Parenteral Administration

Question 1

Syringe

Answer 1

• A 1- to 3-mL syringe is
  usually adequate for a subcutaneous or IM injection.
• Use a
  tuberculin syringe to prepare small amounts of medications (e.g., ID or
  subcutaneous injections). A tuberculin syringe is also useful when
  preparing small, precise doses for infants or young children.
• Insulin syringes (see Fig. 31.11, D) hold 0.3 mL to 1 mL, and low-dose
  insulin syringes (30 units per 0.3 mL or 50 units per 0.5 mL) hold 0.3 mL to
  1 mL. Both come with prea􀄴ached needles and are calibrated in units.
  Most insulin syringes are U-100s, designed for use with U-100–strength
  insulin. Each milliliter of solution contains 100 units of insulin.

Question 2

Needle

Answer 2

Most needles are made of stainless steel, and all are
disposable. A needle has three parts: the hub, which fits onto the tip of a
syringe; the shaft, which connects to the hub; and the bevel, or slanted tip
(Fig. 31.13). The tip of a needle, or the bevel, is always slanted. The bevel
creates a narrow slit when injected into tissue that quickly closes when the
needle is removed to prevent leakage of medication, blood, or serum. A child or slender
adult generally requires a shorter needle. Use longer needles (1 to 1½
inches) for IM injections and a shorter needle (³⁄₈ to ⁵⁄₈ inch) for
subcutaneous injections.
Filter
needles must be used when preparing medication from a glass ampule to
prevent glass particles from being drawn into the syringe. Do not use a filter needle to administer a medication. Place an appropriatesize
needle on the syringe after withdrawing the medication

Question 3

Insulin Preparation

Answer 3

A patient with diabetes mellitus sometimes requires more than one type
of insulin. For example, by receiving a short-acting (regular) and
intermediate-acting (NPH) insulin, a patient receives more sustained
control of blood glucose levels over 24 hours.
Before drawing up insulin doses, gently roll all cloudy insulin
preparations between the palms of the hands to resuspend the insulin. Do
not shake insulin vials; shaking causes bubbles to form. Bubbles take up
space in the syringe and alter the dose.If more than one type of insulin is required to manage the patient’s
diabetes, you mix two different types of insulin into one syringe if they are
compatible (Box 31.21). If regular and intermediate-acting insulins are
ordered, prepare the regular insulin first to prevent it from becoming
contaminated with the intermediate-acting insulin Never mix insulin glargine or insulin detemir with other types of
insulin.

Question 4

Subcutaneous Injections

Answer 4

The best subcutaneous injection sites include the outer posterior aspect
of the upper arms, the abdomen from below the costal margins to the iliac
crests, and the anterior aspects of the thighs.Alternative subcutaneous sites for other medications include the
scapular areas of the upper back and the upper ventral or dorsal gluteal
areas. The rate of insulin absorption varies based on the site; the
abdomen has the quickest absorption, followed by the arms, thighs, and
bu􀄴ocks. Subcutaneous tissue is sensitive to irritating solutions and large volumes
of medications. Thus, you administer only small volumes (0.5 to 1.5 mL) of
water-soluble medications subcutaneously to adults. You give smaller
volumes up to 0.5 mL to children. Nurses typically use a 25-gauge, ⅝-inch (16-mm)
needle inserted at a 45-degree angle (Fig. 31.20) or a ½-inch (12-mm)
needle inserted at a 90-degree angle to administer subcutaneous
medications to a normal-size adult patient.Some children require only a
½-inch needle. If the patient is obese, pinch the tissue and use a needle
long enough to insert through fa􀄴y tissue at the base of the skinfold. Thin
patients often do not have sufficient tissue for subcutaneous injections; the
upper abdomen is usually the best site in this caseTo ensure that a
subcutaneous medication reaches the subcutaneous tissue, follow this rule:
If you can grasp 2 inches (5 cm) of tissue, insert the needle at a 90-degree
angle; if you can

Question 5

Intramuscular Injections

Answer 5

The intramuscular (IM) injection route deposits medication into deep
muscle tissue, which has a rich blood supply, allowing medication to
absorb faster than by the subcutaneous route. However, there is a risk for
injecting medications directly into blood vessels. Any factor that interferes
with local tissue blood flow affects the rate and extent of medication
absorption. Use a longer and heavier-gauge needle to pass through subcutaneous
tissue and penetrate deep muscle tissue. Note that the most common intramuscular injections
are immunizations. The angle of insertion for an IM injection is 90 degrees. The Z-track method, a technique for pulling the
skin during an injection, is recommended for IM injections. Ventrogluteal
The ventrogluteal muscle is the preferred and safest injection site for all
adults, children, and infants, especially for large-volume, viscous, and
irritating medications. One way to locate the ventrogluteal muscle site to use is by the
“V” method (Kara et al., 2015). You position a patient in a supine or lateral
position with the knee and hip flexed to relax the muscle.The vastus lateralis muscle is another injection site used in adults and is
the preferred site for administration of biologicals (e.g., immunizations) to
infants, toddlers, and children. Deltoid
Although the deltoid site is easily accessible, the muscle is not well
developed in many adults. There is potential for injury because the
axillary, radial, brachial, and ulnar nerves and the brachial artery lie
within the upper arm under the triceps and along the humerus

Question 6

Intradermal Injections

Answer 6

ID injections typically are used for skin testing (e.g., tuberculin screening
and allergy tests). Because these medications are potent, they are injected
into the dermis, where blood supply is reduced and medication absorption
occurs slowly.

Question 7

Intravenous Administration

Answer 7

1. Infusion of large volumes of IV fluid containers that contain
   medications mixed, labeled, and dispensed by pharmacy
2. Injection of a bolus or small volume of medication through an
   existing IV infusion line or intermi􀄴ent venous access (heparin or
   saline lock)
3. “Piggyback” infusion of a solution containing the prescribed
   medication and a small volume of IV fluid through an existing IV
   line.
   Use the mnemonic CATS PRRR to help remember safety checks for
   administering IV medications: C, compatibilities; A, allergies; T,
   tubing correct; S, site checked; P, pump safety checked; R, right rate;
   R, release clamps; R, return and reassess the patient.

Piggyback
A piggyback is a small (25 to 250 mL) IV bag or bo􀄴le connected to a short
tubing line that connects to the upper Y-port of a primary infusion line or
to an intermi􀄴ent venous access (Fig. 31.31). The label on the medication
follows the ISMP IV piggyback medication label format (ISMP, 2018d)
(Fig. 31.32). The piggyback tubing is a microdrip or macrodrip system (see
Chapter 42). The set is called a piggyback because the small bag or bo􀄴le is
higher than the primary infusion bag or bo􀄴le. In the piggyback setup the
main line does not infuse when the piggybacked medication is infusing.
The port of the primary IV line contains a back-check valve that
automatically stops flow of the primary infusion once the piggyback
infusion flows. After the piggyback solution infuses and the solution
within the tubing falls below the level of the primary infusion drip
chamber, the back-check valve opens, and the primary infusion again
flows.
Volume-Control Administration
Syringe Pump
Intermittent Venous Access