MP & S - Injections & IV's Flashcards
How hight above site should you attach tourniquet?
3-5in above
What site section should you Avoid drawing blood from?
- Same side as a Masectomy or edema
- Above an IV site or at least 5in below it
- On an arm w/ cannula, fistula, or vascular graft, or hematoma
About vacutainer?
- Uses vacuum to withdraw blood
- Low cost / fast
- Can’t see flashback, not good for small veins
- No transfer needed to lab, ↓ risk of self stick
About syringe?
- Can control amount of pressure
- Higher cost / slower
- Can see flashback & better for small veins
- Transfer to lab, ↑ risk of self stick
Needle sizes?
Length & diameter
• Diameter = gauge = ># = smaller diameter
• 19g – largest-mainly for large volume draws
• 21g – moderate amnt-draw from AC space
• 22g – most frequently used with vacutainer/ 1-3 tubes to draw/ AC space
• 23g – most versatile
• 25g – small veins
About Order of draw?
• Depends on types of tests ordered
o Blood culture → must use Betadine
o Na Citrate coagulation tubes
o Serum tubes, Additive tubes
About Site preparation?
- Clean site w/ 70% isopropyl alcohol
- Betadine is alternative
- Allow to air dry!!!
About Needle stick?
- Reapply tourniquet, Disinfect
- Position bevel up, Pull skin taut
- Enter skin at 15 degree angle
- Stabilize needle and insert tubes
- Untie tourniquet → as the last tube is filling - before withdrawing the needle
- Withdraw needle and apply gauze and pressure for 3 – 5 min (folding the arm up isn’t enough pressure)
Intradermal injection - Procedure?
- Entire bevel penetrates skin
- Raise a “bleb”
- Insert needle at 35-40 degrees
Intradermal injection - Purposes?
- PPD testing,
- Anesthesia
- Cosmetic,
- Allergy test
- Vaccine,
- Sentinal node biopsy
Intradermal injection - Equipment Sites?
- 24-30 gauge,
- ½ inch length
- 1cc small amounts (syringe)
- Alcohol & gauze
Intradermal injection - RFs?
- ***Hematoma,
- Inf
- Hypersensitivity rxn
- Granulomatous rns
SQ injection procedure?
- Prep w/ EtOH,
- Pinch SC tissue,
- roll between thumb & forefinger.
- Insert needle at 45-degree angle,
- Extend ¾ total length
- Aspirate.
- If blood appears = remove!!
- Inject slow, w/draw, apply pressure & bandage
SQ injection - Purposes?
Drugs requiring
- Slow absorption + long duration of action
- i.e. Insulin, Hormones, Vaccines
SQ - Equipment Sites?
23-25 gauge = adults
25-27 = children
5/8 – ¾ inch length
Infants = thigh Adults = deltoid, upper outer thigh, abdomen
SQ - RFs?
Dermatitis
Cellulitis
IM - Procedure?
- Prep w/ EtOH,
- Hold like a dart @ 90-degree angle,
- Hold muscle firm,
- Insert needle quickly,
- Hold barrel w/ weak hand,
- Aspirate,
- Inject slow,
- W/draw,
- Gentle pressure
Gluteal:
- Use UOQ,
- Avoid sciatic
Deltoid:
- Avoid radial in kids
IM - Purposes?
- Drugs not absorbed well orally
- Intermediate rate of onset + duration preferred.
- When parental delivery necessary.
- Abx
- Narcotics
- Pain meds
- Hormones
IM - Equipment & Site?
- 19-22 gauge,
- 1 ½ inch - Long enough to pass SQ tissue.
- EtOH wipes
- Sterile gauze & dressing
- Size depends on muscle size, depth, viscosity, substance
Infants
- buttocks, deltoid
Adults
- ant thigh, butt, deltoid
IM - RFs?
Inject to a vessel:
- Toxic rxn, injury, hematoma
Inject to a nerve:
- Pain, parasthesia,
nerve damage
Needle can break off into muscle
Sterile/septic abscess
Venous Cath - Procedure?
Use largest vein in area where movement around joint wont be disrupted
Venous Cath - Purposes
- Fluid replacement,
- Delivers meds,
- Blood sampling
Consider length of time cath to be in place.
Venous Cath - Equipment / Sites
Size depends on purpose + vein:
- 18-20 gauge = small vn
- 12-18 gauge = lg veins
Smaller # = larger catheter
Need:
- Betadine,
- EtOH sponge,
- Tourniquet,
- Gloves,
- 2 IV caths,
- Tape,
- Sterile dress,
- IV solution,
- Tubing, pole
Venous Cath - RFs
Phlebitis = if use small vn in hand
Infiltration
Infection
Venous Cath - procedure part I?
Procedure Part I:
• Place extremity in dependent position
• Plan for mess
• Apply tourniquet to constrict venous return
• Prepare the equipment
• Prepare the site
• Enter skin and advance catheter until blood return seen – advance plastic sheath into vein – withdraw needle; release tourniquet
Venous Cath - procedure part II?
Procedure Part II:
• Connect the tubing to the catheter sheath
• Tape the tubing to the skin
• Cover the catheter with dressing (semipermeable dressing / Tegaderm)
