parental injections

Question 1

parental equipment when you go into a room:

Answer 1

exam gloves, medication (vials/ampules), alcohol swabs, appropriate syringes and needles (needle to withdraw and needle to inject), medication labels, and clean medication drawer

Question 2

medication vials, always check and document on the vials what?

Answer 2

expiration and always date and initial multi-dose vials

Question 3

the ____ is also referred to as the “diameter”

Answer 3

gauge (g)

Question 4

dermis (ID) length of needle:

Answer 4

1/2” to 5/8”n

Question 5

subcut (SQ) anticoagulant length of needle:

Answer 5

3/8” to 5/8”

Question 6

Subcut (SQ) insulin length of needle:

Answer 6

1/2” to 5/16”

Question 7

muscle (IM) length of needle:

Answer 7

1” to 1 1/2” (most common in adults)

Question 8

smaller gauge needles for ____ solutions (27-20g)

Answer 8

thinner solutions - less painful

Question 9

larger gauge needles for _____ solutions (21-18 g)

Answer 9

thicker solutions

Question 10

non-parental needles are used for ______ ONLY

Answer 10

withdrawing medications

Question 11

filter needle:

Answer 11

smaller filter in hub catches debris and always use with ampules for best practice

Question 12

blunt fill needle:

Answer 12

use with vials (rubber stopper)

Question 13

if blunt fill or filter needle are not available use what?

Answer 13

smallest gauge available

Question 14

syringes are calibrated in ___

Answer 14

mL (mililiters)

Question 15

first calibration line is near the ___

Answer 15

tip of the hub

Question 16

on syringes reading from ____ to ____

Answer 16

zero to volume ordered

Question 17

leading ring is ___

Answer 17

volume ordered (by rubber stopper)

Question 18

how do you decide which syringe to use?

Answer 18

depends on volume ordered, ALWAYS use the smallest syringe needed to correctly deliver the rx’d volume of medication ordered

Question 19

preparing your medications:

Answer 19

acknowledge HCP (health care provider) orders FIRST, prepare only one patient’s meds at a time, clean medication drawer and place a cloth, remove meds from Pyxis and verify against eMAR on computer screen 2ND CHECK, syringe/needle, hand hygiene, check expiration/date multi-dose, label syringes

Question 20

label syringes with a “____ ____”

Answer 20

blue label

Question 21

clean injection port for ___ secs with alcohol swab (single use)

Answer 21

15 seconds

Question 22

third check (exception is insulin)

Answer 22

take original vial/ampule with syringe to verify/scan at the bedside

Question 23

preparing a medication: single dose vial

Answer 23

select appropriate syringe and blunt fill needle, after cleaning top of vial, inject air equal to amount of medication to be withdrawn if needed, withdraw entire amount, prepare to deliver the exact amount of medication ordered, & remove BF needle and attach appropriate sterile needle

Question 24

charging means:

Answer 24

injecting air equal to amount of medication to be withdrawn from single dose vial

Question 25

combining two medications in one syringe: vial A and vial B

Answer 25

cannot exceed acceptable volume for intended syringe/site and medications must be compatible

Question 26

combining two medications in one syringe: vial and ampule

Answer 26

same as two vials, but prepare from the vial first then ampule

Question 27

air & bubbles: troubleshooting

Answer 27

make sure needle is below fluid level, withdraw med slowly single dose vials: withdraw entire volume from vial - except air to follow, then expel the air and medication if more than required is in the syringe to ensure exact dose multi-dose vials: withdraw more med than you need, leave needle in vial, then push med back into the vial via plunger to exact dose, if having issues, can tap or thump syringe gently to move air to top of syringe then purge air back into vial

Question 28

ampules:

Answer 28

single dose medication, made of glass (clear/dark), wear gloves, need a syringe and filter needle (NOT BF NEEDLE)

Question 29

on ampules where do you place the glass ampule and syringe/needle when finished in a patient's room?

Answer 29

sharps box

Question 30

drugs in ___ form retain potency only for a short period of time once reconstituted and need to be administered soon

Answer 30

powder

Question 30

reconstitution is the process of:

Answer 30

adding a liquid (diluent) to a dry or liquid concentrated ingredient (solute)

Question 31

reconstituted volumes __ ___ always equal the amount of ____ because the medication itself has volume

Answer 31

do not, diluent

Question 32

IM injection guidelines:

Answer 32

select appropriate muscle site (deltoid, ventrogluteal, vastus-lateralis), palpate for "belly" of well-developed , relaxed muscle (avoid scars, irritated area, bruises, lesions), assess all parts of the injection equipment before, dispose properly

Question 33

inject at a rate of _____ before removing needle for IM injection

Answer 33

1 mL/10 secs -- wait 3 to 5 sec (want medication to stay in the targeted tissue)

Question 34

post injection for IM, do not ____ or ____, you can ____

Answer 34

rub or massage; apply pressure (rubbing or massaging can displace med in an area it doesn't need to be)

Question 35

angle for ALL IM injections

Answer 35

90 degree angle

Question 36

IM injections in deltoid:

Answer 36

smaller volumes, less irritating, max volume is 1 mL, recommended needle length is 1", recommended syringe is 3mL

Question 37

IM injections in ventrogluteal or vastus lateralis:

Answer 37

ventrogluteal 1st, vastus lateralis 2nd - for thicker, painful, or irritating meds (Deep IM), max volume is 3 mL, recommended needle length is 1" to 1 1/2", recommended syringe is 3 mL

Question 38

what is the objective/purpose of Z-track method?

Answer 38

minimizes pain and makes sure medication stays in place

Question 39

Deep IM Z-track technique

Answer 39

position patient (sims position), select VG or VL site (rotate sites), landmark, quickly assess equipment

Question 40

avoid the ____ MUSCLE

Answer 40

dorsogluteal (bottom of buttocks) because it can cause loss of function or paralysis

Question 41

subcutaneous injections (SQ, Sub-Q, subcut)

Answer 41

insulin: multi-dose vials of medication - short, intermediate, long acting, fragile needle and permanently attached to the insulin syringe, can inject in multiple locations anticoagulant: 3/8-5/8" needle and appropriate syringe in the abdomen as the primary/main location (ANTERO-LATERAL)

Question 42

SQ injection rule of thumb

Answer 42

inject at 90 degree angle if you can "bunch" the skin more than 2", otherwise 45 degree angle

Question 43

SQ tissue can accommodate up to ___ mL

Answer 43

1.5

Question 44

rules of administering insulin:

Answer 44

know/verify blood glucose levels or trends FIRST before, administer in units not mL and within minutes of preparation, do not shake

Question 45

SQ insulin guidelines:

Answer 45

administer in adipose (SQ) "fatty" areas (rotate)

Question 46

absorption rate for SQ is typically faster in the ___

Answer 46

abdomen

Question 47

lipodystrophy feels like ____

Answer 47

little beads (hard, scarred tissue) if not rotated

Question 48

DO NOT _____, _____, or ____ ANY SQ injection

Answer 48

aspirate, rub, or massage

Question 49

aspirate on _____ IM

Answer 49

deep

Question 50

SQ insulin administration what must match?

Answer 50

syringe size (U-100 or U-50) must match the vial, leave insulin vial in Pyxis

Question 51

SQ - enoxaparin injection (anticoagulant)

Answer 51

always abdominal site (love handle), position in reclining/supine, 90 degree angle is recommended for deep SQ - never administer IM, bunch entire time, do not aspirate or expel nitrogen bubble

Question 52

intradermal injection:

Answer 52

allergy testing and TB testing, select site (free of tattoos if possible, blemishes, hair, scarring, bruises, etc), cleanse area, check equipment, stretch middle 1/3 of forearm relatively taut, insert almost parallel angle (5-15 degree) until bevel (facing up) of needle barely disappears, inject med ensuring a "bleb or wheal" so you know medication is in the right area

Question 53

injectable rates of absorption: fastest to slowest

Answer 53

IV (IVP), IM, SQ, ID

Question 54

ID injection needle & syringe

Answer 54

25 g x 5/8" 1 mL tuberculin with needle or 1 mL syringe with attached needle

Question 55

IM injection gauge size

Answer 55

deltoid: 25 g to 20g ventro: 21g to 18g depending on viscosity

Question 56

SQ injection gauge size and syringe size:

Answer 56

27g to 25g 1-3 mL, max volume is 1.5 mL