module 3 (part A- parenteral meds) Flashcards
parenteral=
administered in a manner than is not through the digestive tract
- enter body tissues and circulatory system by injection
- more quickly absorbed than oral
- invasive, pose greater risk
what kind of technique for parenteral meds?
aseptic technique!
when is parenteral used?
faster (emergencies), when pts are vomiting, cannot swallow, and/or restricted from fluids
four routes of parenteral?
subcutaneous
intramuscular
intradermal
intravenous
subcutaneous injection is into..
tissue under dermis of the skin
intramuscular is into
the muscle
intradermal is into
the dermis just under epidermis
intravenous is into
a vein
ethnicity, genetics, and culture influence:
drug response, pharmacokinetics, pharmacodynamics, and patient adherence and education
how do you prevent contamination of solution?
ampules should not sit open, meds should be removed quickly
how do you prevent needle contamination?
avoid letting needle touch contaminated surface, avoid touching the length of the plunger or inner part of barrel
prepare skin of person to avoid infection when giving injection by?
- washing skin soiled with dirt, drainage, or feces with soap and water
- swab from centre of site and move outward in a 5 cm radius
how can you minimize a patients discomfort when giving an injection (many thiiings!)
- use sharp, beveled needles in the shortest length and smallest gauge
- change needle if liquid med coats its shaft
- position and flex patients limbs to reduce muscular tension
- divert pts attention away from injection
- apply vapocoolant spray or topical anesthetic
- insert needle at proper angle
- inject med slow but smooth
- gently apply antiseptic pad to site
- apply gentle pressure
- rotate injection sites to prevent formation of indurations and abscesses
recommendations for prevention of needlestick injuries?
avoid using needles when effective needleless systems or SESIP devices avail
- immediately dospose of used needles
- maintain a sharps injury log
- report all needlestick injuries immediately
- attend education offerings regarding bloodborne pathogens
- do not recap needles after med admin
where is the most frequent route of exposure to bloodborne disease for HCWs?
needlestick injuries!
what is SESIP?
sharp with engineered sharps injury protection- device that is effective in preventing needlesticks
appropriate size, length, and gauge of needle is based on?
quantity and type of medication prescribed and body size of patient
infusion pumps ensure ?
a constant and accurate delivery of medication
types of syringes?
either Luer-Lok or non Leur-lok
leur lok syringe?
- needles or needleless devices that are twisted onto the tip and lock themselves in place
- prevent accidental removal of a needle from syringe
non-leur lok syringe?
needles or needleless devices that slip onto the tip
also known as leur slip
variety of syringe sizes?
0.5-60ml syringes, use smallest size possible
Needles?
- some come attached to syringes, others packed individually
- disposable, made of stainless steel
three parts of a needle?
- hub (fits onto top of syringe)
- shaft (connects to the hub)
- bevel or slanted tip
never use filtered needles when?
administering a med!! it is big
tip of needle or bevel is always
slanted
most needles vary in length from
3/8 to 3 inches
smaller the needle gauge?
larger the needle diameter
needles are color coded for
ease of selection!
longer needles for?
IM injections
ampules contain?
single doses of injectable medication in liquid form
- 1 to 10ml or more
- made of glass with a neck that is snapped off to access med
what needle is used with ampules?
filter needles to prevent glass particles from being drawn up into the syringe
a vial is?
a single- or multi dose plastic or glass container with a rubber seal at the top
- after u open a single dose you must discard it regardless of amt used
- if a multi dose write the date it is opened on it
how do you prepare a ampule (steps)?
- tap top of ampule lightly until fluid moves from neck
- place small quaze around neck and snap
- draw up med quickly with filter needle long enough to reach the bottom of ampule
- hold ampule upside down or set it on flat surface
- to expel excess air bubble, remove needle from ampule, hold syringe with needle pointing up and tap side of syringe
- use sink for disposal if excess fluid in syringe
- replace filter needle with regular sharps
how do you prepare vial containing a solution?
- remove cap covering top
- alcohol swab surface of rubber seal, allow to dry
- remove needle cap on syringe, pull back on plunger to draw amount of air into syringe equivalent to volume of med to be aspirated
- vial flat on surface, insert tip of needle through center of rubber seal
- inject air into air space of vial
- invert vial, keep tip of needle below fluid level
- allow air pressure from vial to syringe gradually with med
- when you obtain desired volume, position nedle into air space of vial, tap side of syringe gently, eject any air remaining at top into vial
- remove needle
- hold syringe eye level 90 degree angle to ensure correct volume and no air bubbles
- if needed change needle to appropriate gauge and length
mixing parenteral meds in one syringe?
some meds need to be mixed from two vials or a vial and a ampule
- avoids need to give more than one injection
- do not contaminate contents of vial with med from another vial or ampule
when you mix meds from vial and ampule, which do you prep first?
-prep meds from vial first, then withdraw med from ampule using same syringe and a filter needle
reasons to give a med by parenteral?
-client is vomiting, client cannot swallow
important safety guidelines for prepping any meds?
-avoid distractions, verify medication not expired, strict aseptic techniques, educate client about med and side effects
what step helps to minimize clients discomfort when giving an injection?
-inject med slow and smoothly
do you use sharp beveled needles with the smallest length and smallest gauge?
yes! when you can always the smallest size
what gauge is smallest?
the largest number is actually the smallest diameter for gauges! so 25 is smaller than 18
what needles should never be injected into a client?
blunt fill needle and filter needle
-both used for prepping the meds
can ampules be used for multi-dose meds?
no! only single dose.
vials can be used for multi dose for one client only!
what is the formulary LWMH for the prevention and treatment of VTE as of June 2019
enoxaparin!
-unrestricted, mainly used to treat/prevent VTE and also used in acute coronary syndrome
format of enoxaparin and dalteparin?
- multidose vials
- prefilled safety syringes
dosing of enoxaparin and dalteparin is based on?
bodyweight and renal function
dalteparin is restricted to?
- cancer associated thrombosis
- trauma
- acute spinal cord injury
- clotting in hemodialysis or renal extracorporeal systems
enoxaparin dosage is in…
MILLIGRAMS
whereas dalteparin is UNITS
