Injections Flashcards
How are parenternal meds administered?
via injection
What are the 4 parts of a syringe?
- plunger
- Barrel
- Needle hub
- Needle
what is the sterility of the tip, shaft, and hub of the needle?
Sterile
Why do we use blunt fill-filter needles to draw up meds from amps when possible?
- because a larger gauge 18G, 1 1/2 length helps with thicker solutions
- prevents unnecessary blunting of injection needles
- filter glass out of medication
What info do we need to review in the PDM before preparing and administering an injection?
- drug class
- alternate names
- student nurse yes/no
- sub cut route?
- IM?
- dosage
- hazards
- stability
- compatibility
- contraindications
what does parenternal mean?
anything not enteral (not GI tract) ie: oral or GI
What part of the Syringe do we not touch? (keep sterile)
- needle hub/tip
- needle
what part of the syringe do we never touch anything with?
needle
what gauge do we never use in a patient but is used to draw up medication?
blunt fill needles (red) 18G
What needle sizes and gauges are appropriate for subcut?
25-29 G
1/2”-5/8” length
after drawing up medication and putting on the correct needle, what must we do?
Label the syringe!
what is the order of patient safety med checks?
- check 1 before getting medication
- prepare medication
- make label
- check 2
- gather supplies and head to patients’ room
- check 3 at bedside
subcut injection sites
- upper back
- back love handles
- abdomen * (heparin especially)
- back of arms
how far do you inject from the last site?
2-5 cm at least
how to give an injection
- clean skin with swab - center to outwards 15-30 sec
- grasp 2-5”
- go in at either 45 ° (2.5cm grasp) or 90° (5cm of tissue)
- sign mar
When mixing NPH insulin with a rapid/short acting insulin, which do you draw first?
- Draw Air into NPH syringe
- Draw Air into Rapid/short insulin
- Draw short insulin first
- With same syringe draw NPH
*rationalle - b/c there is clear insulin in NPH but not cloudy in clear so can’t put cloudy into clear vial
when do we look up drug monograph, prior to preparing the drug or after preparing it?
Prior - so that you don’t draw up the wrong things and waste medication
where do we give intradermal injections typically?
on the forearm area
What is a secondary place you can give intradermal injections typically?
on the back - scapula
Which way does the bevel go for intradermal injections?
The bevel (hole) should be pointing up
what angle should we go with a intradermal injection?
5-15 degrees
What muscles can we give IMs in?
Deltoid
Vastus lateralus
Ventro gluteal
How do we landmark the Deltoid?
- acromion process
- 3-4 finger widths down
- line up with axilla (armpit)
How do we landmark the Vastus lateralus?
- hand on the knee
- hand on the hip
- Just above IT area of the leg
Where is the most common muscle for an infant IM?
Vastus lateralus
What is the preferred site for an IM and why?
Ventro gluteal
1. holds meds the best
2. dense- and safe for all patients
3. most developed in people
4. least risk of hitting nerves
5. safe for people who are incontinent and nonambulatory too
6. Large volume
7. Viscous
8. irritating medications
How do we landmark the ventro gluteal?
- palm over the greater trochanter
- with IX feel for top of illiac spine
- third finger reach towards illiac crest
- Injection site is between your IX and 3rd finger
- place alcohol swab to keep landmark
what site do we not give IMs in anymore and why?
Dorsal gluteal
Because it’s too close to the sciatic nerve
What is Z tracking and why is it used?
When you displace tissue using the ulnar of your hand in the place you landmarked.
-pull skin tight to one side
- Give needle and then when you take it out, release the skin
- It helps seal in the medication so it can’t track up the needle path
- can also pull down - point is to tighten the skin/tissue
- less lesions
- less discomfort for the patient
What does it mean to aspirate when giving an IM?
If you get blood in the syringe then you’ve hit a vein. Wrong. start over
Why do we not aspirate when giving subcut?
- can damage tissue
- very low chance of hitting a vein
What angle do we give IMs?
90 °
What is the speed to inject IM?
1ml/10sec (is a bit too long but the point is inject slowly)
What are the 3 steps for performing reconstitution of IM meds? (mixing powder with sterile water)
- inject air into sterile water
- draw up sterile water
- inject sterile water into ampacilan powder vial
What site is used most often in Emergencies with IM?
Vastus lateralis
When is the Deltoid used most often and why?
Usually only vaccines (small amounts <2mL) because it’s not well developed in most patients
What is the risk of injury with Deltoid use?
-brachial artery
- radial/ulnar nerve
If med is > or = 3mL what muscles do we give IM into?
- Vatus lateralis
- Ventrogluteal
What is the most common IM injection?
vaccination
What’s the most important step to help prevent nerve and tissue damage (right route)?
proper injection site -use anatomical landmarks
