Injections Flashcards
Injection
Administration of fluid in tissue or blood vessel
-the subcutaneous injection (delivered/administered into the fat layer of the skin):
small amounts of fluid (no more than 2ml). The fluid is slowly absorbed by the surrounding tissues or blood stream after administration. Sites: abdomen, the lateral side of the upper arm, and the front and lateral side of the thigh.
-the intramuscular injection (delivered/administered into the muscle): suitable for the administration of larger amounts of fluid (up to 5ml). The fluid is absorbed relatively quickly. Sites:
The buttocks (gluteus maximus or medius muscle), in the upper outer quadrant;
The thigh (vastus lateralis muscle), middle lateral side of the thigh;
The upper arm (deltoid muscle), lateral side upper arm (upper 1/3 part of the upper arm).Check before
Is the correct medication being administered in the correct dosage?
Has the expiration date not yet been passed?
Will it be given to the correct patient at the correct moment?
By which means (route of administration) must the medication be given?
no contra-indications:
coagulation disorders, allergies and inflammation, haematoma or scar tissue of the intended administration site. extremities containing dialysis shunts, iv cannulas or active thrombosis should be avoided. An axillary dissection in the medical history is a contra-indication for venipuncture on that side.
Preparation material
Preparation
Wash your hands.
Collect all materials needed.
Place everything ready on a clean surface.
Verify/check the packing of all materials:
Sealed?
Dry?
Date?
Materials:
Syringe (smallest possible syringe which fits the volume to be administered + 10%)
Filling needle (usually 0,8 x 40 mm)
Injection needle, depending on the injection technique to be used and the posture of the patient, usually:
subcutaneous 0,6 x 25 mm
intramuscular 0,8 x 40 mm
Vile or ampule containing the medication to be administered
Gauze pads
Disinfectant
Kidney dish
Sharps container
Bandage
Non-sterile gloves
Waste collecting container for glass
Tourniquet (for intravenous injection)
Preperation serynge
Open the syringe package and leave it in the packaging so that the connecting part to the needle (the tip) stays sterile.
Open the needle package, fold the flaps back. Be careful to keep the connecting part (the needle hub) sterile.
Connect the syringe and needle (Luer lock) by pushing and turning the syringe into the needle (one fourth of a turn is sufficient).
Turn the syringe and not the needle in order to avoid tightening the protective plastic sleeve/cartridge so that it later becomes difficult to remove afterwards.
Medication from ampule
heck the ampule.
Correct medication in correct dosage?
Expiration date?
Pay attention that all fluid in the ampule is located beneath the breakline (if not, tap against the top of the ampule a few times).
Hold the fingers of your non-dominant hand horizontally.
Put a gauze pad over your index finger.
Place the ampule in this hand, with the break line facing toward you (the break line is located just below the dot on the neck of the ampule).
Place a second gauze over the head of the ampule.
Place the thumb and index finger of your dominant hand horizontally on the head of the ampule (thumb at the dot).
Snap the head of the ampule off by carefully pushing away from you (do not squeeze!)
Throw away the gauze pad (glass in sharps container/appropriate disposable container for glass).
Place the ampule in your non-dominant hand and carefully insert the needle into the ampule (without allowing the outside of the ampule to come into contact with the needle)
Turn the ampule with the needle within upside down.
Draw up the fluid
Place the needle cover carefully back over the needle
Place the needle cover carefully back over the needle
Medication from vial
Check the vial.
Correct medication in correct dosage?
Expiration date?
Vial sealed? If not, when was it opened?
Remove the protective seal from the top of the vial.
Disinfect the rubber top (using a gauze pad with disinfectant) and let it dry
Draw air into the syringe (the same volume as the volume of medication that will be drawn up out of the vial)
Insert the needle into the rubber cap and push the air into the vial
Invert the vial by holding the vial in your non-dominant hand and the syringe in your dominant hand.
Draw up the needed amount of medication (+ 10%) out of the vial, paying attention that the needle stays beneath the fluid level
Turn the vial back, pull the needle out of the vial, and carefully place the needle cover back over the needle.
remove air bubble
Turn the vial back, pull the needle out of the vial, and carefully place the needle cover back over the needle.
Try forcefully tapping the syringe in order to move the air bubbles to the top.
Tip: draw up some extra air at the tip of the syringe, causing the air bubbles to free more easily
While doing this, secure the needle between the index finger and middle finger of your dominant hand, to insure that the needle does not detach.
Push the plunger up to expel air located at the top out of the syringe. Make sure to hold the syringe upright in order to avoid new air bubbles from forming.
Make sure that the medication is pushed up into the hub of the needle
Switch needle
Choose proper injection needle:
subcutaneous 0,6 x 25 mm
intramuscular 0,8 x 40 mm
Open the package of the injection needle , and place this on the table in the packaging, leaving the needle inside (make sure the hub remains sterile).
Twist the needle used to draw up the medication off of the needle and discard of this immediately in the sharps container
Place the injection needle onto the syringe with a pushing twisting movement
Subcutaneous
- Inform the patient about the procedure.
- Choose the most suitable place for injection (priority upper arm).
- Disinfect the area where you will administer the injection by wiping the skin once and waiting until the skin dries.
- Remove the needle cover from the needle and hold the needle and syringe diagonally downwards above a kidney basin (be careful not to allow the needle to touch the basin).
- Expel the air and surplus medication by carefully pushing the plunger to the correct volume indicated on the barrel of the syringe.
- Make sure that the needle remains sterile and dry by tapping against the syringe to remove any fluid drops hanging from the needle.
- Hold the syringe in your dominant hand.
- Grasp a fold of skin (avoid grasping the underlying muscle tissue as well) between the thumb and index/middle finger at the site where you want to administer the injection.
- Insert the needle at an angle of 30˚ at the base of the skin fold
- Release the fold of skin, and carefully manoeuvre the needle. If the needle cannot be moved easily, the tip (bevel) of the needle may be in too deep (in the muscle tissue), and should be pulled back slightly.
- non-dominant hand grasp the tip of the syringe between your thumb and index finger.
dominant hand pull the plunger back to check if the tip of the needle has not accidentally hit a blood vessel.
If syringe fill with blood: redo everything
-Push the plunger down with your dominant hand, speed of no more than 1 ml per 4 seconds
-Pull the needle entirely out of the skin and use a gauze pad to push down on injection site
-Dispose of the needle immediately in the sharps container
-Ask how the patient is doing and safely dispose of all materials
Intramuscular injection
- Inform the patient about the procedure.
-Choose the most suitable place for injection (priority upper quadrant buttocks)
-Disinfect the area where you will administer the injection by wiping the skin once, and waiting until the skin dries. - Remove the needle cover from the needle and hold the needle and syringe diagonally downwards above a kidney basin(be careful not to allow the needle to touch the basin)
- Expel the air and surplus medication by pushing the plunger to the correct volume indicated on the barrel of the syringe.
- Make sure that the needle remains sterile and dry by tapping against the syringe to remove any fluid drops hanging from the needle.
- Hold the syringe in your dominant hand.
- Pull the skin at the injection site tight between the thumb and index finger of your non-dominant hand.
- Tell the patient to relax.
- Insert the needle into the skin in one smooth motion at a 90˚ angle
- Hold the needle with your dominant hand, while using your non-dominant hand to pull back the plunger to make sure that the needle has not accidentally hit a blood vessel. If blood: restart everything
- Push the plunger down with your dominant hand in order to inject the medication at a speed of no more than 1 ml per 4 seconds.
Secure the syringe as much as possible to prevent unnecessary movements as these can be painful in an intramuscular injection - Pull the needle entirely out of the skin and use a gauze pad to apply pressure on injection site
- Dispose of the needle immediately in the sharps container
