Lesson 2: Injections, Venipuncture, IV Insertion, ABG Flashcards
Parenteral?
The administration of medical therapy is in a manner not involving GI or alimentary tract.
Can be intradermal, subcutaneous, intramuscular, or IV.
Indications for injections?
Therapeutic treatment/Maintenance (giving medications). Disease Prevention (immunizations). Diagnosis of medical conditions (allergen response, tuberculosis).
Contraindications to injections?
Allergies to any component of injected substance.
Coagulopathy (especially for IM injections).
Pregnancy (should not have live virus vaccines such as MMR, varicella).
Active infection at the site.
Potential Complications of Injections?
Pain, burning, and erythema at the injection site.
Infection.
Lipodystrophy: atrophy of subcutaneous fat.
Allergic reaction.
How to Avoid Potential Complications?
To Decrease Pain:
Have patient relax arm/muscle.
Allow antiseptic to dry completely.
Gentle massage the area after injection.
Decrease infection risk:
Proper aseptic technique
Decrease lipodystrophy
Rotate injection site
Intradermal Site?
ventral forearm, approx. 10cm from the antecubital fossa.
Subcutaneous Site?
adipose regions of the lower abdomen, anterior or posterior thigh, upper buttocks, lateral lower back, and lateral upper extremities.
Intramuscular site?
deltoid, ventro-gluteal, vastus lateralis.
Rights of Medication Administration?
- Right patient (name, DOB, MRN)
- Right drug
- Right dose
- Right time (hour during day and expiration date*)
- Right route (med comes in injectable form)
- Right site (look for active infection at site)
- Right documentation ( if vaccine, must hand patient a Vaccine Information Statement (VIS)
What not to forget to say?
Introduce yourselves.
Explain procedure – Do not say “it will not hurt”, instead say “small pinch”.
Ask if patient gives consent.
Any allergies to meds – allergic to latex?
Any bleeding disorders or taking any blood thinning meds?
IM Needle?
At least 1 inch length, usually 18-22 gauge.
The larger the gauge the smaller the diameter.
How to draw fluid from vial?
Inject air into vial (amount of air similar to amount going to withdraw).
Inject air above the fluid surface line, withdraw meds below the fluid surface line.
What to do after injection?
“you may feel a little sore”, - If IM
“be sure to return in 48-72 hours” ppd read
Return/call office if any concerns for infection or other concerns.
Indications for venipuncture?
To obtain a venous blood sample.
Contraindications for venipuncture?
Site has active infection, scarring, hematoma.
Ipsilateral side of mastectomy.
Arm with IV in place.
Complications of venipuncture?
Hematoma/hemorrhage. Local skin infection (cellulitis), infection of vein (phlebitis). Thrombosis. Laceration of the vein. Vasovagal episode.
Best vein for venipuncture and why is it the best?
Median cubital vein.
Easily palpated. Well anchored. Least painful. Least likely to bruise. Usually largest vein in antecubital space.
Tips for venipuncture?
Prepare all the materials needed!
Double check test ordered/test tubes.
Look over patient anatomy (before tourniquet) .
Don’t rely only on vision – find good vein (doesn’t roll)
Can’t find vein? Warm washcloth, BP cuff, tap or rub area – gently.
Apply tourniquet 3-4 inches above intended site.
Do not leave tourniquet on for > 2 minutes!
Venipuncture procedure?
Site Preparation: 2-3 alcohol pads, circular motion, start inside then outwards.
Allow to dry since alcohol lyses blood and causes pain!
Use opposite hand to traction vein.
Insert BEVEL UP at 15-30 degree angle, and lower when skin punctured.
Can use vacutainers/or syringe to draw blood.
Fill tubes – keeping needle steady (invert tube gently after each).
Release tourniquet before removing needle*, have gauze ready to hold over puncture site. Apply pressure/or tell patient to apply pressure at least 3-4 minutes.
Venipuncture after procedure?
Throw away your needles in sharps container. MUST DO.
Label tubes.
Properly dispose of contaminated materials in biohazardous waste containers.
Make sure patient feeling ok.
Remove gloves, wash hands.
Return to office if….
