module 3- (subcutaneous injetions/subcutaneous butterfly/intradermal) Flashcards
subcutaneous injections involve=
depositing medications into the loose connective tissue underlying the dermis
there are less blood vessels in subq than in muscles, so..
the medications are absorbed more slowly than with IM injections
what increases the rate of drug absorption?
-physical exercise or application of hot or cold compresses
any conditions that _________ is a contraindication for subcutan injections
impairs blood flow
doses for subcutaneous?
small doses of less than 2ml
describe the solutions of subq
isotonic, irritating, non-viscous, watersoluble
infants and children amount?
0.5ml one site
examples of subq injections?
epinephrine, insulin, allergy medications, opioids
best subq sites?
outer aspect of upper arm, abdomen from below costal margins to iliac crests, anterior aspects of the thighs
key aspects for a good subq site?
- large enough to allow rotating multiple injections within each anatomic location
- easy accessible
injection site should be:
free of skin lesions, bony prominences, and large underlying muscles or nerves
what affects the depth of subq layer?
patients weight and amt of adipose tissue
what effects the needle length and angle of needle insertion?
the patients weight and estimate of subq tissue
generally, what is the needle size and angle?
25 gauge 5/8 inch needle at 45 degree OR
1/2 inch needle at 90 degree
for normal patient
if patient is obese what do you do for needle/insertion of subq?
-pinch the tissue and use a needle long enough to insert through the fatty tissue at the base of the skinfold
sometimes thin patients have insufficient tissue for injections, so where is the best site?
upper abdomen
special considerations: administration of insulin
- type 1 diabetes managed with injections
- not necessary to rotate anatomic site, one area is chosen and systematically rotated within that region
where is insulin most quickly absorbed?
abdomen
where is insulin slowest absorbed?
thighs
timing of injections is critical to insulin admin, what is it?
based on blood glucose levels and when a pt will eat
-must know peak and duration of insulin for effective diabetes plan
special considerations: administration of heprain
- therapeutic anticoagulation to reduce risk of thrombus formation
- thus, patients are at risk for bleeding
- before admin assess for pre-existing conditions that contraindicate its use (cerebral aneurysm, CV hemmorrhage, hypertension)
- assess meds that interact with heparin
- administer heparin subq or IV
where is lowmolec heparin given?
to minimize pain and bruising, given subq on right or left side of abdomen at least 5cm from umbillicus
-do not expel the air bubble in syringe before giving the med
how can you decrease patients perception of pain?
applying ice to site for 1 min
administering subq injection steps?
- clean site with antiseptic swab (centre and rotate outward in circular direction for 5cm)
- remove cap
- hold skin across injection site or pinch skin with nondominant hand
- inject needle firmly at 45 or 90 degree, release skin if pinched
- after needle enters: grasp lower end of syringe barrel with non-dominant hand to stabilize it and move dominant hand to end of plunger and slowly inject med over several seconds
- apply pressure for several seconds
indications for subq butterfly?
- circumstances that preclude or compromise oral admin
- pain or symptom crisis
- poor or variable compliance (dementia, delirium, agitated)
benefits of subq butterfly?
- avoids multiple injections
- avoids turning and repositioning patient
- allows better rest during night
- absorbs effectively
- simple and inexpensive
- if pts at home, family can be taught to give via butterfly
how much extra med is taken when admin of subq saf t intima?
0.4 ml of med more is taken to prime the saf-t-intima tubing and needless connecter
possible complications of subq
- skin irritation
- infection
- pain at site
- bleeding, bruising, swelling
change a butterfly..
weekly at least and at first site of inflammation, erythema, leakage, bruising or swelling
what are intradermal injections typically given for?
-skin testing (eg TB or allergy tests)
because meds of intradermal are potent, they are injected into dermis where…
blood supply is reduced, drug absorption occurs slowly
what could happen if intradermal meds enter circulation too fast?
-anaphylactic reaction
ideal locations for intradermal?
inner forearm (lower mid arm) and upper back
what needle/syringe for intradermal?
tuberculin or small syringe with a short (3/8 to 5/8 inch fine gauge (25-27) needle
angle of insertion for intradermal?
5 to 15 degrees
amount of medication injected for intradermal?
small! 0.01-0.1ml
why is bleb important for intradermal?
if bleb does not appear or if site bleeds after needle withdrawal, med may have entered subq tissue
what do you tell pt when giving intradermal injection?
may cause slight burning or sting
where is the ideal spot exactly for intradermal?
three to four finger widths below antecubital space and one hand width above wrist
administration of intradermal med?
- with nondominant hand stretch skin over site with forefinger or thumb
- with needle almost against patients skin, insert slowly at 5-15 degree angle until resistance is felt
- advance needle through to epidermis approx 3mm below skin surface (you will see bulge of needle tip through skin)
- insert med slowly, note resistance
- note the bleb (approx 6mm)
- after withdrawing needle, apply alcohol swab or gauze gently over site
evaluation of intradermal?
return to room in 15-30 mins ask about acute pain, burning, numbness, tingling
when do you read the TB test site?
48 to 72 hours
-look for induration (hard, dense, raised area) of skin around injection site
patients with no known risk for TB?
15 mm or more
recent immigrants, injection drug users, residents and employees of high risk settings?
10mm or more
HIV positive, fibrotic changes on chest x-ray or immunosuppresed?
5 mm or more
what size needle for a saf-t intima subq?
24 gauge 19 mm
max intradermal amount?
-0.1 ml
most critical potential situation from a nurse administering a injection?
anaphylactic reaction which is seen through wheezing, SOB, flushing, nausea or dizziness
in selecting an appropriate site for subq the nurse must consider?
- patients age (elderly and pediatric specifically!)
- condition of skin
- location of bony prominences
implementation of administering a subq butterfly?
- rotate white safety device 360 degrees, ensure bevel is up
- pinch yellow wings together with dominant hand (textured side down!), pinching skin with non-dominant hand and insert needle at 30-45 degree angle
- securing wings with nondominant hand, pull back on white safety shield to remove needle
- apply transparent dressing
- attach needless syringe and deliver prime (0.4ml) and med if required
