Injections

Question 1

Hypodermic needles

Answer 1

(bevelled tip) - creates a slit

Question 2

Blunt Fill Needles

Answer 2

• Used for drawing up medications from vials and ampules
• Filter in the blunt needle filters glass shards and keeps them from getting into the needle
• NOT used to give the injection, because of the presence of glass shards in the filter of the needle, and because of the blunt end
• Larger diameter will also be unnecessarily painful and leaves a hole

Question 3

Gauge

Answer 3

• diameter of the needle shaft
• The smaller the gauge number, the larger the diameter
• Lower gauge for thicker meds

Question 4

Needle size for IM injections

Answer 4

Adult

Length: 5/8” – 1” if <130lbs (1” - 1 1/2” depending on wt.)
Gauge: 22-25G

Infants & Children

Length: 7/8” – 1”
Gauge: 22-25G

Question 5

Preparing Injections from a Vial (10)

Answer 5

• Liquid or dry format
• Come with plastic cap and rubber stopper
• Closed system, so air needs to be injected into vial in order to more easily remove the solution
• If we don’t inject air first, a vacuum effect in the vial makes it too challenging to withdraw the liquid
• Inject same amount as air as liquid you want to withdraw
• Tap barrel to get rid of air bubbles
• Always clean the vial with alcohol swab
• Not necessary to use filter needle
• When reconstituting with powder, roll or swirl to try and avoid bubbles
• You can draw up or invert vial

Question 6

Mixing Medications or Insulins in One Syringe (3 Principles)

Answer 6

1. Do not contaminate one med with another (the vials)
2. Ensure final dose is accurate
3. Aseptic technique

INSULIN: Inject air into both vials before withdrawing either, and withdraw the clear before the cloudy

Question 7

Intradermal Injections (ID)

Answer 7

For allergy testing, Mantoux (tuberculin/TB) skin test

*Do not massage

Question 8

Subcutaneous Injections (subcut.)

Answer 8

For Insulin, LMWH (heparin), some immunization (MMR, Varicella, shingles)

Stomach is best for insulin and heparin. Make sure to rotate the sites.

Question 9

Needle Size for ID Injections

Answer 9

Length: 1cm
Gauge: 26-27G

Question 10

Needle Size for Subcutaneous Injections

Answer 10

Length: 5/8”
Gauge: 25G

Question 11

Intramuscular Injections (IM)
(4)

Answer 11

• Fast med absorption due to vascularity (10-30 min)
• Less risk of causing tissue damage in deep muscle
• Good for irritating medications as there are fewer nerve endings in deep muscle
• Influenza, pneumonia, HPV vaccines, other medications

Question 12

Sites for IM Injections

Answer 12

• ventrogluteal (preferred)
• vastus lateralis (newborns)
• Deltoid: immunizations adults (small volumes only, careful of nerves)

Question 13

Angle of Insertion for IM

Answer 13

90 degrees

Question 14

Angle of Insertion for ID

Answer 14

5-15 degrees (just into skin)

BEVEL UP

Question 15

Angle of Insertion for subcut

Answer 15

45 or 90 degrees

Question 16

Rate of injection for IM

Answer 16

1 ml every 10 secs for adults, a bit quicker for kids

This allows for the muscle fibers to expand and for the drug to absorb

Question 17

Max. Vol. for IM injections (4)

Answer 17

• Infants and small children: 1ml
• Children, older adults, thin clients: 2ml
• Well developed adults: 3ml (exception: deltoid max is 1 ml)

(Newborns and small infants: 0.5ml)

Question 18

Max. Vol. for ID injections

Answer 18

0.01 - 0.1 mL

Question 19

Sites for subcut. injections

Answer 19

Loose connective tissue under dermis

We want a slow absorption and fat has slower absorption than muscle

Question 20

Sites for ID injections

Answer 20

-dermis (inner arm, upper back)

Question 21

Z-Track Method (zig zag)

Answer 21

For IM injections

• Seals medication into muscle tissue, reduces pain, less leaking
• Good for highly irritating substances

Method: Hold skin taught, hold needle in place, withdraw needle, let skin go, creates a z-track path that seals it in

Question 22

Differences in absorption between subcut. and IM injection

Answer 22

Subcut is slow as it moves through fat

IM is faster, moving through muscle

Question 23

Ampule

Answer 23

Single-dose liquid medication

Question 24

Vial

Answer 24

Single- or Multi-dose container with rubber seal (liquid or dry)

Question 25

Insulin injection?

Answer 25

We inject it rather than ingest it, as our GI tract would digest it.

Question 26

Vastus Lateralis site (IM)

Answer 26

• no major nerves or vessels
• fast drug absorption

Good for infants for immunizations

Question 27

Ventrogluteal muscle site (IM)

Answer 27

PREFERRED SITE

• deep site
• no major nerves or vessels
• easily identified
• good for large volumes, viscous or irritating injections

Question 28

Deltoid site (IM)

Answer 28

• easily accessible
• good for small volumes (immunizations in toddlers, children, adults)

Disadvantages:

• NOT good for infants or children
• If the muscle is not well developed, there’s potential for injury to the brachial artery and radial/ulnar nerves