Module 13: Administration of Medication via ID, SC, or IM Route Flashcards
IM Injections
- Intramuscular
- Patients with developed muscles can tolerate 3 mL
- 0.5 - 1 mL recommended for less developed muscle
Factors to consider for IM injections
- Body weight
- Amount of adipose tissue
- Type of solution
- Supplies
- Landmarking
- Comfort
Needles and Syringes for IM
Length – 1.3cm to 7.5cm
Gauge - 18G to 27G
Angle – 90 degrees
-Needles need to be long enough to penetrate past subcutaneous tissue, but short enough to not penetrate underlying blood vessels or bone
-Syringes need to be large enough for the solution but easy to manage
Proper Landmarking
Avoid sites with:
- Large blood vessels
- Nerves
- Bone
Common IM Locations
- Deltoid
- Ventrogluteal
- Vastus Lateralis
- Rectus Femoris
Ventrogluteal Site
Advantages: -Away from large nerves or blood vessels -Large developed muscle Landmarking: -Heel of hand over greater trochanter, thumb pointed to groin, index finger to anterior superior iliac spine, middle finger extended along iliac crest.
Vastus Lateralis Site
Advantages
- Site of choice in infants, toddlers, and children
- Anterolateral aspect of the thigh
Rectus Femoris Site
- Occaisonally used
- Self-admin
- More painful
Deltoid Site
- Small muscle
- Common for immunizations
- Max volume 1mL
- Use with caution
IM Contraindications
- Nodules
- Lumps
- Abscesses
- Tenderness
Technique Considerations
- Z-track
- Hold skin taut
- 1mL every 10 seconds
- Wait 10 seconds post
- Do not aspirate (as per policy & protocol)
- Remove within same track
- Gentle pressure, do not massage
- Discard in sharps container STAT
Reconstitution
Some drugs may be stored in a powder form because they become inactivated after a prolonged amount of time when mixed in a solution
Reconstitution- Diluent
- Sterile water, sodium chloride
- Check with Parenteral Drug Monograph or Medication Vial
- Must do 3 checks
Subcutaneous Butterfly Catheters
A device which provides access for subcutaneous medication administration and hypodermoclysis
Hypodermoclysis
- The subcutaneous infusion of fluid
- Limited IV access
- Palliative care patients (with caution)
- Mild dehydration
Subcutaneous Butterfly Catheters- Recommended Sites
- Abdomen (preferred)
- Upper arms
- Upper back (scapular area)
- Anterior thighs
- Anterior upper chest
Subcutaneous Butterfly Catheter- Safe Site Considerations
- Lesions
- Erythema
- Swelling
- Ecchymosis
- Inflammation
- Tissue Damage
Subcutaneous Butterfly Catheter-Preparing Medication
- Obtain correct medication
- Obtain syringe and blunt fill needle/ blunt filter needle and alcohol swabs
- Draw up correct amount of medication
Subcutaneous Butterfly Catheter-Technique Consideration
-For needless systems:
=>Additional medication is required to prime tubing and injection cap with FIRST dose
+>Note: Priming amount may change with different sets.
-Only insert subcutaneous butterflies when medication is needed (nurse discretion)
-Don gloves
-Cleanse skin and let dry
-Ensure bevel up and wing bubbles are toward the patient (squeezing wings locks the bevel)
-Insert SC 20-40 degree angle (or as per policy) ***
-Secure with transparent drsg (ie Tegaderm)
Subcutaneous Butterfly Catheter- Safety Considerations
- One medication per site
- Each site to be labeled with Medication, Concentration, Date
- Can remain in site up to 7 days
- Assess site EVERY shift
- Infusion bags good for 24 hours (continuous HDC)
- Sol’n admin sets good for 72 hrs (continuous HDC)
Subcutaneous Butterfly Catheter- Documentation
- Date & Time
- Discipline & -Focus
- Site of Insertion
- Gauge
- Primed with ?
- Tolerated ?
- Signature
Ampules
- Single doses of medication
- Open system
- Glass vial with colored ring to indicate weak spot
- Filter needle required to draw up medication
Vials
- Single dose or multidose container with rubber seal
- Contain liquids or powdered forms of medications
- Closed system, air must be injected into vial prior to withdrawal
Mixing medications from two vials
- Do not contaminate one medication with another
- Ensure final dose is accurate
- Maintain aseptic technique
Mixing from a vial and an ampule
- Prepare med from vial first
2. Use same filter needle to draw up med from ampule
Subcutaneous Injections
Administering medication into loose connective tissue under the dermis
- Is absorbed slower than IM as it is not as rich with blood vessels
- Is absorbed completely if circulatory status is normal
- May experience discomfort as tissue contains pain receptors
Subcutaneous Injection- Sites
- Back of arms (outer posterior aspect of upper arms)
- Abdomen, below costal margins to iliac crests
- Anterior aspects of thighs
Intradermal Injections
- Commonly performed for skin testing
- Medications are potent and administered into the dermis
- Blood supply is reduced so absorption is slower
Intradermal Injection- Sites
- Inner forearm
- Upper back
- Site must be lightly pigmented, free of lesions, relatively hairless
