OSCE: Injections Flashcards
Explain the importance of selecting the proper size syringe and needle for an IM injection.
Syringe Selection:
• Based on the volume of medication to be administered
• Usually, a 3ml or 5ml syringe will be used.
Needle Selection: Gauge
• Based on the viscosity of the medication.
• More viscous (thicker) medications require a larger bore needle. 23G needle will work for most IM medications.
• The larger gauge, the smaller the needle.
Needle Selection: Length
• Based on body habitus of the patient
• Larger patients require a longer needle to reach muscle tissue.
• 1-inch needle length will work for most IM injections.
• For larger patients, use 1.5-inch needle.
Explain the importance of selecting the proper size syringe and needle for an SC injection.
Syringe Selection:
• Based on volume of medication to be administered.
• Usually 1ml syringe will be used.
Needle Selection: Gauge
• Remember – the bigger the number, the smaller the needle
• 25G or smaller (25G-30G)
Needle Selection: Length
• Shorter needles are required for SC injections
• 5/8” or shorter
Explain the importance of selecting the proper size syringe and needle for an ID injection.
Syringe Selection:
• Usually 1ml syringe will be used.
• Often has pre-attached needle.
Needle Selection: Gauge
• Generally 27G or smaller.
• Often pre-attached to syringe (i.e. tuberculin syringe/needle combinations).
Needle Selection: Length
• 3/8” to 5/8”
• Often pre-attached, as noted earlier
Discuss factors to consider when selecting injection sites for IM injections.
Site selection is based on:
•Volume of medication to be administered (larger muscles
accommodate larger volumes). 2-5ml upper limit.
•Body habitus and mobility of the patient
•Patient’s age (children under 12 months: vastus lateralis, Adults and children over 12 months: deltoid/vastus lateralis).
•Co-morbidities (i.e. Avoid limbs with AV fistulas, limbs on the
affected side of mastectomy, and edematous or infected limbs).
•Previous sites. To reduce pain and complications, rotate the sites of injection regularly.
Discuss factors to consider when selecting injection sites for SC injections.
For SC injections Avoid areas with: • Skin lesions • Bony prominences • Large underlying muscles or nerves *If using the abdomen, inject at least two inches from the umbilicus
Discuss factors to consider when selecting injection sites for ID injections.
- Intradermal injections are commonly administered in the dorsal area of the forearm.
- They can also be administered on the upper chest and upper back
Discuss ways to prevent needle-stick injuries
1) Never recap a used needle
- Use the one-handed technique
2) Always use standard precautions
- Wash hands before & after the procedure
- Wear gloves when there’s a risk of coming into contact w/ blood or other bodily fluids
3) Always engage safety mechanisms on needles when available
4) Always dispose of sharps in the appropriate receptacles
immediately after use.
- Only fill sharps containers to ¾ full.
Discuss ways to promote client comfort while administering an injection.
- Properly introduce yourself
- Explain your role
- Explain what will be administered as well as the procedure
- Answer qs
- Perhaps use a distraction technique if they’re antsy
- Sometimes numbing cream may be appropriate
Administer a subcutaneous injection, e.g., heparin (27).
1) Ensure you do a full head-to-toe and check vitals prior to any med administration (right assessment)
2) Ensure you have the MAR and appropriate order. Double check if the order is appropriate.
3) Check that the pt does not have an allergy to the medication
4) Approach the omni cell. Locate the pt and the meds to be ordered at that point.
5) Do the first of the 3 med checks. Check the MAR and the omni cell and confirm: right patient, right time, right medication, right dose and right route. Then remove the med from the omni cell.
6) Do your second med check. Confirm the medication taken from the omni cell matches the MAR. Check the expiry date. Confirm: right patient, right time, right medication, right dose and right route.
7) Complete drug calculations where appropriate.
- Ex: order = 5000 units
On hand =5000 units
Administer 0.5mL
8) Select your syringe, blunt fill needle (not used for administering injections) & injection needle
- 1 mL syringe
- 25G needle (or 27G)
- 5/8 inch needle (SC injections require a smaller needle)
9) Calculate appropriate volume to administer based on your dose and the concentration in the vial.
10) Swab the top of the vial with an alcohol swab.
11) Draw up the appropriate volume of AIR into your syringe.
12) Inject air into the vial (this equalizes the pressure so that medication can be withdrawn with ease).
13) Tip vial upside down while needle is still in place.
14) Withdraw needle until it is just inside the vial stopper (this ensures you will not draw up air from the vial).
15) Pull back on the plunger until you have reached slightly more than your desired volume of medication.
16) Remove needle from vial.
17) Replace blunt fill needle with your injection needle.
18) While holding the syringe upright, prime the tip with the extra medication that you withdrew from the vial by pushing up on the plunger. The needle
is primed when you see a drop of medication at the tip.
- Keep the cap on the needle for priming (to avoid contamination), and be sure not to prime too much of the medication out of the syringe.
19) Prepare your patient:
a) Ensure they have consented
b) Provide privacy by drawing curtain/closing door
c) Drape patient appropriately
d) Explain the procedure and what the patient can expect to feel
e) **Third check of order and patient identification
20) Cleanse the site with alcohol prep pad.
- Start at the centre and wipe in circular motions outwards
- Allow skin to completely dry (usually ~30 seconds)
21) Remove cap of needle
22) Inject through skin.
a) For thinner patients, or for preference, you may wish to pinch up the tissue with your non-dominant hand.
b) Hold needle like a dart or pencil between thumb and first two fingers of your dominant hand.
c) Puncture skin quickly at a 45-90 degree angle, and advance to hub of needle (advancing slowly will cause excess pain). For thinner patients and with shorter needle lengths, use 45 degree angle with BEVEL
facing upwards.
23) Inject medication slowly ( about 1ml/10 seconds).
- No aspiration is
required for SC injections.
24) Withdraw needle smoothly and steadily.
25) Apply gauze gently over site.
26) Educate pt on potential side effects. Answer any questions.
27) Evaluate the intervention.
Discuss the types of insulin available
Rapid-acting insulin
- Fiasp and NovoRapid® (insulin aspart)
- Humalog® (insulin lispro)
- Apidra® (insulin glulisine)
Short-acting insulin:
- Actrapid®
- Humulin® R
Intermediate-acting insulin:
- Humulin® NPH (a human isophane insulin)
- Protaphane® (a human isophane insulin).
Long-acting insulin
- Lantus® (glargine insulin) –> slow, steady release of insulin with no apparent peak action. One injection can last up to 24 hours. It is usually injected once a day but can be taken twice daily.
- Toujeo (glargine insulin) –> this insulin has a strength of 300 units per ml so is three times the concentration of other insulin in Australia. It is given once a day and lasts for at least 24 hours. It is given for safety by a disposable pen only. It gives a slower, steadier glucose profile especially during the night.
- Levemir® (detemir insulin) –slow, steady release of insulin with no apparent peak action and can last up to 18 hours. It is usually injected twice daily.
Identify different insulin syringes available for use
Use a 30-unit syringe if you take 30 units of insulin or less.
Use a 50-unit syringe if you take 50 units of insulin or less.
Use a syringe that shows 1/2-unit marks if you need 1/2 a unit of insulin.
Draw up regular insulin using a sliding scale (25).
1) Do full head to toe & check vitals
2) Tell nurse you can’t take blood sugar levels & ask what the pt’s levels are
3) Depending on their level will determine if they get blood sugar or not & what amount
4) Check titratable MAR - Orders on one page to indicate how much should be given based on how high the levels are
- Ex: if this pt’s blood sugar is >12, give 2 units of the dose
- There is a difference in nighttime and daytime doses (specify which dose you’ll be giving
5) Do your first med check. Grab MAR. Confirm the order matches the titratable MAR then grab meds. Confirm: right patient, right time, right medication, right dose and right route.
- It likely won’t be in omni cell since they’ll be taking it a few times a day. It’ll be stored at room temp (only stable for 28 days) in the pt’s bin.
- Do first med check at bedside from bin
6) Do second check when preparing meds. Confirm: right patient, right time, right medication, right dose and right route.
7) Prepare insulin pen (check if it’s stable).
8) Open pen & swab the end then let it dry.
9) Grab an insulin pen tip & open it then connect the two together.
10) Then open it & prime it.
- Put it at 2 units.
- Cap it
11) Then, put it at the units needed ex: 2 units.
12) Get someone to sign it off
13) You’ll need the MAR & insulin you have primed with the units needed to be administered with the cap on, gauze & alcohol swabs
14) Prepare your patient:
a) Ensure they have consented
b) Provide privacy by drawing curtain/closing door
c) Drape patient appropriately
d) Explain the procedure and what the patient can expect to feel
e) **Third check of order and patient identification
15) Pick correct location:
- Behind arm
- 5cm away from umbilicus
16) Put on gloves
17) Cleanse site w/ alcohol swab & use it to landmark
18) Put gauze in between your fingers so you can apply pressure afterwards
19) Remove cap
20) Pinch skin, press it all the way in to engage the needle until you hear a click. Administer med.
21) Wait 10 seconds with the needle in to ensure the med entered properly.
22) Remove slowly then apply direct pressure w/ gauze.
23) Clean up.
24) Document
- Then chart afterwards on the other side of the order what the time was when it was given, the blood sugar parameter & how many units you gave.
25) Evaluate the intervention.
Correctly administer an intradermal injections (28).
1) Ensure you do a full head-to-toe and check vitals prior to any med administration (right assessment)
2) Ensure you have the MAR and appropriate order. Double check if the order is appropriate.
3) Check that the pt does not have an allergy to the medication
4) Approach the omni cell. Locate the pt and the meds to be ordered at that point.
5) Do the first of the 3 med checks. Check the MAR and the omni cell and confirm: right patient, right time, right medication, right dose and right route. Then remove the med from the omni cell.
6) Do your second med check. Confirm the medication taken from the omni cell matches the MAR. Check the expiry date. Confirm: right patient, right time, right medication, right dose and right route.
7) Complete drug calculations where appropriate.
8) Select your syringe, blunt fill needle (not used for administering injections) & injection needle
- 1 mL syringe
- 27G needle (or smaller)
- 3/8 to 5/8 inch needle (SC injections require a smaller needle) -> often preattached
9) Determine appropriate volume to administer based on your dose and the concentration in the vial.
10) Swab the top of the vial with an alcohol swab.
11) Draw up the appropriate volume of AIR into your syringe.
12) Inject air into the vial (this equalizes the pressure so that medication can be withdrawn with ease).
13) Tip vial upside down while needle is still in place.
14) Withdraw needle until it is just inside the vial stopper (this ensures you will not draw up air from the vial).
15) Pull back on the plunger until you have reached slightly more than your desired volume of medication.
16) Remove needle from vial.
17) Replace blunt fill needle with your injection needle.
18) While holding the syringe upright, prime the tip with the extra medication that you withdrew from the vial by pushing up on the plunger. The needle
is primed when you see a drop of medication at the tip.
- Keep the cap on the needle for priming (to avoid contamination), and be sure not to prime too much of the medication out of the syringe.
19) Prepare your patient:
a) Ensure they have consented
b) Provide privacy by drawing curtain/closing door
c) Drape patient appropriately
d) Explain the procedure and what the patient can expect to feel
e) **Third check of order and patient identification
20) Cleanse the site with alcohol prep pad.
- Start at the centre and wipe in circular motions outwards
- Allow skin to completely dry (usually ~30 seconds)
21) Remove cap of needle
22) Inject through skin.
a) With non-dominant hand, stretch skin over site with forefinger or
thumb.
b) Hold syringe nearly parallel to the skin with your dominant hand.
c) Puncture skin at a 5-15 degree angle with BEVEL facing upwards. Be sure not to advance needle too deeply.
23) Inject medication slowly ( about 1ml/10 seconds).
- No aspiration is
required for ID injections.
24) As you inject, you should see a bleb form in the skin.
25) Withdraw needle smoothly and steadily.
26) Apply gauze gently over site.
27) Educate pt on potential side effects to look out for. Answer any questions.
28) Evaluate the intervention.
Correctly administer an intramuscular injections (28).
1) Ensure you do a full head-to-toe and check vitals prior to any med administration (right assessment)
2) Ensure you have the MAR and appropriate order. Double check if the order is appropriate.
3) Check that the pt does not have an allergy to the medication
4) Approach the omni cell. Locate the pt and the meds to be ordered at that point.
5) Do the first of the 3 med checks. Check the MAR and the omni cell and confirm: right patient, right time, right medication, right dose and right route. Then remove the med from the omni cell.
6) Do your second med check. Confirm the medication taken from the omni cell matches the MAR. Check the expiry date. Confirm: right patient, right time, right medication, right dose and right route.
7) Complete drug calculations where appropriate.
8) Select your syringe, blunt fill needle (not used for administering injections) & injection needle
- 3 or 5 mL syringe
- 23G needle (if it’s more viscous, go lower)
- 1 inch needle (for most pts). 1.5 inch needles for bigger pts
9) Calculate the appropriate volume to administer based on your dose and the concentration in the vial.
10) Swab the top of the vial with an alcohol swab.
11) Draw up the appropriate volume of AIR into your syringe.
12) Inject air into the vial (this equalizes the pressure so that medication can be withdrawn with ease).
13) Tip vial upside down while needle is still in place.
14) Withdraw needle until it is just inside the vial stopper (this ensures you will not draw up air from the vial).
15) Pull back on the plunger until you have reached slightly more than your desired volume of medication.
16) Remove needle from vial.
17) Replace blunt fill needle with your injection needle.
18) While holding the syringe upright, prime the tip with the extra medication that you withdrew from the vial by pushing up on the plunger. The needle
is primed when you see a drop of medication at the tip.
- Keep the cap on the needle for priming (to avoid contamination), and be sure not to prime too much of the medication out of the syringe.
19) Prepare your patient:
a) Ensure they have consented
b) Provide privacy by drawing curtain/closing door
c) Drape patient appropriately
d) Explain the procedure and what the patient can expect to feel
e) **Third check of order and patient identification
20) Cleanse the site with alcohol prep pad.
- Start at the centre and wipe in circular motions outwards
- Allow skin to completely dry (usually ~30 seconds)
21) Remove cap of needle
22) Inject through skin.
a) For thinner patients, or for preference, you may wish to pinch up the tissue with your non-dominant hand.
b) Hold needle like a dart or pencil between thumb and first two fingers of your dominant hand.
c) Puncture skin quickly at a 90 degree angle, and advance to hub of needle (advancing slowly will cause excess pain).
23) Aspirate slowly, if indicated*, by pulling back on plunger (5-10 seconds). If
blood returns into syringe, needle must be discarded and a new one prepared.
24) Inject medication slowly ( about 1ml/10 seconds).
25) Wait 10 seconds, then withdraw needle smoothly and steadily.
26) Apply gauze gently over site.
27) Educate pt on potential side effects. Answer any questions.
28) Evaluate the intervention.
Correctly prepare injectable medications from a vial (15).
1) Ensure you have the MAR and appropriate order. Double check if the order is appropriate.
2) Check that the pt does not have an allergy to the medication
3) Approach the omni cell. Locate the pt and the meds to be ordered at that point.
4) Do the first of the 3 med checks. Check the MAR and the omni cell and confirm: right patient, right time, right medication, right dose and right route. Then remove the med from the omni cell.
5) Double check your medication label.
a) Medication name
b) Dose
c) Expiry (For most multi-dose vials, expiry is 30 days after opening)
6) Calculate appropriate volume to administer based on your dose and the concentration in the ampule.
7) Swab the top of the vial with an alcohol swab.
8) Draw up the appropriate volume of AIR into your syringe.
9) Inject air into the vial (this equalizes the pressure so that medication can be withdrawn with ease).
10) Tip vial upside down while needle is still in place.
11) Withdraw needle until it is just inside the vial stopper (this ensures you will not draw up air from the vial).
12) Pull back on the plunger until you have reached slightly more than your desired volume of medication.
13) Remove needle from vial.
14) Replace blunt fill needle with your injection needle.
15) While holding the syringe upright, prime the tip with the extra medication that you withdrew from the vial by pushing up on the plunger. The needle
is primed when you see a drop of medication at the tip.
- Keep the cap on the needle for priming (to avoid contamination), and be sure not to prime too much of the medication out of the syringe.
