parental injections Flashcards
parental equipment when you go into a room:
exam gloves, medication (vials/ampules), alcohol swabs, appropriate syringes and needles (needle to withdraw and needle to inject), medication labels, and clean medication drawer
medication vials, always check and document on the vials what?
expiration and always date and initial multi-dose vials
the ____ is also referred to as the “diameter”
gauge (g)
dermis (ID) length of needle:
1/2” to 5/8”n
subcut (SQ) anticoagulant length of needle:
3/8” to 5/8”
Subcut (SQ) insulin length of needle:
1/2” to 5/16”
muscle (IM) length of needle:
1” to 1 1/2” (most common in adults)
smaller gauge needles for ____ solutions (27-20g)
thinner solutions - less painful
larger gauge needles for _____ solutions (21-18 g)
thicker solutions
non-parental needles are used for ______ ONLY
withdrawing medications
filter needle:
smaller filter in hub catches debris and always use with ampules for best practice
blunt fill needle:
use with vials (rubber stopper)
if blunt fill or filter needle are not available use what?
smallest gauge available
syringes are calibrated in ___
mL (mililiters)
first calibration line is near the ___
tip of the hub
on syringes reading from ____ to ____
zero to volume ordered
leading ring is ___
volume ordered (by rubber stopper)
how do you decide which syringe to use?
depends on volume ordered, ALWAYS use the smallest syringe needed to correctly deliver the rx’d volume of medication ordered
preparing your medications:
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
label syringes with a “____ ____”
blue label
clean injection port for ___ secs with alcohol swab (single use)
15 seconds
third check (exception is insulin)
take original vial/ampule with syringe to verify/scan at the bedside
preparing a medication: single dose vial
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appropriate syringe and blunt fill needle, after cleaning top of vial, inject air equal to amount of medication to be withdrawn if needed, withdraw entire amount, prepare to deliver the exact amount of medication ordered, & remove BF needle and attach appropriate sterile needle
charging means:
injecting air equal to amount of medication to be withdrawn from single dose vial
combining two medications in one syringe: vial A and vial B
cannot exceed acceptable volume for intended syringe/site and medications must be compatible
combining two medications in one syringe: vial and ampule
same as two vials, but prepare from the vial first then ampule
air & bubbles: troubleshooting
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
ampules:
single dose medication, made of glass (clear/dark), wear gloves, need a syringe and filter needle (NOT BF NEEDLE)
on ampules where do you place the glass ampule and syringe/needle when finished in a patient’s room?
sharps box
drugs in ___ form retain potency only for a short period of time once reconstituted and need to be administered soon
powder
reconstitution is the process of:
adding a liquid (diluent) to a dry or liquid concentrated ingredient (solute)
reconstituted volumes __ ___ always equal the amount of ____ because the medication itself has volume
do not, diluent
IM injection guidelines:
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
inject at a rate of _____ before removing needle for IM injection
1 mL/10 secs – wait 3 to 5 sec (want medication to stay in the targeted tissue)
post injection for IM, do not ____ or ____, you can ____
rub or massage; apply pressure (rubbing or massaging can displace med in an area it doesn’t need to be)
angle for ALL IM injections
90 degree angle
IM injections in deltoid:
smaller volumes, less irritating, max volume is 1 mL, recommended needle length is 1”, recommended syringe is 3mL
IM injections in ventrogluteal or vastus lateralis:
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
what is the objective/purpose of Z-track method?
minimizes pain and makes sure medication stays in place
Deep IM Z-track technique
position patient (sims position), select VG or VL site (rotate sites), landmark, quickly assess equipment
avoid the ____ MUSCLE
dorsogluteal (bottom of buttocks) because it can cause loss of function or paralysis
subcutaneous injections (SQ, Sub-Q, subcut)
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)
SQ injection rule of thumb
inject at 90 degree angle if you can “bunch” the skin more than 2”, otherwise 45 degree angle
SQ tissue can accommodate up to ___ mL
1.5
rules of administering insulin:
know/verify blood glucose levels or trends FIRST before, administer in units not mL and within minutes of preparation, do not shake
SQ insulin guidelines:
administer in adipose (SQ) “fatty” areas (rotate)
absorption rate for SQ is typically faster in the ___
abdomen
lipodystrophy feels like ____
little beads (hard, scarred tissue) if not rotated
DO NOT _____, _____, or ____ ANY SQ injection
aspirate, rub, or massage
aspirate on _____ IM
deep
SQ insulin administration what must match?
syringe size (U-100 or U-50) must match the vial, leave insulin vial in Pyxis
SQ - enoxaparin injection
(anticoagulant)
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
intradermal injection:
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
injectable rates of absorption: fastest to slowest
IV (IVP), IM, SQ, ID
ID injection needle & syringe
25 g x 5/8”
1 mL tuberculin with needle or 1 mL syringe with attached needle
IM injection gauge size
deltoid: 25 g to 20g
ventro: 21g to 18g
depending on viscosity
SQ injection gauge size and syringe size:
27g to 25g
1-3 mL, max volume is 1.5 mL
