Injections Flashcards
Hypodermic needles
(bevelled tip) - creates a slit
Blunt Fill Needles
- 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
Gauge
- diameter of the needle shaft
- The smaller the gauge number, the larger the diameter
- Lower gauge for thicker meds
Needle size for IM injections
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
Preparing Injections from a Vial (10)
- 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
Mixing Medications or Insulins in One Syringe (3 Principles)
- Do not contaminate one med with another (the vials)
- Ensure final dose is accurate
- Aseptic technique
INSULIN: Inject air into both vials before withdrawing either, and withdraw the clear before the cloudy
Intradermal Injections (ID)
For allergy testing, Mantoux (tuberculin/TB) skin test
*Do not massage
Subcutaneous Injections (subcut.)
For Insulin, LMWH (heparin), some immunization (MMR, Varicella, shingles)
Stomach is best for insulin and heparin. Make sure to rotate the sites.
Needle Size for ID Injections
Length: 1cm
Gauge: 26-27G
Needle Size for Subcutaneous Injections
Length: 5/8”
Gauge: 25G
Intramuscular Injections (IM) (4)
- 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
Sites for IM Injections
- ventrogluteal (preferred)
- vastus lateralis (newborns)
- Deltoid: immunizations adults (small volumes only, careful of nerves)
Angle of Insertion for IM
90 degrees
Angle of Insertion for ID
5-15 degrees (just into skin)
BEVEL UP
Angle of Insertion for subcut
45 or 90 degrees
Rate of injection for IM
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
Max. Vol. for IM injections (4)
- 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)
Max. Vol. for ID injections
0.01 - 0.1 mL
Sites for subcut. injections
Loose connective tissue under dermis
We want a slow absorption and fat has slower absorption than muscle
Sites for ID injections
-dermis (inner arm, upper back)
Z-Track Method (zig zag)
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
Differences in absorption between subcut. and IM injection
Subcut is slow as it moves through fat
IM is faster, moving through muscle
Ampule
Single-dose liquid medication
Vial
Single- or Multi-dose container with rubber seal (liquid or dry)
Insulin injection?
We inject it rather than ingest it, as our GI tract would digest it.
Vastus Lateralis site (IM)
- no major nerves or vessels
- fast drug absorption
Good for infants for immunizations
Ventrogluteal muscle site (IM)
PREFERRED SITE
- deep site
- no major nerves or vessels
- easily identified
- good for large volumes, viscous or irritating injections
Deltoid site (IM)
- 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
