IV & Injections Flashcards
What is the anatomy of a syringe?
plunger barrel HUB needle bevel
Venipuncture site selection
Attach tourniquet 3-5in above the site
If using a pressure cuff inflate to 40mmHg
Avoid drawing on the same side as a mastectomy or edema
Avoid drawing above an IV site or at least 5” below it
Avoid drawing on an arm with a cannula, fistula, or vascular graft
Avoid an obvious hematoma
Venipuncture equipment– vacutainer
Uses vacuum to withdraw blood
Low cost / fast
Can’t see flashback and not good for small veins
No transfer needed to lab tube ↓ risk of self stick
Venipuncture equipment– syringe
Can control amount of pressure
Higher cost / slower
Can see flashback & better for small veins
Transfer to lab tube ↑ risk of self stick
Needle Size for venipuncture
19g – largest used mainly for large volume draws
21g – moderate amount to draw from AC space
22g – most frequently used with vacutainer/ 1-3 tubes to draw/ AC space
23g – most versatile
25g – small veins
Site preparation for venipuncture
Clean site with 70% isopropyl alcohol
Betadine is alternative
Allow to air dry!!!
Types of intradermal injections
TB PPD testing Intradermal anesthesia Cosmetic procedures Allergy testing Vaccine Sentinel node biopsies
What is the equipment for intradermal injections
Needle: 24-30g; ½ inch length
Syringe: 1cc small amounts
Alcohol
Gauze
Risk and benefits for intradermal injections
Benefits= Procedure Risks Hematoma Infection Reaction to med/product
How do you perform an intradermal injections
Angle syringe along long axis of arm (parallel) Inject with bevel facing up Entire bevel penetrates skin Raise a “bleb” with injectate solution under skin
Tip to novices: bend needle at 35-40 degree angle- Keeps needle in skin
SubQ Injections
For drugs requiring slow absorption and long duration of action
Insulin
Hormones
Vaccines
Risks: dermatitis or cellulitis
Equipment used for subcutaneous injections
Syringe: size depends on use
23-25 gauge needle in adults/older children; 25 or 27g in infants
5/8 to 3/4 inch length sufficient; 1 inch optional length
In adults and older children subcutaneous injections are put where?
Deltoid
Upper outer thighs
Abdomen
in infants where is the subQ injection inserted?
thigh
SC procedure (12)
Select & expose injection site
Prep with alcohol wipe
Fill syringe (2-3 cc usually)
Pinch up subcutaneous tissue into roll between thumb and forefinger
Insert needle with one quick motion at 45 degrees to skin
Advance needle to about 3/4 of total length
Release the roll of skin
Aspirate to ensure that the needle is not in vessel
If Blood appears remove and pick new site
Inject slowly
Withdraw needle
Apply pressure, and bandage
Indications for IM injections
Drugs not easily absorbed orally
Intermediate rate of onset and duration of action preferred
When parenteral delivery necessary
What type of medications need to be IM
Antibiotics
Narcotics/ Pain meds
Hormones
Vaccines
IM sites for adults
Thighs Anterior
Buttocks
Deltoid
IM sites for children
Buttocks
Deltoid
Complications of IM injections
Injection into a vessel
Injection into a nerve
Needle breaking off (into muscle)
Sterile or septic abscesses
IM injection equipment
Alcohol wipes Syringe (depends of volume to be injected) Needle size depends on depth of insertion size depends on drug viscosity Substance to be injected Sterile gauze sponge Dressing (bandage)
IM procedure
Select & expose injection site (thigh, buttocks, deltoid)
Prep with alcohol wipe
Hold syringe like a dart at 90 degree angle to site
Hold muscle firmly with other hand at site
Insert needle straight into the skin quick, firm motion
Hold the barrel with weak hand
Pull plunger back a bit to check for blood return
If blood is encountered, withdraw needle - replace needle - try new site
Slowly push down plunger until syringe is empty
Remove needle quickly
Apply gentle pressure to site with alcohol wipe or cotton ball
Purpose for venous cathterization
Fluid replacement
Delivery of medications
Blood sampling
Site selection for venous catheterization
Largest vein in area where movement around joint will not be hampered
Consider purpose: if drug to be infused don’t use small vein in hand = phlebitis
Consider length of time catheter to be in place
necessary items to start an IV infusion
betadine and alcohol sponges Tourniquet gloves two IV catheter devices tape sterile dressing
Complications for venous cath
Infiltration
Phlebitis
Infection
