mL

68
Q

What to do immediately before and after injecting IM med?

A

Before: aspirate
After: wait 10 secounds

69
Q

Should you massage an IM site after admin?

A

No - just apply gentle pressure (massage can damage underlying tissue)

70
Q

When mixing meds from ampule + vial, which to draw from first?

A

Vial (then use filter needle to take from ampule)

71
Q

When preparing insulins, what to do with the med first?

A

Roll vial in hands to suspend med.

72
Q

Can you mix insulins?

Which to pull up first?

A

Yes, if compatible

- always prepare short or rapid-acting first to prevent contaminating it with long-acting

73
Q

Procedure for mixing meds from 2 vials?

A
  • Wipe tops of vials with alcohol swab
    1) Inject air into vial A
    2) Inject air into vial B
    3) Withdraw med from B
    4) Withdraw med from A
74
Q

Procedure for mixing short and intermediate/long acting insulins?

A
  • Aspirate air into intermediate/long acting first
  • Then into short acting
  • Draw up short acting
  • Draw up long acting
75
Q

How should a child be positioned during vaccination?

A 
NOT SUPINE (as results in more pain)
- sit upright or in arms of parent
76
Q

How to ease pain in infants under 12 months receiving vaccines?

A
  • have breastfeed if breastfeeding

- Otherwise administer sweet tasting solution

77
Q

Is the aspiration, slow injection technique used for children?

A

No, no aspiration + rapid injection technique used for children

78
Q

When administering multiple vaccinations to a child, should the most painful be administered first or last?

A

Last

79
Q

Technique for minimizing pain for children 4 and up during injection?

A

Offer to rub or stroke the skin near injection site with moderate intensity before + during vaccination

80
Q

Children ____ years and older can engage in slow, deep breathing or blowing during vaccination

A

3

Nursing 242 (6 decks)

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